Dear Nurse Beth,
I graduated from nursing school in December of 2013 with honors (magna cum laude, 3.91 GPA, Sigma Theta Tau - the whole works). Unfortunately, like many new grads, I had a hard time finding a job. Finally, 9 months after graduation, I landed a new grad RN residency; however, I always dreamt of being an ICU nurse and was now working in a behavioral health hospital 150 miles away from my home. Either way, I was happy and relieved to have a job vs no job. 9 months into the residency, I began taking RN refresher courses at the local JC in order to prepare transitioning into "acute care." The professor of the program really liked me and offered to help me get into acute care.
Weeks later I found myself with an offer for a med/tele floor. I was beyond excited. Everything that I had worked so hard for finally paid off.
Little did I know, this med/tele floor from nursing would be the textbook version of "nurses eat their young." I was told I would be given 2 weeks (6 12 hour shifts) of orientation. I told them I was still a new grad and needed more training, they refused. The RN orienting me told me she wanted me to "feel the pressure of nursing" and gave me 5 tele patients and 3 med surg patients - I live in the state of California where the ratio for tele is 1:4 so I knew this was wrong but was so overwhelmed on the floor that I didn't realize it until I got home that morning. The nurses on the unit would talk about "black people," "gay people," and "Mexicans" saying how they were beneath them etc. Mind you, I spent my childhood in a lower middle-class neighborhood and don't discriminate against ANYONE so this situation was very uncomfortable for me. They also went on to tell me about how awful the other nurses were, and when I would go talk to these "other" nurses, they would tell me how awful my preceptor and her friends were! I was caught in the middle of this historical feud.
I finally mustered up the courage to email the manager. He didn't say anything about the ratio situation - he remained silent. About the politics, he said no matter where you go there will always be politics - I reminded him that when politics interfere with patient safety and care, it is a BIG problem. He asked me for an example, I told him that the nurses who didn't like my preceptor, refused to help ME turn or reposition patients - something that simple. He basically said I should suck it up and reposition them myself.
I realized that the environment there was not conducive for a new grad and began putting the red flags together - I now knew why the nurse educator had said: "they haven't had a new grad RN there for over 10 years...."
Nevertheless, I resigned. I informed the professor who got me the interview - only to find out that she had resigned from the hospital 2 days before me due to "out of control politics."
I was extremely disappointed. I felt depressed and broken. Fortunately, my husband continued to support me tirelessly. Within a couple of days, I found a job doing nursing case management. I enjoyed it - until I realized that my supervisor (not a nurse) didn't know the difference between an RN and MD. I showed her our scope of practice, I attempted to educate her. She insisted that I see patients and diagnose them, she insisted that I sign off on other nurses assessments - nurses who no longer worked there. Things became really shady very quickly. I felt my license was in danger and wanted to leave. I took PTO in order to avoid resigning.
Nurse Beth, I am no longer optimistic about nursing. I had dreams of becoming an ICU nurse but now I am questioning nursing - why did I become a nurse? Where do I go from here? Is it me? Is something wrong with me?
Devastated and depressed - kind of a new grad.
Dear Devastated and Depressed,
This isn't about whether or not you should have become a nurse, it's about the employment you've had so far. And also about recognizing red flags that are indicators of bad employers. Don't give up but do proceed with caution.
Here is the pre-hire red flag that should have served as a Keep Away Warning:
Telling you orientation would be 2 weeks long. I know you were happy to get into acute care, and the opportunity may have blinded you, but what this says is that patient safety is not a priority. They went on to violate California state ratios, and tolerate lateral violence. The attitudes towards other ethnicities and cultures in the workplace that you describe are honestly enough for a hospital to put their accreditation at risk, or be sanctioned by the Department of Health if formal complaints were made.
When you run into problems of this magnitude on the job, it is better to talk to your manager in person rather than email. Not to say it would have made a difference in your case, as he has no intention of making any changes, but for future consideration. (Also it's not wise to "remind" your boss that politics is a patient safety problem).
You were wise to leave this facility. But I'm concerned about the next employer who hired you to be a case manager, because case management generally, and for good reason, requires a couple years of bedside nursing experience. I think you answered my question of "Why would they hire a non-experienced nurse to be a case manager?" when you went on to describe your supervisor.
It makes sense in an organization where the supervisor is uninformed of the correct procedure and nursing scope of practice. A supervisor who is not a nurse is not even qualified to evaluate you on your nursing performance when performance appraisal time rolls around.
It's understandable you are discouraged at this point because you haven't yet experienced anything near a normal, well-run facility yet.
With your high GPA, your self-motivation to learn and improve yourself, and your determination to improve yourself, you have all the makings of a good employee. Again, don't give up all you've worked for.
At your next interview, be prepared to ask questions that will help reveal some of these problems ahead of time.
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What kind of orientation will I be provided?
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Who will I be reporting to (my direct supervisor)?
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What is the nurse: patient ratio on your unit?
Listen carefully to avoid selective hearing, and cultivate your intuition. Good luck to you, friend.
Best wishes,
Nurse Beth
