Currently, I am working on one of my hospital's sought after ICUs, where I have worked for the last 8 years. Except for a six-month stint on a progressive care unit, this is the only nursing job I have had. Throughout the last 8 years, I have had the pleasure to precept many new orientees. While some of them are still working on our unit, and we have even become good friends, there are others that have had to, unfortunately, move on, despite the best efforts of all.
Three months ago, we had to let one of our orientees go. Now, this orientee had a lot of positive attributes. She was always ready for work, showed up every for work, constantly tried new ways of improving herself, always had a good attitude, and took our constant criticism actually quite well, although she was a sensitive and emotional person. However, her sensitivity may have been one of the reasons why she was not successful, as she found it hard to bounce back after tough days.
Thing is, despite her intelligence, she just was not grasping a lot of the critical thinking elements, even though things had been explained to her quite well. It was obvious she was not very technically inclined, as it took her awhile to even grasp placing a blood pressure cuff appropriately. With that, she struggled with other technical skills (which may have been why her critical thinking suffered, she was too focused on learning basic nursing skills).
I recently heard today that she has been working at a SNF. Apparently, she has progressed quite well. The patients love working with her, she is one of their favorites (whereas, patients on our unit, when they were able to, expressed grave concern). Now that I think about it, her personality is more suited to that work setting and with that population. The patients are not as critical, but they do require a lot of patience and compassion, which she does have. They generally do not require immediate life-or-death interventions which she struggled with. They also probably appreciate that she does not have the abrupt personality some of my coworkers have.
What have been your experiences? Have you noticed certain people are simply more suited to different areas more than others?
Yes, I worked with a guy who was a terrible ICU nurse, the kind of nurse nobody wants to follow, but he became one heck of a great flight nurse. He found his niche in a big way.
I think it all depends on the situation. Some people are quick learners, adrenaline junkies, or somewhat experienced; for those people, the sky is the limit. Then there are the others.
Some areas (like ICU and the ED) are places that those “other” nurses should just not be starting out on. “New-to-everything nurses” (i.e. never been in health care or “other” nurses) should really be going through med-surg (or something similar) first – if only to solidify their skill-set. I say this for the simple fact that I WAS one of those terrible orientees. Yes me. I was the nurse who no one thought would make it through orientation… but now – years later – I am an entirely different nurse.
Some people learn slower. Some need to experience things on their own. Some people are more paced for day shift and others for night. I don’t necessarily think that there are people who should “go elsewhere,” so much as I think that there are people who may not fit the specified mold. The mold, obviously, is harder to change than the people you try to place into it. As for those people who don’t fit it initially, sometimes they just need a bit more kneading and rolling.
Quote from ladedah1
... Some people learn slower. Some need to experience things on their own. Some people are more paced for day shift and others for night. I don’t necessarily think that there are people who should “go elsewhere,” so much as I think that there are people who may not fit the specified mold. The mold, obviously, is harder to change than the people you try to place into it. As for those people who don’t fit it initially, sometimes they just need a bit more kneading and rolling.
Like trying to squeeze square pegs into round holes!!
Personalities also need to mesh with clinical roles. Not everybody is cut out to be supervisory/management material regardless whose idea. Longevity/seniority should NOT be too much a determining factor. But this is a whole other post.
I think that people develop different coping skills as well as technical skills at their own unique pace. Sans a rigorous rubric/scoring tool that evaluates a person for the daily grind of the floor, the whole definition of “fit” is dependent upon the sole observer.
My hospital requires an interview for every single position change - be it from nights to days, part time to full time, unit to unit, or floor to management. With each opportunity, the interviewee is evaluated based upon a hiring panel as to whether or not they are a certain caliber or not.
It just doesn’t seem right for one single, solitary person to decide whether or not a person is a “fit” for that particular specialty. Something like that should require more than a few people to weigh in and give merit to the observations that are being seen.
I think personality is extremely important. Nursing is a complex job that demands swift critical thinking, a myriad of clinical skills and the right personality fit.
For example, I could think of nothing more horrible and boring than bedside nursing. It's a vital role that provides an invaluable service. But if that role was the only one available to nurses, then I would never have gone into this field of work.
Psych/behavioral health, detox and correctional nursing? I'm so down! I don't need the technical clinical skills that is needed in the ICU, but I can set limits while building rapport like no one else. I don't get bothered when patients are non-compliant, lie to me, or get aggressive. It's all part of the job. Most nurses would hate all that and likely be intimidated by the environment in corrections. But correctional nurses have the personality and right skill set to provide great clinical care to this difficult population. We keep vulnerable inmates safe while the system where we works keeps the community safe.
I can change up/improve my clinical skills to work in ICU/Med-surg. But nothing will change my personality to make that an attractive option.
I was recently working with an RN on Noc shift who had been a critical care nurse for 20+ years, but who switched to corrections due to a terrible spine injury that makes him forever unable to do bedside nursing. He is just the guy you want in a code and I learned so much from him, clinically. But the dude just couldn't talk to the inmates. He was constantly getting sucked into long non-nursing related conversations with them in the continuous observation psych area. If I worked his post the inmates would express disappointment because they could cajole goodies and attention out of him. The attention is important- if you have a guy in an isolated cell, he is more likely to falsely threaten self-harm if he knows it will get him one on one time with a sympathetic nurse. When the RN in question went on vacation, the inmates lost interest in the continuous observation unit and the unit was deserted. Suddenly no one was suicidal because they know they'd get a nurse who followed protocol and wouldn't give them goodies.
The RN asked me for coaching (I've worked with similar populations since the 1990s) and we'd run role plays/discuss scenarios during slow times, which improved his interactions a bit.
But he is just not the right personality for that place. It is definitely more than clinical skills that make a good fit.
I have noticed that certain people are more/less suited to ICU based on personality. I went out of my way to recruit a student nurse for our unit. She had done her practicum on our unit and I found her to be intelligent, hard working and eager to learn. Plus she was an older student with much life experience and I found her interesting to talk to -- I wanted to work with her. She resigned halfway through orientation because she found she "didn't ever want to have to move that fast" after a couple of shifts with a really unstable patient. I was disappointed. She went to work in Med/Surg and despite the higher ratios, is very happy there. She's still interesting to talk to and fun to do things with.
The LTC nurses who cared for my mother and my mother-in-law are, for the most part, visibly happy in their jobs. After chatting with one of them when I happened to encounter her dining alone at a restaurant close to her work, we both discovered that we loved our own jobs and would hate the other's job. I don't have the endless patience that she seems to have; she doesn't want to work with technology rather than people.
I think you're very right that some people are more suited to different areas than others. It's wonderful that there are so many opportunities in nursing -- I'm glad there are people who want to work LTC, Psych, Peds and L & D. I know I'd hate it. I love my ICU!
This is so true for psych. I've worked with very knowledgable nurses who just caused chaos when they worked and you could track restraints by their schedule. Once I had to close a nurse in the med room to keep her from making a situation worse. I may not know all the latest studies but I can help my patients and give them the respect they deserve.