Greetings all!

My family is considering a move to another state, and unfortunately that leaves me in the unfamiliar position of applying for a new job as an RN. :stone

As a relatively new RN, I somehow lucked into a desirable position as a cardiac critical care nurse,with a years experience in the OR prior to that. But there are times when I am not certain if critical care is the right fit for me. Many times I walk off at the end of my shift feeling very satisfied-- as if I had made a difference, and am learning new things every night. Other nights, I feel completely inept, and question myself-- and those times make me feel that I am doing more harm than good to the people I am caring for. (This feeling is usually exacerbated by my more knowledgeable co-workers who seem to be at their wits end with my inexperience, and who can blame them!? They need experienced people who know their stuff during emergent situations, and I am just learning!)

Since it seems I am forced to look for employment in another state, I am expanding my areas of search to include hospice, OR (which I absolutley loved every single day) and out-patient surgery.

I am not 100 percent certain if critical care is the best choice for me, although I *know* that given time I could be a valuable asset to the team, I have failed to prove that at this point, and while my director bends over backwards to make me feel comfortable, my co-workers at times ostracize me, and I have discovered that that hurts me to the point that I dread going back to work with them, sometimes as often as two days before my next shift!)

Therefore, I am thinking that perhaps I would fit much better in a hospice setting, where it seems to me, the stress level is much lower. I am aware of being called out of a sound sleep for an emergent situation, and that doesnt bother me at all. In fact, I honestly feel that I am more of the personality type who would derive great satisfaction from assisting not only the patient's comfort, but the emotional comfort of their families, and easing the transistion for all. constantly being on your toes and the aweful stress that goes along with critical--where patients are full code, and you know that their death is imminent, and you have to stand by and continue to carry out these invasive, planful orders on the same pts day in and out, knowing their chance of survival is very low anyway, looking at their painful expressions of fear, while they are intubated and cannot say a word to carry out their wishes.

I have already had callbacks from several hospitals who know my limitations, and my strengths, looking to hire me on the spot for cardiac critical care, but I have this nagging suspicion that I simply do not fit there. (My co-workers are a special breed that I am starting to believe would much rather see me fail or (best case) go back to med-surg-- which I have never done)

So now you know my background, but I should add that I was precepted for three months by the most competent, knowledgeable critical care RN imaginable, who has since left the hospital -- not even close to the amount of time one needs to be a competant CC nurse, but damn, she was good!)

So I am asking those of you who have been in similar situations what kinds of questions should I now be asking my perspective employers? Can anyone provide sage advice were I to go to a hospice environment or a outpatinet surgical center? I know and have provided care for vented CVVHD pts, baloon pump pts, post CABG pts, and cath lab patients, but working with some of my co-workers, and taking their sometimes cold-shoulder makes me want to quit nursing alltogeter, but I have invested too much, and have never been a loser/quiter.

You have a fellow nurse here with limited experience, who is reaching outside of her co-workers who may be biased against newbies-- yet I have spent over a year in this high stress environment, and I honestly doesnt think this is the correct fit.

I guess I may have given more info than you all need, but I beleive that basically, at heart-- anyone who goes into nursing in the first place, has compassion not only for their pts, but for newer nurses like me, and that whole "nurses eat their young" cannot possibly apply across the board.

What questions should I ask potential employers in order to find the best fit in my next employment situation?

As always, your replies are very valuable to me, and I thank you all from the bottom of my heart for your valuable insights. :)

I wish so much that I had some words of wisdom for you. Unfortunately I do not. As a matter of fact I am facing the same thing as you right now. I am an LPN studying for RN. I have yet to find my place. The nurses eating their young does seem to be pretty wide spread. I have been an LPN for awhile now and the only place I did not experience it was my first place of employment. I just wanted to let you know you are not alone.

My first point to make with you is it will be alright. As you have already found getting a job long distance isnt hard. The last two Ive gotten with no more than 30 minutes on the phone.

Of course when you get there things are what they are and you have to deal with that. In both cases I wished things could be different But I also found that even if you visit the place in person, problems dont really surface until youve been there awhile.

My second point is I dont think that an employer is going to be much of a help to you with your situation. You are asking them to pick your area of specialty given your perception of yourself. They are trying to fill shoes.

It took me two years to be comfortable in ICU. Just now at four years I feel pretty confident.

You have a great background for ICU. You know what happens to pts before they get to you, how some procedures are done, and how to keep a sterile field.

Now you have a bit over two years experience. I think you'll be comfortable at three. I was told by an instructor that I could go directly into ICU from school, as long as I was willing to live in fear for 2-3 years. How right she was.

There are nights I go home walking on cloud nine, from having made a difference. There are others when I am grateful I didnt kill anyone. Much of the time I feel as if I dont make a difference at all.

I think that at least part of your problem might be the culture of your unit. Another part is nursing in general. And yet another might be you.

Try sitting down with a piece of paper. Write in one column everything you think you did well on this last job. In the other write down everything you might have done better. Then at the bottom write down what you could do to improve.

If you asked me I would say stick with ICU another year. I found that most of the RN's I respect the most whether floor, hospice, instructor etc have all worked in ICU a few years.

If you want specific questions to ask an ICU, I have 31. If you want to know what questions to ask an employer to find the "fit for you" I havent a clue. Possible you might ask yourself what you could do to fit better no matter what unit or specialty you work-

HTH

11

Why not consider agency nursing so you can not only try different areas, but learn about the local hospitals and facilities! I have advised this to many groans and "oh okay..grrrrr" but they thank me every time! I mean, you can work in your favorite area of nursing...but it may not be satisfying at all if you are stuck in a horrible mismanaged hospital!

Maybe that can help :)

...but it may not be satisfying at all if you are stuck in a horrible mismanaged hospital!

I think this is the root of your bad experience in the CVICU.

There's NO WAY you should, at this point in your experience, be expected to work completely on your own without eliciting the help of others. That ICU is a bad ICU. It's not your incompetence.

At my CTICU, we have an orientation period of 3 months for new to ICU nurses and new grads. After the orientation period, the new person does go into the count, but is usually paired close to someone with experience for support (we all do it, it's part of the success of the unit). Also, new people are assigned or choose volunteer mentors who follow them for three years making sure they are getting the education and support they need. Could be their preceptor, could be someone else.

In a prospective new job, maybe you could ask if a place provides something like this. I'm so sorry you feel eaten alive! That's so wrong. CTICU is so stimulating and fun, but can be so depressing and very challenging at the same time. I too remember feeling completely incompetent and somewhat of a fraud at the beginning.

I have been thinking of cutting my hours in the CTICU and doing hospice nursing concurrently with the ICU. I think hospice would be a really good match to ICU nursing for me and help me deal with some of the stuff we do to those poor people in the ICU.

If you really want to stay in ICU, don't give up, find another place. It takes a couple of years to really get the experience to feel competent for everyone coming in!

Good luck whatever you decide, for only you can really make that decision. It doesn't matter what area of nursing you work (ICU/med surg/hospice) if the culture of the unit is not supportive, then you will have these same discouraging feelings.

I agree. I feel that in any critical care setting you should have the ability to get assistance from other nurses with your patients, no matter how experienced you are. I love the ER I work in because it is such a team approach to everyone's patient. No matter what nurse is assigned to the patient, you will almost always find other nurses and the techs helping with other nurses patients. this works wonders when one nurse gets the crashing patient and needs to devote time to that patient, other nurses can then pick up the slack with their other patients. The more experienced nurses should also know from their time in that you don't know everything right away, and learning on the job happens. They should not shun you because you are still learning.

If there is a nurse who thinks s/he knows everything there is to know about every patient in every situation, then there is something wrong.

Good luck on your decision, but remember every time you change settings there is a new amount of learning associated with the area.

.There are nights I go home walking on cloud nine, from having made a difference. There are others when I am grateful I didnt kill anyone. Much of the time I feel as if I dont make a difference at all.

Ahhhh. The life and times of an ICU nurse.

I want to thank each and everyone of you for taking the time to read my post, and for helping me to know that I'm not alone.

Thanks 11:11, for your advice about writing down my strengths and weaknesses, and my main weakness is a biggie--- Inexperience!!! :chuckle

I'm also trying to write a list of questions to ask a new employer, such as nurse pt ratios, conflict resolution (got that idea from another thread on this board) training/preceptors, etc..

Begalli, My hospital's orientation is much like yours, 3 months training with a preceptor, and then they use a "buddy system" where you choose another nurse who will be your mentor.. Unfortunately, that doesnt always work due to scheduling differences, and sometimes (as in the other night) she's just not available. (too busy--what RN isn't anymore?)

Anyway, I just wanted to thank you all for your support. Your words all help me much more than you could know. :)

Why not consider agency nursing so you can not only try different areas, but learn about the local hospitals and facilities! I have advised this to many groans and "oh okay..grrrrr" but they thank me every time! I mean, you can work in your favorite area of nursing...but it may not be satisfying at all if you are stuck in a horrible mismanaged hospital!

Maybe that can help :)

Triage, you won't hear any groans or gutteral utterings from me! :chuckle In fact, I intend to start calling some agencies tomorrow. Thanks!! :) :)