New Nurse Having Bad Experience with Nursing - How can I get on track to ED Nursing?
Hi Nurse Beth, I have been a nurse for 8 months and haven’t experienced the best of nursing. Prior to being a nurse I had been a phlebotomist for 13 years, six of which I worked at one of the best hospitals in town.
When I finished nursing school my belief was I was going to be easily hired within my organization into the new grad program, unfortunately that was not the case. When I questioned my seniority with the other candidates that were not already employed I got told that I would had to wait another year to reapply for the new grad program because they didn’t have the time to go through all the applicants to see who was already hired within.
I decided to apply with another organization in town in which I got offered a position with their new-grad med-surg program. I signed a contract for 1 year in which they promised to guide me through my 1st year as a nurse and provided me with all the support I would need. Unfortunately the work environment was terrible, short staffed, harassing physicians, high patient acuity, and lack of support from the program when told of issues with the unit and that fact that it was affecting me emotionally and physically. At the end of one of my shifts in April I resigned and I had never quit a job without giving at least two weeks’ notice.
I then got employed with a long-term facility for which I thought was going to be a floor nurse and to my surprise they hired me to be charge nurse. The facility has been open for 8 months and they have had 7 charge nurses hired and resigned because they don’t provide proper training and also the few RN’s they do have are not too happy I’m not of the same ethnic group as them and spend all day speaking in their native language. Most days I come in and feel like I have no clue what I’m doing, luckily most of the LPN’s I’m “supervising” have years of experience.
I started for the third time looking for employment again and decided to try staffing agency while I still worked the long term facility. The staffing agency offered to give me assignments at the hospital I had work for as phlebotomist and in other facilities that had med-surg floors.
Unfortunately once I finished the hiring process and all their test and paperwork, I got offered assignment in another long-term care facility because they stated that orientation for the hospital wouldn’t been done till September and the other hospitals require more experience from nurses.
Now I’m stuck with two employments I don’t like and have no clue how I will get back into acute care. When I worked as a lab tech I loved my job when I worked trauma E.R. and my heart was set in me becoming an E.R. nursing. How do I get back on track to acute care and potentially prepare for emergency nursing with my current background?
Dear Having a Bad Experience,
You are right, you have not had a good experience thus far.
In 8 months of being an RN you have worked in acute care which you quit without notice after signing a 1 year contract, and then in long term care, which wasn’t what you expected.
Reading your letter, you had expectations of being hired at hospital A because you were employed there as a phlebotomist. Is there a reason you believed you would automatically be hired as an RN, meaning did you talk to any nursing managers, or did anyone lead you on?
Being hired by Hospital B was good fortune because you were given an opportunity as a new grad to work in acute care. What was your career plan when you resigned without notice due to frustration? Unfortunately nursing can be a small community and let’s hope this event does not trail you from facility to facility.
My question about working registry is how will it be tolerable for you working in acute care as a registry nurse if it was not tolerable working as a staff nurse? Plus you really need 1 year’s experience minimum to work as a registry nurse.
Your strategy now is damage control. That will take some reflection and insight into yourself to avoid future rocky employment situations. Were your expectations unrealistic? Do you consider yourself to be impulsive to your detriment? What part of this unhappy 8 months of employment is your responsibility?
You may get lucky and land the job you want, in ED, and that would be great, especially if they give you a good orientation. Be careful what you wish for, because ED is stressful and demanding. Talk to some ED nurses so you know what you can expect.
You may have to compromise and work in another setting for a time, such as long term care. Look for a job that is not a Charge Nurse position so you can get the experience you need.
Best of luck to you,
Nurse BethLast edit by Joe V on Oct 20, '17
Jul 16, '16Welcome to the "new" world of nursing. Chronic understaffing, completely inadequate training, dangerous patient "care". It difficult for an experienced nurse, and for new nurses it is damn near impossible. Good luck.Jul 16, '16I get how you can feel very frustrated in a new situation, and not feel that you have been adequately trained to handle what is given to you. It happens to all of us. I do agree with the above comment, that you may have had certain pre conceived notions about what your nursing career was going to be, and it is not what you hoped for. There are a lot of good nursing jobs out there. But there are even more bad nursing jobs out there, unfortunately. And especially when you are a new nurse, we are often subjected to units that are understaffed, and often miss managed. It may take you 2-3 years to find where you want to work and stay in nursing. But I would highly suggest that you get a job on a med surg unit, and stay there at least a year or more. As a new nurse, it may hurt you to have spotty employment, because a responsible mgr will be reluctant to hire someone they know will quit when times get rough. So you are really going to have to work on that account to prove you can handle tough situations and stick with it. And always go to the supervisor or mgr when you feel that you are being put in unsafe conditions. They may not be aware that a new grad is being given these assignments without better training. The reason I suggest med-surg is because there is an abundance of jobs available. It is a good, basic ground for the rest of your career. I think it would also help you if you start soon in ER to be able to walk in the door and already know your basics. ER is very fast paced and stressful. You may not have time to look up drugs and medical conditions when you are new to nursing in general. The only other thought might be if you are willing to move from your area. There may be other programs across the country who may be willing to take a fairly new grad into a program to train new ER nurses. You may be obligated to stay and work for them for a certain period of time, and you can always return home. Just a thought. Best of luck to you in finding a job that you like. Nursing can be a rewarding and stable career to have, but most of us have to 'pay our dues' when we start so we can get to where we want to be.Jul 17, '16As an ER nurse myself, you have ALOT to learn to be a great ER nurse. My suggestion to you would be: Get a job working ICU for at least a year - this will help you greatly in the ER for several reasons. First, the most critical pts are in ICU, so when you get a pt that is critical in the er, you will be able to recognize that the pt is critical. You will also become familiar with the treatments for these critical issues, you will gain experience in reading your heart rhythms and knowing them the moment you see them, and you will become familiar with codes/ACLS one crisis at a time before you get to the ER and have several crisis going on at the same time. ICU will give you ALOT of much needed clinical experience AND help train you for remaining calm in a crisis in the ER. Before ER, ICU is some of the best experience you can get. Make sure you are ACLS certified and that you know the algorithms well. Also, there is a TNCC course that you can take - Trauma Nursing Core Curriculum. This will teach you the systematic approach to treating a pt. Such as ABC's, etc. Airway, breathing, circulation, c-spine, etc. The order of concern for all pts., especially trauma pts. All of this will help prepare you for work in the ER. I hope this was helpful! Best of luck to you!Jul 17, '16You have some great advice already...so I will only say find a job in the hospital somewhere. Smaller Hospital would be a good start.....If you can not get into ICU(most want experience) do Med- Surg. It has a vast variety and a good teaching area....Working in a Nursing Home as a new grad will not get you what you need. One reason NH use seasoned Nurses is they have to be able to see something going wrong and know where it is going. Definitely not a good environment for a new Nurse to learn. I will caution you to learn how to deal with your stress as you will have it everywhere. Remember you are one person so to me priority is the first to do. multitasking will come as time goes by. Something we all had to learn to do...Jul 17, '16Just one thought--the patient's you had on your Med-Surg floor had to come from somewhere, and likely the majority of them were ER admits. If you thought the acuity of the med-surg patient's was too high, how would you handle having 4 (or more, depending on where you live) patient's at a time, with no clue what is going on with them. Once the basic labs and tests have been done and you have a better picture of who is stable, who isn't, who is going to go home and who is just seeking pain medication or attention, you then have to discharge patients, admit patients, and deal with new patient's at the same time if you end up with one empty bed.
Not to mention there's a critical patient coming in with pulse ox in the 60s on bipap that your neighbor is going to get but it's going to take at least three nurses to stabilize your patient, and oh wait, the grandmother that doesn't look "sick" and has normal vitals is suddenly nose diving and her stomach is hard and rigid when it wasn't early, and her HgB dropped 2 points in the three hours she's been there, plus her T-waves look a little peaked and you want to double check her potassium, and wait, it came back at 5.9...and that new patient might have dislocated their shoulder which means it's going to be a conscious sedation with the doc and RT to reduce the shoulder...Jul 17, '16OP: six years at the hospital as a phlebotomist and they said they didn't have time to go through the applicants...come back next year." Why this is called the old fashion bum's rush.
I'm not saying you're a bum but why the brush-off on their part. After all you should have been a known quantity to them having worked there and worthy of some professional consideration despite being a fairly new graduate.
Take a deep breath, leave behind the negative karma you have experienced and find a workplace that will value your potential and drive. It just takes time and the crap you take at the start of a nursing career is just called trial by fire and most often necessary to temper you to become a teacher and roll model to those who will be lucky enough to follow in your hard-knocks footsteps.Last edit by Buyer beware on Jul 17, '16 : Reason: wordJul 17, '16Quote from NurseDianeThis "new world of nursing" has been going on since Hitler was a corporal, but I thank you for bringing it up again as nobody was listening even back then in the olden days.Welcome to the "new" world of nursing. Chronic understaffing, completely inadequate training, dangerous patient "care". It difficult for an experienced nurse, and for new nurses it is damn near impossible. Good luck.Jul 18, '16Gemmi999, How right you are!!! I don't know about your hospital but, in ours the pt. Had to be totally taken care of before they went to any floor - IV, foley, first dose of abx, etc. What you wrote is exactly why I recommended ICU for her. This will also give her experience with most things like central lines, art lines, chest tubes, vents, etc. that you don't usually see alot of on the floor. If anybody wants experience, work in an area where things are likely to happen.Jul 20, '16We need to be supportive of all new Nurses. I don't believe we give enough information to new grads. from Nursing Schools. They do need to be prepared for the issue's they may face when hired and on the floor's for the 1st time, especially.
Those of us who have been well seasoned nurses know the nursing arena has changed in many ways, in this day and age.
Compassionate care should still be primary out there in the medical field. Somewhere there needs to be a bridging of the gaps between administration, educational instructional schools of nursing, corporate run and owned healthcare institutions, and the real world of healthcare today.
Nurse to Patient Ratio's should be everyone's concern, as it is too costly to the lives of patients, and the health and well being of nurses, as well, to not talk about this issue.
Legislators need to be aware of the changing needs in Healthcare Today, too.
Nurses are nurses by education and choice of profession, they are their patients advocates always. Patients count and so do the Nurses who care the most for them.
Jean WeigelJul 23, '16To the OP, the experience/phenomenon you are describing is not uncommon for many newly graduated nurses and it sounds like it has taken a heavy toll on you mentally and physically. I agree with Nurse Beth when she mentioned that you need to be in "damage control" mode at this point. It sounds as though you have had a difficult time transitioning to practice because your expectations for support and training didn't match what was provided by your employers. Unfortunately, because you resigned from this position and have only 8 months of RN experience it will make you appear as a risky hire for any future employer and this is what you will have to overcome (but it is not impossible).
Like you I worked for a large teaching facility for many years prior to graduating nursing school and I was told by my department head that I was very likely to be hired into the Pediatric ED as a new graduate nurse because of my great work ethic and continued commitment to the department (I was employed as a per-diem CNA at least 24 hours/week during school and 40+ hours during vacations/summer breaks). Needless to say, when I graduated nursing school and applied for the new graduate position in the department and didn't get it. It ended up being awarded to the daughter of one of the nurses in the department and I had to find a job elsewhere. The point of this is that things happen for a reason and can't count on a "sure thing" until it has happened.
OP I would suggest that if you really want to be an ED nurse you will need to obtain certifications in ACLS and PALS and build up some time at your current position before jumping ship. You said that you do LTC but I'm not sure exactly how sick some of your residents are or what kind of medical equipment they have. If you can gain some experience with IV access, PICC/Port accessing/maintenance, wound treatments, and managing trachs. or vents. that would be marketable. I would stick it out for about a year so that you can have some steady experience on your resume. Keep in mind when you start to look for ED positions you will probably have to look for local facilities and for off shifts (evenings/nights) because you lack experience and you are looking for someone to give you a shot.
Keep in mind when you start to look for ED positions you will probably have to look for local facilities and for off shifts (evenings/nights) because you lack experience and you are looking for someone to give you a shot. Without previous ED experience, you are unlikely to be hired for a travel/contract position in that specialty and you want to be hired into a program/facility where you can be supported and properly trained. Best of luck!
!ChrisLast edit by cjcsoon2bnp on Jul 23, '16Jul 25, '16Thank you Nurse Beth and everyone else who has commented on my question. I'm glad for the feedback! I went and had a talk with my nursing school director and she wasn't much help but said she knew of situations in which hospitals (that I had applied to) had hired new grads to minimal experience in periods of insufficient staffing. I will continue to try to apply at hospitals and hopefully when the timing is right I can return to acute care and build from there. Mean while I'm trying to learn much as possible from being charge nurse and I'm also glad to say that I will be returning back to school in a few weeks.Aug 3, '16For those who allude to LTC not being a great wealth of experience-I disagree.
I worked in LTC as a Charge nurse; to be able to have the ability to perform assessments, manage complex pts, interpersonal relationships and peers, identify without all the machines if a patient needs to be sent out successfully and work indisciplinary successfully ALL prepared me when I started working in a Level 1 Trauma Pediatric ED.
People discount LTC as major experience; however, being able to assess, educate, and interact with the basic to below basic equipment and using ones nursing process gives one the instinct to question the monitors when the pt doesn't look right, and give a spidey nurse sense and be on anticipation mode in the ED.
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