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- by Mwende Oct 26, '11Hi everyone, I recently moved and started a new job. My experience is in a large MICU in a University hospital setting. I've just started in a SICU in a smaller private hospital. When I took the new position many things seemed positive, smaller unit, great pay, the hours I wanted. What could be so different hospital to hospital . . . and ICU to ICU??? I'm still in the orientation process and find myself ALREADY wanting to leave. The people are friendly, although many seem to gossip a lot about their patient's families. This I could deal with. My larger frustration is that I feel like the care is not given as urgently as I feel it should be in an ICU. It took me forever the other day just to get someone to replace my patient's potassium. The dynamic is much different from the University setting and feels disorganized and slow.
Here's the dilemma. On one hand I feel like it could just be the orientation process and getting used to a new hospital. Maybe I should give it a few months off orientation?
On the other hand, I really don't want to waste their time or mine if my gut says "I don't feel good in this care environment."
Wondering if anyone else has chosen "the wrong hospital" and switched before they were even off orientation? And if so, how do I explain this at any potential interviews?
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- Oct 26, '11 by hoopschickHaving been in similar shoes, I say give it a few months, learn how the process really works, and get to know the system before you give it up.
In my experience, every new job I have ever started had me second guessing myself...it's always more comfortable when you think about where you were, because you knew everything, had a pattern, a process, knew the people, who to call, the numbers, etc.
I think it's very hard to judge what work is "really" like until you've been somewhere long enough to be off of orientation, and establish a routine.
PS...A small hospital transition from a University/teaching hospital is especially a challenge, I agree. No residents, no 24 hours for basically any and everything you need. But, like you said, there are trade offs and benefits to working in smaller community hospitals too, just give it 3 months minimum.
- Oct 26, '11 by MwendeQuote from hoopschickWow . . . you couldn't have said it better. I miss the residents (never thought I'd say that) -PS...A small hospital transition from a University/teaching hospital is especially a challenge, I agree. No residents, no 24 hours for basically any and everything you need. But, like you said, there are trade offs and benefits to working in smaller community hospitals too, just give it 3 months minimum.
I just feel like every time I ask my preceptor, I'd like to get an order for . . .this . . .or that . . . she says, just wait an hour or two and if the doctor isn't around by then we'll call.
- Oct 26, '11 by hoopschickOne more PS....Preceptors vary in teaching and nursing style. Maybe another preceptor would be more proactive, and the thing is, once you're off orientation, you can do it the way you want.
I do know smaller community based hospitals have certain unwritten protocols they follow, because they generally know the doc's and their preferences.
Personally, I was used to either a resident, a hospitalist, or an intensivist being available 24/7, and to have to wait to get an order used to drive me nuts.
If that continues to be the norm, then sure, re assess and decide whether or not you can get used to practicing like that. If you have real life and death concerns though, call anyway, even though the "private" with privileges doc may not be happy, we're not there for that purpose.
One reason I love ED- doc is right there, and it's collaborative.
- Oct 26, '11 by canoeheadI've been there, and usually you will find some redeeming qualities to the new place. On the up side, you will be able to bring better care to the patients, and things will change for the better because of it. A positive influence will have an effect. In the meantime, take your care guidelines from national standards, not from what is usually done where you work. You have found a difficult situation, but it's not unworkable, unless you are in charge of people who are neglecting or abusing patients.
- Oct 26, '11 by MwendeThanks for the responses. You all make excellent points. I have to keep reminding myself is that off orientation I will be able to manage the patients how I want to.
Unfortunately, it's so hard not to let someone else influence my feelings. My preceptor seems offended every 5 seconds by family members or other staffers and turns around after they walk away and berates them. I need some positive energy
- Oct 26, '11 by JanetCCURNThis happened to me when I moved from my first hospital CCU to a MICU. It was so bizzare I felt like I went from high standards to a place keeping afloat and trying to meet minimum standards. So much so that my preceptor and others would share stories about what they got "dinged" on during Survey. It was jaw dropping the things I was told. Yes tons of gossip. As far as families, I just here people vent but if it's abusive or from a lazy and unempatheic stand point, it would drive me to say something. Extremely funny coincidence was that the preceptor I had at this hospital 20 plus years ago was oriented by my very first preceptor from the hospital I left. So in essence I felt a bit of kindship. When I spoke with my first precepter she said "did going to that ICU make you wanna turn around and run as fast as u can?" I've been there ever since only because I control the kind of nurse i wanna be and contacting a doctor and I will page them a million times until they call me back. Im obvious not gonna harrass them for things that can obviously wait but I'm gonna call down my list of consults if I had to and keep documenting. Using what you know and what you've learned and share it in this new hospital might help you feel like a contributor as opposed to feeling like you have to conform. If you have a better way of doing something or feel like there should be a policy in place for a particular situation construct and formulate a plan with your management. Hopefully they are receptive and openned. But yes give it time if you don't like it or no one invites new ideas then move on....
- Oct 26, '11 by catundra21I too just started a new job. It's for a private practice gynecology clinic. Not my first choice, but my first job offer and the opportunity was too good to pass up. Now however, I wonder if I made a mistake. I am the only RN. The nurse before me stayed long enough to train me for 6 days (which the physician said was all wrong) and then she was gone. It's just the physician, the office coordinator, and myself. The front desk girl quit and the doctor has decided to take a medical leave for at least 4 weeks. So really it's just myself and the office coordinator. I've been working for 3 weeks now and I really don't know what I'm doing. Every time a patient calls asking a question, I have to tell them I'll call them back after I talk to the doctor to get the right answer, and that's if I can get ahold of her. There are no protocols for me to fall back on. I never did a clinical rotation specifically in women's health during nursing school. I feel like I am really out of my element and I just wish there was some organized system that I could utilize. That's what this place is lacking, organization. So I guess my question is, do I stay, hoping to gain nursing experience working in a chaotic GYN office? Or do I go back to my old job, which I've kept as an on-call basis, but it isn't working as a nurse. I would appreciate any advice from nurses who have been in a similar situation.
- Oct 27, '11 by obprofI have a different opinion than the others. I think it's better to leave while you're still in the orientation phase if your gut is telling you it isn't right. I recently did just this because of safety issues and lack of respect from the doctors. I had been at this hospital for only 6 wks. I had another job lined up before I quit and asked a friend of mine who works at the new hospital about the situation there. I feel very relieved I did that. It's a hard decision and a difficult thing to do. Good luck in your decision!
- Oct 27, '11 by llgI made a similar transition from major university hospital to a large community hospital. It was different -- but each had its advantages and disadvantages. I think you should give it a couple of months -- time to get off orientation, see and appreciate the advantages as well as the disadvantes. Only then will you be able to make a truly informed decision.
Now, several years after that transition ... I am back at another major teaching hospital. While I value what it has to offer, sometimes I wish for the more supportive culture of that community hospital.