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 ?

[Morainey, BSN, RN]

I read your post, and you sound just like someone I graduated with - he was an older gentleman who tried a couple of different high-acuity areas (started in ED) and kept downgrading acuity (all the way to nursing home) until he decided he just wasn't cut out for nursing as a second career - couldn't really keep up with charting, meds, treatments, report, etc. Not to say that you can't or won't be able to keep up - but you're not the only person in the world who feels that way.

[VivaLasViejas, ASN, RN]

Michael, if I could I'd just reach out and give you a huge HUG!! You've been so forthcoming about who you are and what your limits might be, and you are also perceptive and wise and you deserve better than what you've gotten so far from this career.

I'm well past 50 myself, but graduated at 38 and so I've learned the politics pretty well, even though I stay above it as much as humanly possible. That's all you can do realistically......nursing is a world all unto its own and unfortunately is dominated by women and the young, all of whom can be unmerciful to those they view as not 'fitting in'. Best I can tell you is to not let the (w)itches get you down, and don't let people treat you like crap!

[Makkiel, ADN, RN]

I would suggest you keep going. Maybe you are at the wrong facility, the wrong type of nursing, etc. This is one of the reasons I chose nursing - it is so diverse. If I don't like one area/facility, or I am not good at an area/facility - I just find another. Maybe you just need more time to hit your groove there. I would suggest that you be intellectually honest in your self-reflections - so if you identify a problem you have - you cited retention - be honest and own it - which you did - and you also addressed the possible solution but showing up early and checking the charts etc. So it seems you are committed and honest. Just keep those going - and try different areas if necessary, but I would hang in there and keep going. And in the end, if you finally realize this area isn't for you - then try another type of nursing. As far as you co-workers - they don't matter. If they are isolating you, not liking you, I would consider it their loss (assuming you are a nice guy of course).

[jadelpn, LPN, EMT-B]

Hmmmmm nurse educator watching you struggle? Any other seasoned nurse would have flipped over the no orders nor med rec thing. Even the nitro stat order I am not too fond of.....on admission??? You have to do a quick assessment first--BP in the toilet, heck, for all you know with no med rec the patient could be on viagra and then it would be all about your lack of assessment skills--I am confused on that one-- There's lots of this that is wrong on a number of levels. Who ever the MD is that admitted this patient needs to give orders. And the nurse that passed the patient off to you needed to be sure the med rec was completed. I could debate this to kingdom come, but bottom line is that this is a situation that sets people up to fail.

A transfer to Med Surg is not a bad thing. The diversity can make you hone in on the type of nursing that you would like to do. Helps to find your niche.

Something that you may want to explore is palliative care, addictions nursing or home health. Those are a few that I think are great options that take a special type of personality, someone who thinks about the whole picture type of nursing.

Don't let anyone under value your contributions. As a former automotive engineer, you have a keen sense and gift for the details. Although in nursing A+B doesn't always equal C, the rational will come to you.

Best of luck in your endevours.

[xoemmylouox, ASN, RN]

Don't give up already! I think most nurses do not stay with the same type of nursing their whole career. Some places are just too much to handle, especially if you are not trained right.

I quit an LTAC job one without any sort of notice. I had had enough. The staff was ridiculous (I had a charge nurse throw a specimen at me even!) the training they promised was all a lie (I was promised ACLS, Vent training, etc) and they hired a ton of new grads with limited experienced staff so no one was confident or well versed in care.

Some places are just toxic. Try again with another employer or on another floor. Good luck!!

[anotherone, BSN, RN]

Comming from a young female who has been a med surg rn for a few years...... never checked facebook at work. I have seen many new grads go and many come after a failed stint in cvicu and icu. They seem to expect you to get it all and not need much help at all. We have gotten plenty of nurses icu/cvicu said were too slow, incompetent etc... on med surg they seem to do as well as all the others. not any better (even after months in icu) but not worse either. You get more pts but they are

more stable and frankly you won't need to know as much. You mentioned turnover is high that's a problem in many ways. Our turnover is high and we get almost all new grads. That is a huge complaint among the existing nurses. Everyone is sick of precepting and dealing with helping new hires(we are all human). staff requests experienced nurses only be hired.... very sink or swim attitude. seems to be ok to ask for help as long as it's not a demand and they understand even experienced staff gets overwhelmed and needs help.. At this point if they asked you to go, try to get a job on med surg or tele and go. go with a smile . If report takes too long , I cut people off all the time. I am getting the report so if they drag on and on I will ask questions.

When I was a new grad .... it was awful..... very mean nurses, heavy assignments , in subordinate aides, etc . Rude comments or refusals if i asked for help etc. i teAmed up with some other new grads and we helped each other when we could. I never complained. Never. then I started to figure out who's who . who would help, who would need my help. sad but it can be very political. i would not want to go theough this again. those were the worst 6months of my life..I don't envy you at all!

But if I had a question I asked. oh well. but now i understand how overwhelming being the "experienced" nurse can be.

[SuesquatchRN, BSN, RN]

Hang in, Michael. I'm really good at getting fired. And walking out. You'll find your niche.

[swansonplace]

Michael,

I am just starting out so I am just throwing things out there.

Not sure, but maybe a system that has a support system for your first year. Residency program. I heard that they have a higher retention rate vs students that go straight to the floor.

Also look into finding a niche that fits your personality. Wound care, home health, nursing infomatics, biomedical related nursing, legal nurse. I even heard of a hospital that specializes in robots. I once heard of a job in cardiac cath that has specialized nurses just to run the equipment for pacers.

Please let me know what you come up with as I am in a similar position. I am just graduating from school studying for my nclex, and I have a techie background. I was thinking about med surg, and maybe doing a med surg cert for more practice or doing another clinical.

[netglow, ASN, RN]

IDK. Sounds like a set-up. Seriously.

Either they are a crappy hospital with all marketing-talk and no real action "Heart Center" (bal-o-ney) which is common, or you were set-up. The CE there to set-up and document inadequacies is telling. If you have no way to run down a protocol/software sequence on your own so you can practice and gain speed - there is no way you will be able to quickly jump to it in a situation like this. EMR's suck. I'd bet if you were IN the clique you'd have all the help you needed.

An admit without stabilization/rec/orders in the ER is crap. If your CE/unit will take such a patient that has not been figured out enough to move out of the ER, they are a joke. What do they want you to do? Drop the patient with that Nitro?

That's an ER dump.

[poppycat, ADN, BSN]

I have to agree, Michael, that this whole thing sounds like a setup. It sounds like they just didn't want a new grad on their floor & did whatever they could to make sure you failed. It's not your fault! Shame on them.

Like Viva said, I wish I could reach out & hug you right now. Hugs are some of the best medicine.

Hang in there. You'll find your place in nursing & show that floor that they are not the be all end all!

[nurseprnRN, BSN, RN]

When you start in a critical care area they do need you to be up to speed fast. This has nothing to do with a "set-up," "NETY," "toxic environment," or anything else. It is a matter of the ability to care for critical patients at a higher level than you were able to demonstrate at the time. No excuses matter at this point. You weren't able to do it for whatever reason, so they decided to give you a chance to get better in a place where the stakes weren't so high.

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. "May have been in pain longer than he needed to be" absolutely doesn't cut it in infarction-land; this would have been a career-ending knee injury for a new grad (or any nurse) in many settings.

I hear you being proud of having scored this job, so you're probably embarrassed that it didn't work out and you aren't the supernurse you thought your peers thought you might be. But you can try again later after you've had a chance to get your feet underneath you and get better at systems and priorities. This is why it's the very rare new grad that succeeds in critical areas; nothing personal. I wish you well.