New grad change of heart

[Nattydawg]

I am a new RN who returned to school at age 42, and I landed a "new grad nurse residency" in my local hospital's ED. I did my capstone on that very unit and was bitten by the seductive nature of the fast pace and adrenaline pumping environment. I originally decided to go to nursing school to pursue Hospice nursing and have been a Hospice volunteer. I've cared for friends and loved ones as they faced the end of their lives, but out of school was informed i would need 1 year of experience or more before I could go to work for Hospice. It was a decent start but the reality is there really isn't any structure to the new grad nurse residency and my training has been kind of all over the place. I've been placed in some unsafe situations and there is no genuine receptivity on the part of management for me to express my concerns. I've straddled the line between wanting to be more assertive in expressing my concerns and sticking it out because I know nursing is stressful and I chalked what I've been going through up to being green and having to pay my dues. But, the allure of the seduction has faded quickly and I find I'm being 'called' back to the Hospice track. I have been given an opportunity to pursue that original goal much sooner than I expected and without the whole year of experience I was once told I needed. It appears that being older and having life experience, having been a volunteer, and having worked with people prior to my return to school can count for a LOT. My dilemma is how do I resign from this program? I will be interviewing soon for the hospice position and most definitely want to pursue ( as originally intended) a career in palliative and end of life care. I have been in this NGNR for just over three months and there are three months remaining. I feel unethical about continuing to allow the company to train and pay me when I know I don't want to work in the ED. As new grads we can easily run toward the shiny new job and have regrets about it later. As a mature person I had thought I was able to avoid that and here I am finding myself disheartened, disappointed, and eager to get the heck outta the ED. I ran for the shiny thing because I thought I had to.

I do realize it's foolish to jump ship without a rescue boat and I should stay until I have another offer. While that will be tough, I can do it. But when I do resign, do I bother with two weeks notice? They're not going to lose any coverage in the unit because I am not yet independent on the unit and my preceptor and I work the same bed assignments that she would have with or without a NGNR. Do I tell them now and put an end to their investment in me? do I stay until an offer is made and then what? I guess I don't see much point in giving two weeks notice. That's two weeks they would be training me for a job I am leaving. Let me just say that while the hospice opportunity isn't etched in stone, there's a HIGH probability I will be offered a job with them. I can't really go into why but I need any responses to recognize that the rescue boat is close and getting closer. When I first started in the ED I was so sure that I wanted to be there. My capstone was fun and exciting. It was VERY different starting to train to actually work there. I struggle with the jaded attitudes and what appears to be a total lack of empathy or compassion I see my coworkers exhibiting. There is very little overt kindness and there is zero time to hold a hand or hold space for a family member who is upset. Those are things I need. The nursing tasks are not the hard part for me. Yeah, I can start ivs and draw blood and dress wounds and ulcers and bathe a patient and attend to ostomies and do compressions and administer medicationsetc etc etc. Blood, poo, urine, vomit, no big deal. But I need that human connection and I need to be able to hold that hand or let that person cry on my shoulder. I need to express my compassion and that's what I love about Hospice. I've watched and worked with their nurses while volunteering and it inspired me to go to nursing school. It's all coming back around to the beginning.

Knowkng all of this. Should I stay or should I go and if I go, how does one get out from under a new grad. nurse residency with grace?

Thanks for your feedback folks!

[JKL33]

My capstone was fun and exciting. It was VERY different starting to train to actually work there. I struggle with the jaded attitudes and what appears to be a total lack of empathy or compassion I see my coworkers exhibiting. There is very little overt kindness and there is zero time to hold a hand or hold space for a family member who is upset. Those are things I need. The nursing tasks are not the hard part for me. Yeah, I can start ivs and draw blood and dress wounds and ulcers and bathe a patient and attend to ostomies and do compressions and administer medicationsetc etc etc. Blood, poo, urine, vomit, no big deal. But I need that human connection and I need to be able to hold that hand or let that person cry on my shoulder. I need to express my compassion and that's what I love about Hospice.

I think a lot of newer nurses struggle in meshing important nursing principles we learned in school with real life.

You have some life experience that is guiding you and giving a sense of direction about what you want from your nursing career, but just the same I believe it might be useful to take a few steps back. I say that because I don't think this crisis of personal ethics/expectations is rare at all. As soon as one gets past the initial couple of weeks' orientation, the conflicts are readily apparent. I've thought many times that more school time should be devoted to exploring this phenomenon and preparing for it, because it is so frequent in my observation. I feel as if that's kind of the stage you are in right now.

All of this is important because I can almost assure you that Hospice will include similar concepts of conflict. When you are the Hospice RN responsible for patients there is *much* more to do than "deliver the human touch," so-to-speak. You will find that there are expectations and requirements and red tape that evoke different but similar dissatisfactions to what you experience in acute care.

The ED has plenty of lessons to learn. If you aren't recognizing examples where people deliver compassion in the ED, then it's possibly a unit culture issue OR just that you don't have good examples to emulate or haven't had the opportunity to witness it. I find a lot of instances where an extra moment or two, a genuine smile, a hand on a shoulder (if appropriate) are possible...these opportunities are everywhere in the ED. Advocating for one's patient is another way compassion is shown and put to good use. Pursuing excellence in one's skill and developing a solid breadth of knowledge are other great ways to care for (and about) the ED patients. I am confident that there are innumerable experiences from ED nurses here that we could share about the art of caring. I have a number of memorable experiences myself. ED nurses get good at making connections on a short timeline. But...

I suspect that finding time and developing the personal style of caring in the ED is something that usually comes after mastery of skills and very solid knowledge of the "nuts and bolts" of ED medical/nursing care. It's very difficult for new grads to focus on interpersonal things when there is so much information to digest and the pace moves so quickly. My observation has been that this "art" evolves over time - and that it comes after a good deal of wisdom has been gained and self-assurance/confidence has developed. You kind of come to a point where you realize (and know, logically) that the hangnail can wait (unnamed patient survey company be damned), so that you can attend to the spiritual or emotional care of someone else.

Anyway, all that to say I just wanted to provide some food for thought. The ED provides life experience like no other. It is also good, solid nursing experience upon which to build your future.

Mull it over. :)

PS - If you decide to leave, you always give adequate a proper notice of intent to leave. If they wish to end your obligations at that point, they will (and I suspect they will, for the reasons you stated).