Katie Duke : Overwhelmed at Work

From the Katie Duke blog–

So it’s officially been 4 months since I started my job as an ACNP in Cardiology. I would be lying if I said I wasn’t full of anxiety every shift, and additionally if the transition was easy.

It is not.

I had 3 months of orientation and during this time I worked directly with an experienced NP who was honestly very welcoming and warm and knowledgeable. She really helped ease my initial “omg I’m starting a new job” worries. During this time I worked day shift and then 3 weeks of nights and took care of a steadily increasing patient load as my comfort and workflow grew. I shadowed her and familiarized myself with the service and the procedures, the medications and the physicians, their practices and preferences, and the patient population. But that wasn’t the most difficult aspect.

The fact that I was literally brand spanking new and hadn’t been the new person in over 10+ years was really difficult. It left me very vulnerable, very nervous, very humble. I forgot what that felt like because I had been the senior nurse for quite some time, but now I was the brand new NP.

Cue : complete breakdown (outside the hospital of course) ?

I guess at this point I realized that everyone has a first day, a first job, a first week, month, year. I will certainly have a bad patient, a bad decision, and a bad shift. That’s inevitable. But that’s part of life. It’s how we handle these moments that makes us strong. One thing that kept me sane during my orientation was the “up to date” app. All the latest and greatest evidence based information and protocols and practice guidelines.

You can download that here: ?

UpToDate by UpToDate, Inc. – https://appsto.re/us/bWh7t.i

I use this for everything. It’s always best practice to investigate and research what you’re treating and for new grads this is a must.

So now time finally came for me to be out on my own and I just knew that I wasn’t all the way ready for it. I wanted more learning time. Buuut that’s not possible.

As nights went on I was always so thankful when all of my patients were alive and well (or remotely well) by the end of my shift. I realized quickly that you depend heavily on the supportive staff around you. The nurses were and are my eyes and ears and I am so thankful for the work that is done by them every shift. The experienced NP’s also have given me support with my medical decision making and approaches and it’s something that I have become so grateful for.

But then then came the shifts where I was managing the care of 16, 17, 18 patients. And I cannot even begin to tell you the amount of ANXIETY and FEAR I had.

I consider myself a strong and focused person, but holy h*ll- managing the care for 17 cardiology patients – fresh post cath, TAVR post op day 3, STEMI, Rapid AFIB, post ablation, Heart Failure on Milrinone……. Add onto that the ER admits.

Cue epic WTF moment.

Why is this ok? Why is this allowed? Why is this OKAYYY!!??

There’s an interesting facet of healthcare in today’s age that resonates with all of us; staffing issues. We have all been there done that when it comes to this, and I’m sure just the thought of it makes you give epic side eye. ?

I had experienced this in great proportion as a nurse over the last 12 years, but it also hit me hard as a nurse practitioner. When did our healthcare system become so overwhelmed with patient satisfaction and Press Ganey and pain scales that we completely let SAFE STAFFING RATIOS fall by the wayside?

I know this all sounds like a rant, and that it may be, but we get so burnt out on this as healthcare providers.
  • Isn’t healthcare founded in patient safety and outcomes ?
  • Isn’t it supposed to assure the patient gets the care they need in a timely and efficient manner?
  • How am I supposed to be thorough and safe when I have 17 patients?
  • How are the nurses supposed to provide safe and efficient and timely care when they’ve got 9 patients and each patient care technician has half the floor?

Now, I am certainly not bashing my hospital or calling out any major administrative breakdown. In fact, this has nothing to do with my hospital- this is a nationwide issue. Of pandemic proportion. So before anyone gets all in a huff about “you’re speaking negative about your hospital!!” – stop.

I love my hospital, and all the providers therein. But I want to bring some light to what it’s like being the new NP on the unit with massive patient loads. It’s hard, and it’s scary.

If you’re the new one on the unit, take a moment to reflect on how you’ve progressed, how you’ve learned your new role, and who and what processed helped you get there. As for the staffing issues, I certainly cannot fix this alone, and the only way we will is to band together and unite in one solidified voice.

In summation, I’ve grown a lot in my short span as an NP, and I look forward to the growth that is ahead, but it has had its moments.

Let’s all make sure we support new staff, no matter the role.

We all have to start somewhere.

This is more of a venting and reflection, and I encourage everyone to ask questions and leave comments.




Katie Duke is an emergency room nurse, Board Certified Acute Care Nurse Practitioner, marathoner, editorial contributor, healthcare media consultant, public speaker, mentor, and social media influencer. Duke has been featured on 2 seasons of NY MED on ABC, and 2 seasons of NY ER on the Oprah Winfrey Network, TLC, and Discovery Life Channels. She is a frequent contributor to television and news media, and has been a regular guest on Fox News, The Doctors Talk Show, and the Dr Oz Show. Impressively, she is the very first Nurse to ever receive a column in Emergency Physicians Monthly Magazine, the number one publication within emergency medicine. Duke has been a Nurse for over 12 years and recently completed her Masters of Science Degree from prestigious Columbia University in the City of New York. There are many Doctors in the media: Gupta, Oz, Besser, Phil; yet we have no nationally known Nurse. Katie Duke will not only be that Nurse, but also the woman to follow for lifestyle enthusiasts throughout the nation, and most importantly, the people.



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  2. Well there ls the major problem with nursing in hospitals. Understaffed, patio ratios are ridiculous with the amount of work involved, the over documentation that’s endless, the amount of responsibility a nurse has in just keeping the patients Alive, then there’s the nurse being the go between communicator between the doctors, God forbid they talk to one another, and these are just a few of the overall demands and expectations of nurses in a hospital setting. Oh yes and the nurse expected to be jolly and keep up patient and family satisfaction answering all and every question imaginable many and most the doctors should be responsible for!
    Now I ask you how are we nurses compensated In salary? Poorly. Raises? Raises based on your call outs and what your clinical ladder is not your on the job performance any more. But yet make a mistake or not satisfy a patient your crucified by supervisors. And what about the decency of just nurses week? No real appreciation, actually none even noted where I work. Major Holiday bonuses? Not even a supermarket gift card. And so I ask where is the incentive to go far and beyond that’s asked of us? We are just a number, just another new nurse around the corner to be hired so we are really just not respected or appreciated in hospital settings. And I have worked in several hospitals. When do hospitals learn the value of the nurse? I don’t thing it will happen ever again until there is a major upheaval by all nurses to stand up together as a unity. You see rare any more unions. I went into nursing to help people. Not document all day, not put in the doctors orders, not to act as the liaison between the physicians. Hell where is my consultation fee for that lol. But then you ask why nurses are frustrated and angry.

  3. I understand the feeling of being overwhelmed–I did oncology for 22 years. But, in response to Vivian Evans’ comment about priorities and “patients come first”–that is true–at work. But, I have learned over the years that when you leave work, you must leave the patients there too, or overwhelmed won’t be the word you will use to describe yourself anymore. Psychotic might be a better example. While Katie Duke does have a lot of outside interests, remember, most nurses work 12 hour shifts, 3 days or nights a week–that leaves a lot of time for other things. Remember, you work as a nurse–it shouldn’t be what or who you are. You are still a person with other interests, friends, family, hobbies, etc. Don’t let nursing consume you–that’s one of the leading causes of burn-out. There’s so much more to life than nursing–don’t become one of its victims.

  4. I understand her feeling and being over whelmed,: I was a floor nurse for 12 years then went onto IVTherapy the last 13 years, but look at all her other outside activities. Is she over extending herself? There has to be priorities and the patients are first; get them taken care of, then engage in out side activities …..just a thought..

    • In response to Vivian Evan’s comment about Katie Duke and being overextended: I understand what it feels like to be overwhelmed. I worked oncology for 22+ years, and also did IV Therapy, and enjoyed them both. But, I also know the feeling of being overwhelmed. Most nurses work 12 hour shifts, 3 days or nights a week. That leaves a lot of time for other things. I agree, patients ARE your first priority at work, but when you leave work, you MUST leave the patients there too. There are a lot of nurses who identify themselves as a “nurse”, and not someone who “works as a nurse”. Nursing is your job, not your life, and if you continue to think like that, nursing will consume you and that is one of the biggest causes of burn-out. It is an honor and a privilege to be a nurse, but don’t let it consume you. Don’t become one of nursing’s “victims”.

  5. Excellent article! And it is so true. We are all new at some point, whether a new role or same role at a new employer. We must support each other.

    You are also on point when it comes to “safe staffing ratios”. It seems no matter the setting one works in, more and more is expected. This extends to insurance case management roles as well as hospital roles.


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