I dont think acute care floor nursing is right for me. What is?

[klaRN01]

I've been an RN for a little over 2 years on a cardiac imcu/med surg unit. Previously I worked LTC as an LPN for about a year while pursuing my ASN. I am now in school for my BSN. Before even earning my LPN, I knew I didn't want to work in LTC and I was right. I hated it. So, after I got my LPN license, I rushed right back to school to earn my RN.

Once I obtained my RN license, I thought I would finally be content working in acute care. I started as a new grad on the cardiac imcu/med surg unit and (as is for all new grads), it was tough. But about 6 months in, I started feeling more comfortable. After about a year I was pretty comfortable and confident in my abilities. The unit I work on has very knowledgable and supportive veteran nurses so I am lucky in that aspect.

Now a little over 2 years in I am close to miserable, but not just at work. It carries over to my outside life as well. I don't expect to love my job (that's why it called a job), but should I really dislike it this much? I've become increasingly stressed, impatient, fatigued, have more health complaints, no energy, and etc... I cant believe I put the time and money into a earning a degree to be this unhappy with my career.

Some of my issues are: staffing ratios (job was pitched as 4:1 day/evening ratio but it's usually 5:1, and at times lately its been 6:1); rotating shifts (Hired as day/nights but as the older RNs left, I moved up to mostly to days. But now that staff is leaving or new hires decide they don't like nights, I get thrown back to them. I hate nights); time taken away from my child & home life; being scheduled over my FTE (im a 0.8 get, but frequently am scheduled 0.9 or 1); and heavy workloads; constantly added inconvenient extra duties.

As far as scheduling is concerned, I have never been a person who can tolerate a 5 day work week. I like to work as few days as possible. Currently I am a 0.8 (32 hrs/wk). I like to do 12 hour shifts so I can work 3 versus 4 days a week. When I first started working, I was told people with seniority got the 12 hr shifts first which is understandable. But since then, multiple senior people have left and the majority of the nurses have less seniority than me and I still don't have the schedule consistency that I would like.

Maybe the inconsistency is just something that goes along with acute care since it's 365 days 24 hours. Since I like a more structured schedule, maybe the hospital setting isn't for me. As far as extra duties, it's not just about patient care anymore. A licensed nurse on my floor may have to be a secretary, janitor, or even doctors (take on responsibilities that aren't a nurse's job). Since reimbursement is changing, there is increased focus on scripted customer service. You cant just go in and be genuinely nice to a patient, but you have to ask key questions and say key phrases so the hospital gets + survey responses.

Currently, I'm pursuing my BSN because I would like to be more marketable and have more options. Even though school is adding to my workload and stress, I feel I have to stick with it. I am currently trying to decide if after completeing my BSN, I should pursue an advanced nursing degree or try to obtain a minor or certificate in another field or flat out pursue another degree. I like nursing theory and the educational aspect of it, but I really want a lot less to do with the hands on aspect.

Job attributes I am looking for is: decreased manual and floor work, but still enough contact to maintain and enhance my nursing knowledge; and no offshifts and rare to no weekend or holiday obligations. Overall I would be content with a job in the healthcare industry, but a desk type job. I even think I would be OK with being an NP.

In nursing school they told us that there are so many career possibilities/paths for nurses. I'm just trying to find an educational path that will get me to a job that is more tolerable for me.

Any insights or suggestions as far as educational paths and career options are much appreciated. Are any of you nurses who returned to school to pursue an entirely different major and if so, what did you major in and what career did it lead to?

[KelRN215, BSN, RN]

There are MANY options. Home health, outpatient clinics, day surgery, endoscopy, school nursing.

[sauconyrunner]

Many options, and also there are many many units out there that don't have some of the crazy things you complain about. I do think that a desk job is kind of hard to find even though there are a lot of Nursing Jobs that have different hours/shifts etc...they are usually involving some kind of patient care.

[sapphire18]

What about nursing education? It seems like it could be a good fit for you especially since you say you like the nursing theory aspect. Of course, you would need an advanced degree. However, this is the most short-handed area of nursing these days. This means salaries will also be going up.

[Guest296136]

There is a lot more going on than just choosing which path to take. First you shouldn't be jerked back and fourth from day to night, 2nd a 4:1 ratio is almost unheard off unless you live in California. I have worked both shifts and am currently working nights because I took a clinical supervisor position and didn't have a choice. I am almost finished with my BSN and plan on going into more administrative roles and wil continue on for my MSN. Don't let the stress of one unit determine if this is right for you, try tranferring to another unit or outpatient work, such as infusion therapy etc. Bedside is rewarding but it has the highest stress level and it will get worse with the new medicare laws coming down the road.

Try something different you may be surprised what you will find.

[klaRN01]

Thank you for your response. I've been thinking about transferring to another unit for a few months now im just one of those people who are cautious when it comes to change. But I definitely have to try to find an area of nursing that is a better fit for me. Your insights are appreciated.

[klaRN01]

@ sapphire18,

While in nursing school I became interested in nursing education and wanted to eventually pursue it. But I feel I would need to get more experience first as I have only been a RN for 2 years (i was an lpn in LTC for 1 year while getting my RN). Currently I am working on my BSN and i do plan on pursuing an advanced degree. Im just in need of a more satisfying position while im working toward my degrees. Thank you for your response.

[RNHURT]

Hi klaRN01 i can identify with some of your feelings. its not something new these days except for hourly rate everything changes once you start job on hospital floors. You have to be strong and make use of the degree you got through so much hard work. Its survival of the fittest. Never leave one job until u hv another as job market is very bad. Yes, you can teach with advanced degree as many colleges require only 2 yrs floor exp but you should be quite knowledgeable in yr stuff and skills to be a good instructor. I can feel what you are going through but this phase will pass soon, concentrate on advanced degree and aim for different area of pt care.

[Ruby Vee, BSN]

the more advanced your education, the more you specialize. i'd encourage you to figure out what it is you want to do before you spend a lot of time and money on advanced degrees that may not prepare you for something you'd enjoy doing. if med-surg (or maybe just your current unit) isn't doing it for you, try a transfer. if you like floor nursing, try oncology or renal. maybe icu or or is your niche. i wouldn't encourage anyone to take on more debt until they've defined their goals a bit more thoroughly than you seem to have.

[emilysmom,RN]

I know exactly what you mean. I have been a home health nurse for 2 years and I am not happy. I see pts almost every weekend with no day off during the week. I am getting better at saying no but feel very guilty when I do. I am up nights worried about my non compliant pts. I use to come home and type out my notes, no longer doing that. After 2yrs doing this I should feel more comfortable and be happy. I hate to keep changing jobs but need to be happy. Recently been offered a job that pays alot less but it is 10min from home and no weekends and no holidays and I know the staff and most residents the the ALF. I also want to go for my BSN but can not do it with my current job. I also have 2 school aged children. I am 48 yrs old and need to slow down with less stress.

[mindlor]

Oy you have my dearm job!!!! 4:1? Sometimes 5:1!!!!

Try 6:1, often 7:1, all strict contact iso, all incontinent of B&B. All on vents or trachs. All with multiple comorbidities. All with demanding families. All with a list as long as your leg of meds that must be crushed and given via tube q4. Sprinkle in three or 4 discharges and admits per day.

My advice is take a moment and thank god for the job you have. I assure you the grass is not greener :)

That said, you have your magic experience. You should be able to pick and choose where you work now :)

Follow your heart....

ps, sounds to me like you work for the VA...yes?

[klaRN01]

@ Mindlor

Sounds like you have it tough, but i guarantee you my job is FAR from a dream job. No i dont work for the VA. I am thankful to have a job but BS is still BS. As far as ratios 4:1 5:1 in my opinion it is not good when you have cardiovascular surgery patients (i.e. open hearts), cardiac drips, when neuro is full new and evolving CVAs "stable" enough to not need neuro-icu, monitored transports for diagnostics, frequent vitals with drip titrations and returning surgicals, insulin drips with q2hr one touches and etc. Im no stranger to patients with a tube from every orifice and demanding families. On my unit the discharges, admits, and transfers are constant as well. I guess its just less than idea conditions everywhere. Until there are stricter laws r/t nursing staffing and conditions we're going to continue to get screwed i guess.