Need Grad School Advice!

[PedsRN03]

Hi!

I've been a nurse in acute care pediatrics for almost 2 1/2 years. I always assumed after graduating nursing school I would work for a year or two and then go to an MSN program to become a Pediatric Nurse Practicioner. However, after 2 years in the hospital I still don't feel like I'm very confident with my physical assessment and clinical skills. Most everybodys lungs sound fine to me. I don't pick up on decreased lungs, edema, IV infiltrates..etc. I can't palpate a liver or a bladder for the life of me. Invasive procedures still freak me out. I try to avoid patients with trachs, deep suctioning, wound packing, and changing central line dressings at any cost. I have yet to successfuly do a straight cath or place a foley (on a boy or girl) after serveral attempts over several years. I don't try to avoid these situations because I am lazy. I just do not feel comfortable or that I am competent in these skills. I used to jump at the chance to do any of these things when they came up to try to improve, but I am tired of feeling like I'm making patient's suffer. I always break sterile technique no matter how hard I try not to and most of these things end up a disaster when I attempt them. I have worked in 2 hospitals and have had an awesome support system in both, I am just getting frustrated with myself. I was allowed to slip through the cracks and pass school and orientation with the excuse that these skills would be improved with time and I could ask a senior nurse if I need help..well they haven't and I am starting to feel like I am putting the patient's health and safety (not to mention my lisence) at risk at times. I feel like I have worked very hard to improve my clinical and physical assessment skills and they have improved a little (I can actually finally insert an NG tube. yay!), but I just dont' feel like I have very much natural talent for this.

On the positive side I am good at some things. At my old job I did a lot of patient/family education mostly in Diabetes care and LOVED that part of nursing. I also loved assessing the families needs and collaborating with the case manager/social worker to get them set up with their supplies. I find that my thinking is very psychosocially based in my care. (For example, I had an argument with the charge nurse the other night because I agreed at the parents' request to wait an hour for the parents to be present to replace the 3 year old's PIV. He was due for scheduled lasix..but was in no acute distress).

I'm starting to figure out now that clinical nursing is not right for me for the long term. Do you think I've given it enough time after 2 years and trying 2 different clinical areas to come to this decision?

I've come to the point where I feel like its the right time in my life to return to school. I feel like the only thing keeping me at the bedside is the nice paycheck, but I don't see myself really going anywhere with this path. My dilema is just about what kind of grad program to apply to. I do like some parts of my job. I love the kids (for the most part) and I can't imaging working for any other cause. I also have an interest in pediatric, perinatal and reproductive public health issues. I am interested in either case management, health education, or public health. I am also interested in eventually participating in research on the psychosocial impact of illness and on stress and depression among nurses. I know I can get experience in all those things through an MSN program and I feel like the natural thing to do would be to go from BSN to MSN. However it seems through my research that most MSN programs are focused on physical assessment and diagnosis and I don't really see myself doing well in an NP program (or being a good NP.) The only thing pulling me toward doing an MSN as opposed to another type of program is that people with an MSN generally make a higher salary. I have done a lot of research and I am considering applying for either a Masters of Social Work with a health care concentration or a Master's of Public Health with a concentration in either Maternal Child Health or health education or a dual degree MSW/MPH program. I know these aren't the traditional route to go from a BSN, but I feel the curriculums of these programs meet my strengths, interests, and career objectives better than an NP program. I also loved the few social welfare classes I took in college and would have taken more if it had fit into my nursing curriculum.

Thanks for reading my long drawn out dilema..does anbody have advice on what route I should take? I think I know what the right decision for me is but it is a huge decision.

P.S. I'm not really as bad of a bedside nurse as I make myself seem

[Thunderwolf, MSN, RN]

I think you have put great thought and angst into this. There is nothing wrong acknowledging your strengths and weaknesses. Many a nurse have a dual license or a dual focus. If clinical on hands nursing is not for you, exploring other avenues is perfectly OK. Maybe, education, research, social work, or counseling/psychology would fit you best. Sure, go for it.