New Nursing Career: 90 days - UM suggests I voluntarily resign

[RNmichaelJ]

Warning this rant is long and likely something you hear too much about but here it goes...

I am a displaced automotive engineer, passed my state boards 03/2013 and started last April on a step down cardiac unit. I was let go after being told repeatedly that I was doing great then one day called in and let go during a low census after I struggled with a direct admit from a nearby smaller hospital. Since it was only a four weeks from when I began solo so I was taking my time and asking for help with this difficult admission.

I work 11-7 and that night the admission came at start of shift (SOS). As fate would have it the clinical educator (CE) was overseeing the handoff to me. Ultimately it was that handoff that I was called out on. The nurse handing off to me was talking to me like I was slow and the report went 45 minutes into the shift with the CE hawking us. I was told I was not getting it and that by this time should be getting through report quicker.

The transfer involved a former CABG w/ uncontrolled angina. He arrived with no orders entered and without med-reconciliation and I later discovered needed nitro for chest pain STAT. I needed to resolve his medrec and VORT/TORB w/ a cranky physician using a portion of our Cerner Powerchart/PowerPlan I was unfamiliar with because I had only a few admissions and they were all from ER or had been processed through ARTC. So the guy may have been in pain longer than he needed to be, I asked for help on what I was "supposed" to be up to speed on, I riled up a physician, and it all started with a handoff where I was treated like forest gump.

I was told that if I voluntarily resign they will keep me as an employee for a week or so to transfer as a current employee to a Gen. Med-Surg. floor. So I did and have completed the transfer applications.

When I started on this floor I decided ....no new car or new expenses and no 401k roll-over until I have 6 months in. My gut feeling was that I may not pull this off. I wanted Med-surg but ended up where the turnover is high providing my opportunity. However, things were starting to click and this came as a bit of a surprise especially when the CE who should know better witnessed the SOS and was familiar with my exposure to that point.

My world took a big hit. This is a multiple top 50/100 magnet hospital and our communities largest employer. I landed a job in the seven floor "Heart Center" on a Beacon awarded floor with the highest acuity attained by anyone in my nursing school cohort.

One side of me is dissed that they would bale on me after my (and their) investment and the other is relieved to not be where I might say they "eat their young". In the last few weeks I noticed that nursing pods with 3 stations were full while I was alone with a whole station to myself and I was always in the break room alone. I suspect I never hit it off being a non-traditional employee working among much younger females. At times I had to interfere with their facebook and tablet video entertainment to ask a "dumb question".

I can acknowledge that part of my problem is a "me" issue, not having the gift of gab with the other staff, however I came from an environment where we did not treat work like a social club. Being 50+ years old and making this change late in life I also found that I was retaining less information than I used to as well which put me behind the younger new hires even when I would show up early for work to dig into H&Ps, labs, vitals, etc. prior to shift.

If anyone out there has any suggestions, similar experience, or has some perspective from a UM or traditional nurses point of view I will be real interested to hear from you...I'll be dipped ?

[swansonplace]

What are good positions for new grads? Wound care, Med Surg, Nursing infomatics, etc.

[Esme12, ASN, BSN, RN]

RNmichaelJ said:

Warning this rant is long and likely something you hear too much about but here it goes...

I am a displaced automotive engineer, passed my state boards 03/2013 and started last April on a step down cardiac unit. I was let go after being told repeatedly that I was doing great then one day called in and let go during a low census after I struggled with a direct admit from a nearby smaller hospital. Since it was only a four weeks from when I began solo so I was taking my time and asking for help with this difficult admission.

I work 11-7 and that night the admission came at start of shift (SOS). As fate would have it the clinical educator (CE) was overseeing the handoff to me. Ultimately it was that handoff that I was called out on. The nurse handing off to me was talking to me like I was slow and the report went 45 minutes into the shift with the CE hawking us. I was told I was not getting it and that by this time should be getting through report quicker.

The transfer involved a former CABG w/ uncontrolled angina. He arrived with no orders entered and without med-reconciliation and I later discovered needed nitro for chest pain STAT. I needed to resolve his medrec and VORT/TORB w/ a cranky physician using a portion of our Cerner Powerchart/PowerPlan I was unfamiliar with because I had only a few admissions and they were all from ER or had been processed through ARTC. So the guy may have been in pain longer than he needed to be, I asked for help on what I was "supposed" to be up to speed on, I riled up a physician, and it all started with a handoff where I was treated like forest gump.

I was told that if I voluntarily resign they will keep me as an employee for a week or so to transfer as a current employee to a Gen. Med-Surg. floor. So I did and have completed the transfer applications.

When I started on this floor I decided ....no new car or new expenses and no 401k roll-over until I have 6 months in. My gut feeling was that I may not pull this off. I wanted Med-surg but ended up where the turnover is high providing my opportunity. However, things were starting to click and this came as a bit of a surprise especially when the CE who should know better witnessed the SOS and was familiar with my exposure to that point.

My world took a big hit. This is a multiple top 50/100 magnet hospital and our communities largest employer. I landed a job in the seven floor "Heart Center" on a Beacon awarded floor with the highest acuity attained by anyone in my nursing school cohort.

One side of me is dissed that they would bale on me after my (and their) investment and the other is relieved to not be where I might say they "eat their young". In the last few weeks I noticed that nursing pods with 3 stations were full while I was alone with a whole station to myself and I was always in the break room alone. I suspect I never hit it off being a non-traditional employee working among much younger females. At times I had to interfere with their facebook and tablet video entertainment to ask a "dumb question".

I can acknowledge that part of my problem is a "me" issue, not having the gift of gab with the other staff, however I came from an environment where we did not treat work like a social club. Being 50+ years old and making this change late in life I also found that I was retaining less information than I used to as well which put me behind the younger new hires even when I would show up early for work to dig into H&Ps, labs, vitals, etc. prior to shift.

If anyone out there has any suggestions, similar experience, or has some perspective from a UM or traditional nurses point of view I will be real interested to hear from you...I'll be dipped ?

I'm with Viva....so here is a What is wrong with everyone these days??? I just don't get it! why was the CE there in the middle of the night? Is this usual for her or...were they setting you up. You can't learn everything on orientation especially how short they are these days....what happened to ehlping a co-worker out

Now....with a PMH being transferred for angina.....with active chest pain...why was this patient not on a Nitro gtt? Had they been given anything for pain???? Patients with active chest pain are unstable and should NOT be transferred with pain unless absolutely necessary as an emergency. What did the transferring nurse do for the chest pain?

The first year is the hardest....organization is key.

FinalGraduateShiftReport (1).doc

5 Pt. Shift (1).doc

1 patient Float (1).doc

MTPMedSurg (3).doc

horshiftsheet (1).doc

[sneeds]

You'll find a place that fits you that you are happy in. This one is not it. It's obvious that this unit does not want to grow nurses. They want to save money on new grads but want them to practice as if they have years of experience. They do this now and it sucks. It may not seem like it now but you're gonna be happy to not be there when you get your new gig that fits. You'll be thanking God and remembering what you learned from the experience and it won't seem so bad anymore. That time is coming.

[jadelpn, LPN, EMT-B]

GrnTea said:

And big hint: No matter what else you think needs doing, you never, never, never delay giving pain relief in the form of nitrates to a patient with chest pain, not for any reason.

EXCEPT for that pesky thing called an order, some sense of where the patient is at vitals wise, and if they have contraindications that nitro should not be used. Which is impossible to determine if the patient comes with no paperwork at all.....and a hand off nurse spending 45 minutes giving report. While the nurse educator just looks on.....If the patient was in active chest pain, the educator and the nurse handing off should have responded to that stat, as opposed to making the OP look like an idiot at the expense of a patient in pain.

[BlueDevil,DNP, DNP, RN]

Due respect, this takes 30 seconds. Time is muscle. No excuse for that part, except that the OP was in over his head. They saw that he was and took action.

As for the rest, I get it. From one old guy to another, I get it. I do not understand the world's obsession with facebook, lol. It is so vacuous and vapid, and people spend hours on it. I get why my 12 year old likes it, but adults? It is mind boggling. In any event, I think you are going through a fairly typical new grad phase, coupled with a poor fit for your first unit led to a rocky start. I also think there is a bit of culture shock as you realize the vast chasm between your former professional world and that of Nursing. It is going to be a big adjustment, and in many respects, Nursing will not compare favorably. Lead by example brother. They make not like you, but they will come to respect you, which frankly, I've always found preferable.

Stick out the new job for a few years while you learn the ropes and find your passion, and then transition toward the arena where you think you have the greatest impact.

Best regards.

[OCNRN63, RN]

jadelpn said:

EXCEPT for that pesky thing called an order, some sense of where the patient is at vitals wise, and if they have contraindications that nitro should not be used. Which is impossible to determine if the patient comes with no paperwork at all.....and a hand off nurse spending 45 minutes giving report. While the nurse educator just looks on.....If the patient was in active chest pain, the educator and the nurse handing off should have responded to that stat, as opposed to making the OP look like an idiot at the expense of a patient in pain.

But the receiving nurse needs to take the bull by the horns in that situation and say, "Stop! This pt. is having angina and is unstable. I need to get orders for him/her." I would hazard a guess that the person giving the report was disorganized; I've never seen a report on one patient go on for 45min.

Paperwork can almost always wait. In the case of a pt. who is unstable, things like med. rec. sheets take a backseat to stabilizing the pt. Nitro does more than just relieve pain, and getting that for the pt. was priority.

As GrnTea said, give yourself some time in a less acute unit, then try again later if you still want to work in critical care. Who knows, working in med-surg for a while may show you that your real passion is with working in another specialty (e.g. oncology, ortho, etc.)

[nurseprnRN, BSN, RN]

jadelpn said:

EXCEPT for that pesky thing called an order, some sense of where the patient is at vitals wise, and if they have contraindications that nitro should not be used. Which is impossible to determine if the patient comes with no paperwork at all.....and a hand off nurse spending 45 minutes giving report. While the nurse educator just looks on.....If the patient was in active chest pain, the educator and the nurse handing off should have responded to that stat, as opposed to making the OP look like an idiot at the expense of a patient in pain.

If that's the case, and you have no standing protocols, then your absolute priority is to call the physician stat to communicate the chest pain and get the NTG order. This isn't something that requires an educator or an experienced staff nurse to recognize and deal with. I stand by my assertion that nothing, but nothing, should stand in the way of pain relief for chest pain, and the pesky fact is that even a new grad should know and recognize and act on that.

[jadelpn, LPN, EMT-B]

And with all due respect, without some sort of report, (which should have started with "this patient is experiencing chest pain, so lets deal with that first") I get the feeling from the OP that he was not made aware too quickly that this was the case.

I am not too fond of patient's suffering because multiple nurses are playing "you can't be in our club" stuff. If report was not done at bedside--how was the OP to know that there was pain? If report was done at bedside, then of course one should take the lead and act on that. But there's a game playing that seemed to dominate this whole mess, and at the expense of the patient.

Critical care is a specialty. And not something I would be even slightly into specializing in if I were an RN, however, nurses who do are amazing. But it takes a good sense of foundation. Otherwise, any new RN could feel out of their element.

[HouTx, BSN, MSN, EdD]

swansonplace said:

What are good positions for new grads? Wound care, Med Surg, Nursing infomatics, etc.

Sorry guys, but 'specialist' roles usually require a very strong clinical background first. There just doesn't seem to be any way to escape paying your 'dues'.

As a semi-archaic person myself, I cringed when I read the OP's comment about being older and the effect it has on memory..... that's pretty much been disproved.

I'm an educator & my specialty is critical care. I think that there's a factor that everyone seems to be missing in this discussion - the ability to multi-task. There is a wide variance in the number of "things" an individual can pay attention to at any given time. In educator (& human factors) lingo it's called "cognitive load". This does not have anything to do with intelligence. Some people cannot adequately process more than 3 or 4 separate things simultaneously while others can handle up to 7 or 8. If you are not one of the latter group, a very fast paced, high intensity clinical area is not for you. Although it gets better as expertise develops, this sort of environment will always feel chaotic to someone with low cognitive load capability. Of course, I don't know the OP at all, but based on friends (& family) who are in engineering fields, they tend to be natural linear thinkers... very thorough, logical and rational, but not comfortable with multi-tasking.

There's an 'ideal' environment for everyone. There are many nursing roles in which the OP's wealth of experience, skills & knowledge would be very valuable. Occupational health may be a great fit since he is probably far more knowledgeable about non-healthcare work settings than most of us. Jobs that require analysis and processing of quality data may also be a good fit.