Probably getting fired from ICU...how can I move into full-time LTAC from prn status?

Specialties LTAC

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Hi, there. I found out today that I may get "let go" from my ICU job, and I'm wondering how to best position myself to ask to go full-time at my prn LTAC job.

Background: After 4 years of med-surg nursing, I got into an ICU residency (for RN's with no ICU experience). During 12-week orientation, I didn't do too well on the unit with critical thinking, and administration was helpful enough to extend my time under my preceptor and give me feedback. Now, it's 5 months later, and, try as I might, I'm still not performing well. They say I don't quite "get it" and my critical thinking suffers. They're still giving me the stable patients (basically, LTAC patients, or patients about to transition to the floor). Today, I learned that if I don't improve within the next 6 weeks (by September), I'll be let go, with 2 to 4 weeks notice.

I'm going to keep trying to improve (particularly because I have to pay up about $8-10,000 for some form of breach of two-year contract if I'm fired), but I need a Plan B.

I have a prn job in the ICU floor of an LTAC (just got off orientation for this LTAC job - my first off-orientation night is in a couple of days). These patients are trachs, vents, wound care, sedative drips, some hemodynamic drips, central lines - and I've felt more comfortable working there than in ICU; this work seems more "do-able" to me. My question is, how do I best present myself to move from PRN to full-time, with my current situation? And when?

I just checked the LTAC website today, and they are hiring for full-time in the ICU portion of the facility, the same floor that I currently work at prn. When I go to the supervisor and mention that I want to move to full-time, is there a good way to avoid stating that it's because I'm being fired for ICU incompetence? Or, if it comes out that I've been fired, how do I best present that information?

**Important: I'm not trying to put any patients at risk, and I don't really think that I will, in the LTAC. I have felt more comfortable there than in my ICU job. I never really had any "red-flag" incidents in the ICU where I put a patient at risk (except for removing restraints too soon from a fall-risk patient when he appeared more oriented) - the thing is, I'm just not really functioning as a full-fledged ICU nurse (not seeing the big picture, lack of confidence, not focusing on "if this happens, what then / what does this mean / what should I be looking out for" - which wasn't really so much of an issue for me when I was working medical-surgical). Obviously, if I find that I'm still not cutting it in the LTAC ICU and that my judgment is putting patients at risk, I'll look for another type of nursing job.**

Fortunately, I live right within a couple of blocks from my LTAC job - literally walking distance -- so I'm thinking that I could present the ultra-short commute as a reason that I want to make the LTAC job full-time?

And WHEN should I approach my LTAC job manager? Maybe just make some casual comment about it now (about how friendly the people are - which they really are - and how convenient a commute it is), since I still have 6 weeks? I don't want to wait too long and, if I wind up fired, maybe the full-time LTAC job is gone.

I feel a little weird about the whole thing, because I'm normally a very honest person, and I don't really like to feel sneaky...but the reasons that I'd like to work at the LTAC are genuine (I just want to leave out the whole getting-fired thing). And obviously I gotta pay my bills and avoid becoming homeless. :( If I get fired from ICU, I'm thinking that transitioning from PRN to full-time in my LTAC job will be a lot easier than starting from scratch, going into job interviews and having to explain why I "left" ICU less than a year after starting, or filling in "yes" to the "Have you ever been fired from a job?" question, or trying to figure out the "Can we contact your former employer?" question.

Appreciate your advice. Take care.

Why not just inquire about a. F t position at the LTACH? People leave jobs all the time. Its easy enough to say you aren't happy and considering leaving.

I hope so. The LTACH job would be easier on me, yes. I worked there last night, and was thinking about how much my peace-of-mind is worth.

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