Being out of work for year, need confidence

[meandmymen]

Today I just had a job interview for a prn rn medsurg position, and I need some advice, guidance, and confidence. I graduated from RN in May 2008 and had two RN jobs that were not at all good for me (one was ER and the second ICU-stepdown where I was basically forced to quit from due to the recession and not learning fast enough) I really don't want the same thing to happen again otherwise I'm quitting nursing for good. I feel like and have been told by an experience nurse that medsurg or a nursing home would be the best for me in order for me to become the great nurse I know I can be.My last job was almost a year ago and I have since then took a year off to have a baby, stay home with my kids and to care of myself.

The job I interviewed for has 2 medsurg floors with a maximum of 46 patients. One nurse would have 20 patients and LPNs and CNAs to help with meds and patient care and I would do admission and all the other stuff that they can't do (assessments, hanging blood, etc) The remaining 6 patients would go to the RN who does everything for them and in rare circumstances I may have 10 patients to totally take care of. They have given me 6 to 8 weeks 3 days a week for orientation.

First of all I'm pretty rusty with my nursing skills and I was wondering what points would be the most important and most helpful on the first day (if I do get the job).

Also any advice for a new nurse would be great because I feel overwhelmed:crying2:.

Would I be better off turning down the job and going with something else in nursing(which I have no clue what)?

Should I take the job if offered and do my best?

I really don't want to give up being a nurse, please help!!

[tokmom, BSN, RN]

Ten total care? As is a hospital? Seems rather heavy for a med surg floor. Anyway, I would bone up on assessment skills and common meds/doses.

[meandmymen]

Yeah but it is rare according the manager. Also what is a good routine to stay on top of things and try to stay organized?

[bill4745, RN]

It seems like a heavy load, even for an experienced nurse. Also, when a manager says "rare" it means almost every day.

[classicdame, MSN, EdD]

if that is a hospital it is an unacceptable ratio in my opinion. Could be setting you up for failure. If it is an LTC there might be some wiggle room. Everyone has their own way but I like to make a grid with hours on the x asix and room numbers on the y axis. Create a grid then fill in what needs to be done at what time to which patient. Then check off as they are done. But for 20 people, I think you are going to have to come up with a better plan. Ask other RNs on that unit to share ideas.

[fungez]

Holy canolli. I've been doing this almost two decades and there's no way I'd take an assignment the way you described. And, though I've never worked ICU, I have worked ED and one's not harder than the other - they're different. ED's problem oriented and m/s is goal oriented, but they're both difficult.

My advice - keep looking. And remember, you passed nursing school and you passed boards so you are competent.

[sharposgirl]

I know how you feel! Though not quite the same, I started in a nursing home for a lack of hospital jobs and was there for two years before going to a busy county med/surg facility. I felt like a fish out of water. Nurses who work in long term care work very hard, but in a very different way and with very different skills than a med/surg nurse. My advice to you would be to be very honest about your needs during orientation. Take a few extra classes to get back in the acute care mode. Don't let them take you off orientation until you are ready. I would also suggest going full time. I know that is hard with a family, but that is the best way to reinforce your skills. Then, when you are comfortable, go to a per diem position. It will be difficult, but you can do it and the worst will soon be behind you!

Also, I just looked at those staffing ratios-not the best for nurses or the patients! Maybe you should keep looking. Nursing is slow right now, but you also want to be safe.

[shoegalRN, RN]

Can you try applying to a clinic or doctor's office?

[HouTx, BSN, MSN, EdD]

I think we're all jumping the gun a bit here.

Let's make sure you get a decent orientation process in order to ramp up your skills. It doesn't sound like this was done very well in your previous jobs. Orientation should not just be this vague period of time in which you fill in checklists. Talk to your manager to make sure you understand exactly what the expectations are for orientation. How long will it be? Exactly what skills or abilities will you need to demonstrate? What are the milestones that need to be accomplished each week? What is the criteria by which your performance will be evaluated?

During the orientation period, you should ask for formal weekly feedback: how well you met your goals for the week; what you still need to work on; goals for the following week; development resources (classes, self study, etc) that you can take advantage of, etc. Encourage them to be very direct with you about your performance and make sure you remain open to constructive criticism. Try very hard to get this information in writing so that you can refer to it when you need to.

I would also advise you to take a 'full load' from the get go... with your preceptor's help. You take the patients, and your preceptor takes you. This is the BEST way to become confident & comfortable with handling a full load - with someone at your elbow, willing to step in if you start to sink. It will also gain you more respect from your colleagues, manager and preceptor. Over my umpteen years as a clinical educator I have found that the traditional 'stepping up' method (gradually increasing patient load) does provide enough opportunity to learn what method works best for you to manage your time.

If you have a good orientation - you don't need to worry about adapting to the unit... it will happen naturally and you will feel like you 'fit in' with the new team you're working with.

[meandmymen]

Thanks for the replies everyone. I really want to work and I thought med/surg would be good for me as a new nurse but after the interview I wasn't sure... I have some applications at a couple of nursing homes, would these be a better fit?

[rosey2007cna]

I am only a CNA but I think that if you get the job you should do the best you can. I you cannot remember something ask questions. I hope you that you get the job:)

[mentor.ruby]

You have received excellent information so far. I would suggest a refresher course in nursing, then return to the workforce with refreshed skills. If you can not afford it, clearly discuss with your Manager the need for additional orientation time. Face your deficiencies in skills, organization, etc. Work full-time. If you choose to work part-time try to work on the same floor study your books, upgrade your skills as if you are on the job.

10 patients in the hospital setting is unfair. Do not work there.

You have my support and prayers. Be safe!