change to other department or not? please give me advise!!

  1. I am a new grad and already on orienation 7 weeks working at "step down" or "DOU". I had a full load of patients for about 6 weeks now and have 4 more weeks left. I am still disorganized, constantly missing breaks,shorten meal times just to catch up. My preceptor is not too supportive, very harsh on me.I constantly feel that I am such a stupid nurse. I floated to ICU and CCU with my preceptor twice, I was freaking out about it. There are 2 to 3 drips which needed to titrate. I was told that I would supposed to get the easiest patients in the unit, and not get any drips from my educator and manager.The reality was not true;even though I would have a resource nurse to help me out,if anything went wrong with the patient, I would be the one blamed (how can I float to those units without critical care training? My educator told me that the hospitial would not offer the critical class to step down nurses, but we would still have to float step down nurses to ICU or CCU, if they are short and I will float after 3 months). I worked too hard for my license, these situations make me fear losing my license. I seriously thought about switching units, when I had my first code blue 2 weeks ago.
    I was always weak on my clinical, when I was in the RN program. I thought that working in step down, would help improve my skills and clinical practice, but instead it has brought me alot of fears, and uncertainties. Do you guys think that I should start from med surg first, instead of step down for this situation? Please advise!!!
    I do not enjoy to going to work at all, I drag my feet to go to work.
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  2. 14 Comments

  3. by   Tweety
    You might be jumping out of the pan and into the fire. Med-surg is tough as well, because you will have more patients, and you will get some of the same issues. I've been in med-surg for years and miss breaks and feel disorganized. Most of the time I feel like I've been shot out of a cannon, or just putting out fires going from situation to situation with no rhyme or reason.

    I'm sorry to hear that your unit and preceptor are not supportive. What you are experiencing are entirely normal new grad experiences and you should feel supported in that.

    You are not going to feel organized and like you have it together for a while now.

    About floating in three months, don't freak out about that yet, in three months you'll be more knowledgable and in a totally different space. But you might practice saying "I'm not comfortable with this assignment being a new grad, this being my first float, please change it now." But cross that bridge when you get there.

    Good luck to you in whatever you do.
  4. by   KatieBell
    Off topic for 2 seconds- nice halloween costume tweety!

    Step Down units are in my opinion, very difficult places to work. I used to work ICU and float to step down and all I wanted to do when I floated there was scream. The patients are not on vents (usually), but they are still really sick, and usually require lots of medications,and lots of blood draws, etc...and lots of effort if they are coming out of sedation, starting to move etc...
    The stuff you got as patients when you were precepting(in ICU) was more due to your preceptors skills than your skills. Usually when you float like that, the charge should give you the easier patients.

    At this point, you are really unhappy in your unit. I'd talk to the manager, see what he/she thinks, it's possible a transfer to a different unit might be really the ticket. OR- you may find that you are being "your worst critic" and everyone is pretty satisfied with your progress.

    If you do decide to transfer, and there are a few Med/Surg type units- be sure to talk with the hospital recruiter about what you were uncomfortable with in the step down- that way the recruiter who should know all the units, can suggest one that might better fit you!
    Good Luck...
  5. by   nursebear168
    Thank you so much for the good advise! I just need to vent my feelings here, because I don't have a support system at work, who can really listen to me. When I tried to talk to my manager about how my orientation went,she would said " what was your problem now?" then I would said "nothing". On the hand, my director seems much nicer, she would listen to me. Some preceptors said I should be ready on my own, and my main preceptor said that I was very unorganized and " how I could be on my own", and sometimes she would say " I knew you eager to learn everything in one day, keep in mind, it took me five years to be comfortable". She is kind of bipolar. Well! Katie, you were right about the assignment they gave my preceptor, when I was floating to ICU because she was a ICU nurse for a while. The eastiest patients at ICU might still be difficult for me, because if those patients are that easy, they should be in the step down already and not in ICU.
    I think I will stick around until the end of orientation, and on my own for 2 weeks. If I amstill not comfortable, then I will switch to another unit.
  6. by   Daytonite
    Hi! An old stepdown nurse (and old nurse to boot!) here to give you some words of encouragement. First of all, stepdown is a very busy, busy unit for any grad to be working. Everyone's tolerance level is piqued because of the high stress in these units. Learning to organize yourself and prioritize are not things that you learn in 7 weeks. You need to figure on at least 6 months before you start to feel like, maybe, you know what you are doing and that applies to any hospital unit you are working on. I would say that it took me a good 5 years before I felt like I was really on top of things--and, I'm not bipolar, I assure you. Developing organization is going to be an ongoing process throughout your career. It's just harder when you're first starting.

    When you get home from work make time to sit in a comfortable chair or lie on the bed to meditate on what happened at work. In other words, do a self-analysis of your performance. What did you do right? What did you do that didn't quite turn out the way you had hoped? Think of other ways you could have handled that situation. Figure out a plan on what you will do when these things happen again. In other words, careplan your own performance! Update it daily. If you don't do this kind of self-evaluation continually your improvement will be much more painful. Do you have a poop sheet (brains, report sheet) that works for you? It needs to be organized in a way that makes sense to you, not to anyone else. This is not excusing your co-workers and manager, but the hospital is a very stressful place and people tend to get short and snippy with each other without being aware that they are doing it. We're all guilty of doing that. I was always blown away at parties we had outside work to find that many of these snippy, negative people were actually pretty nice! It's the high paced environment that does it. Therefore, you need to find ways to de-stress when you get home.

    With regard to floating. . .we had to float to ICU and CCU also. We were almost always given the two easiest patients, kind of an unwritten rule. The two easiest patients aren't always of stepdown caliber--it happens. When I was a supervisor and had to reason with people who were relunctant to float to ICU I told them that they were expected to do basic nursing care. No one was going to expect them to do wedge pressure or cardiac outputs. First of all, you don't know how! The same goes for the various medicated drips. The ICU nurses should be aware of that. And, if they're not, remind them that you don't know the first thing about titrating a dopamine drip. They'll help you. Most of them are very aware that floats from the medical floors are shaking in their shoes when they float there. The things you can do are take vital signs, attend to the IV site, do dressing changes on a variety of different kinds of wounds, keep on eye on IV fluids and drainage tubes, turn and reposition the patient, measure I&O, and I'm sure there's other stuff. While the ICU nurse was doing a wedge pressure or giving an IV med for me, I was answering a light with one of her patients. Don't be afraid to talk with these nurses and work together as a team with them. Attitude counts for everything in a situation like that. Be positive and take the opportunity to observe some of the things the other nurses are doing. It will increase your understanding of what has happened to the patients who eventually transition over to your unit.

    Hang in there! It's hard work, but will be satisfying. You are going to have the same problems with organization on any med/surg unit you work. It is just something you have to learn to master.
  7. by   Kristen_RN
    I think that I follow Dayonite to every post....

    Dayonite is so right! SHe said it all....
  8. by   Jessy_RN
    Just want to wish you nothing but the best in whatever you decide to do.
  9. by   llg
    As my clinical experience is Neonatal ICU and not adult med/surg ... I'm not going to comment on some of the particulars of this situation. However, one thing stands out in my mind that is common across areas that is worth thinking about.

    NO new grad feels COMFORTABLE working as a staff nurse for quite a while. If you are looking to feel comfortable as a new staff nurse, you are bound to be disappointed in any clinical area. Nursing is just too complicated to pick up quickly and it takes time to reach that competent phase at which you can breath a sigh of relief.

    Try to guage whether or not you are progressing at a rate satisfactory for a new grad. Compare yourself to other new grads, not to competent staff nurses who have been working for many years. Don't set yourself up to feel like a failure because you can't perform at the same level as people who have much more experience that you.

    Take care,
    llg
  10. by   Daytonite
    Quote from llg
    NO new grad feels COMFORTABLE working as a staff nurse for quite a while. If you are looking to feel comfortable as a new staff nurse, you are bound to be disappointed in any clinical area. Nursing is just too complicated to pick up quickly and it takes time to reach that competent phase at which you can breath a sigh of relief.

    Try to guage whether or not you are progressing at a rate satisfactory for a new grad. Compare yourself to other new grads, not to competent staff nurses who have been working for many years. Don't set yourself up to feel like a failure because you can't perform at the same level as people who have much more experience that you.
    Good advice. Another thing you new grads should do is keep a journal. Some of you certainly write books on some of these posts so I know you like to write. Print them out and save them in a notebook. Whenever you get to feeling really bummed, open these journals to page one and start reading. You will be surprised at how many of your earlier problems you have conquered! You'll feel renewed hope that you are doing a lot better. Mastery of all the skills nurses have to learn does not occur overnight or in a few weeks. It takes time and lots of it. You must be patient. That's a hard thing for most of us nurses because we are just used to getting things done NOW. Most education is like a fine wine--it has to age for awhile to be really appreciated. Learning the hard way is just that--the hard way. Nursing school prepared you and sent you out into the world with a bagful of information and tricks to help you in your journey through this profession. Have you apprentices looked to see what is in your bags lately?
  11. by   nursebear168
    Thank you all very much for all the advice you all have given to me, and especially to Daytonite (by the way, if you live in Arcadia, I live really closed to you.) About writing a jounery, it is a good idea. I usually sit down on the sofa at home, and think about what I did wrong and right during the whole shift. Sometimes I just feel so impatient about my own progress, and eager to be competent nurse. Like you said this process take years and years to master;I will hang in here.
  12. by   bluesky
    I just want to say that you are very wise to have reservations about this unit. But the fact that the hospital is comfortable letting a float nurse from stepdown manage a critical pt on multiple pressors that are being titrated is definitely a red flag to me... unless your preceptor has had extensive previous ICU experience. You might think about another hospital alltogether.
  13. by   PedsRN03
    Hi Nursebear,
    Your preceptor can make all the difference. You still have a good 4 weeks left, and if your preceptor is bringing you down it can make this difficult time even worse. I graduated 2 years ago and had a similar situation with my new grad orientation where my preceptor had unrealistic expectations of me and was negative and harsh, and I almost left the unit. I was scared to ask to work with somebody else because I did not want to make a bad impression at my first job..but I finally ended up making that request. Having a preceptor who could provide balanced constructive feedback made a world of difference and I ended up staying and doing very well. As for the time manangement...work as hard as you can on it, but don't let it get you down. With all the things going on and the interruptions and changes in the plan, admissions, discharges, etc. hospital floors are a hard place to work. After two years, I still feel like I'm pulled in too many different directions and have too much to do and too little time most days. Good luck!
  14. by   blueheaven
    I agree with Daytonite whole "heartedly" When I was a new grad nurse working on a cardiac stepdown unit, I really didn't have much orientation or precepting. I was scared to death! Fortunately for me I had very knowledgable experienced LPNs who helped me (especially on days when I wanted to totally SPAZ out) and they got me through the first year and taught me a lot. I also found a couple of ICU nurses who acted as resource persons for me. Have you asked about a different preceptor? It sounds like the one you have may not be a good fit for you. Having someone that you know you can go to and be supportive will make a big difference. As for being organized etc...I still have days where it just will not come together Just a part of life! Keep on keeping on! Good luck!

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