New grad on orientation, but want to switch already -- how does it work?

Pediatric Critical Care Columnist · Dec 31, 2007

You're not the first and you won't be the last nurse to find the spot you're in to be a poor fit. Your best bet is to be truthful and up-front about why you're not going to hang around. When you interview for your next unit, the interviewer will have heard your story before, with some variation, and won't be at all surprised. Lots of people think they know where they fit when the graduate, only to find out they were really wrong. It's always best to face facts and do what is necessary. The unit you're in now will be sorry to see you go, and a little annoyed at the financial outlay they've made in your orientation but they'd rather know sooner rather than later that you just can't stay. ICU isn't for everyone, in fact it's really a hard place to feel comfortable in. No doubt there have been others before you, in your unit, who have gone through the same exact progression. Relax. No one is going to crucify you for not liking ICU!! But they might crucify you if you stayed and just couldn't do the job well. Most of us respect those who know and acknowlege their own limits. The rest don't matter... Find a place where you feel like you belong and you'll never regret it.

SoundofMusic · Dec 31, 2007

Thanks, Jan -- you've given me some good talking points. Knowing my limits is truly the heart of it. And I'm at my limit now ...beyond it, in fact -- so thanks so much for the insight!

Pediatric Critical Care Columnist · Dec 31, 2007

I'm glad I could help. I've seen enough nurses who thought ICU was the place for them find out very quickly that is isn't what they thought it would be, or that they aren't who they thought they were, but stuck it out because they didn't want to admit to anyone, even themselves, that they'd made a choice that wasn't right for them. Things generally only get worse from there. As I said, the ones who recognise it early and seek out other options are clearly ahead of the game. Who wants to go to work in a place that makes them feel anxious before they're even out of bed?

I've heard from somewhere that the average ICU orientation costs the hospital somewhere around $60K per nurse. If you multiply that by the number of nurses who finish their orientations but don't last a year in a given unit, the number is mind-boggling. Our unit spent nearly a million dollars on orientations a couple of years ago for nurses who left within a few months of completion. Admittedly, some of the responsibility for that has to rest with those doing the hiring... some of these nurses were clearly not suited to the pace and the acuity. More recently we've had a bit better success with retaining new hires, but whether it's sustainable is anyone's guess. The units who benefitted from our losses are lucky to have nurses who know they are where they should be. Don't be afraid to test the waters in other areas before you settle. This isn't just a career, it's a calling, and you have the power to change people's lives... starting with your own.

SoundofMusic · Dec 31, 2007

OMG, you hit the nail on the head with the hiring process. Mine was totally disjointed. The person who interviewed me subsequently left and I never was even introduced to my managers before I walked on the unit. No one ever really stressed the true nature of the unit -- or asked those pointed questions. They need to be straight with a new grad -- ask them if they're up for the pressure, describe scenarios -- what their personal situation is -- if it could interfere with work, etc. Those are questions that really need to be asked. How fast do you think? How well do you know your information? How well do you take criticism? There should already be an aura of skepticism built into the the interview . ..make the new grad prove he/she can handle it ...

I also feel a new grad should shadow for a length of time on an ICU, if possible (although I can see the problems with that), and perhaps even put through a very lengthy interview process. Hell, I was put through a 5 hr interview for a lesser job in marketing in my past . . .why is it a nurse for ICU work is interviewed for only an hour?

My own personal situation is that I'm a single mom of 3 now with hubby deployed . . .if they knew that, perhaps that should have been a red flag to them . ..but really all you hear is come, come ...come work here . ..hurry. You'll do fine.

Well, NO, you don't do fine if you can't rest at home, you go into work already tired, already stressed. That sort of stress with ICU stress is undoable.

Don't be afraid to test the waters in other areas before you settle. This isn't just a career, it's a calling, and you have the power to change people's lives... starting with your own.

This is great, great advice. I will not forget it. Thanks again.

marilynmom, LPN, NP · Jan 1, 2008

Thanks for your post.

I will be graduating in May (go me!) and I work as a nurse tech in a large PICU. I love my job but wonder sometimes as a new grad if I'm going to just be wayyy over my head? I have no idea. All the RNs tell me I sure will be, and they did it so why can't I? Some told me they threw up everyday before work and it was a nightmare for the first 6-12 months--is that what I want? But still... it's very scary. I will have 10 weeks of orientation and then I'm on my own.

Your post was insightful and I appreciate it :)

cherokeesummer · Jan 3, 2008

I had a very similar situation. I did my senior internship in a nicu and thought that was the place for me. So I interviewed and got a job offer with a great hospital and a high acuity nicu. I started orientation and realized soon that it was a lot of intensity and more than I even experienced in nursing school during my internship (lower level nicu then). So I kept trying but I noticed that I was not retaining anything, I cried before it was even time to go to work, one day I cried and cried and begged my husband to help me come up with a solution - it just was not for me. I was up front with them and was offered the opportunity to go to a med surg peds unit where I went. I knew that long term I wanted to be in mother/baby postpartum nursing so I kept my options open for an interview and eventually got one. So I did start over and it wasn't frowned upon but it did take me a little longer b/c it was later in the year and most of the new grad orientations were already full. So it may take some persistence but do what you feel is right for you - if you are dreading work like I was, then it will make for a badddddddd day!

SoundofMusic · Jan 3, 2008

Oh, Cherokee -- that is so it. I am not retaining ANYTHING when I go into this unit. There is just too much to learn -- every system and every critical thinking process that goes with it, every basic nursing skills, as well as all the critical skills and equipment -- with three kids at home, I have no time to study on my off days and it's all just too much.

It's got me yearning for a speciality type of nursing, where my focus is more narrow. I'm interviewing at a stroke unit today, and then telemetry. We'll see how it goes.

Count me in also for crying before and after every shift, and sometimes even during ... there's just got to be an alternative to that type of existance. It's just plain embarrassing.

Also, having some of the veteran nurses mumble, "just try not to kill anyone" as they walk by doesn't exactly boost your confidence either. All of them put in several years in med surg before they got there ...so they see us new grads as extremely brave --which I have found out, I am not.