Advice about my career

[grobertson10]

Hi all:) I couldn’t find a NICU specific section, but this post might make sense to NICU nurses more! But I accept advice from all!

So I have been a nurse for 3+ years now. I started in Adult ICU for 1.5 years- I was good at my job, excelled quickly, but did not like my job- the patients were mean and the work was hardly rewarding (I.e always sending patients to nursing homes or my patients would pass away)

I have been a NICU nurse now for 1 year and 7 months. My job is rewarding now but I am not progressing. I still feel so stupid and think maybe I should either quit or ask to only have feeder growers. This is the situation- bear with me it is a lot to explain.

I work in a level IV NICU where we get the SICKEST babies. Our assignments are heavy- double vents, admission + surgery, discharge one baby and have 2 others on bubble, 3 IV babies, so on. Our unit is chaotic- management doesn’t help. Every nurse on my floor is miserable because we are overworked, and our nurse culture is very negative. You would think me working on this floor that I would progress quickly as a nurse, right? WRONG. They don’t trust “newer nurses” so they give us low acuity assignments allll the time. So when I finally do get high acuity I am #1 panicked and #2 have to relearn everything and embarrass myself because it’s been months since I’ve done anything (ex- assist with line insertions, complicated line changes, giving blood, you name it). I forget so much that it has led to mistakes (minor mistakes thank God) but mistakes none the less. Either that or I make a mistake because our unit is too busy and hectic (like forgetting to do something or even giving my antibiotic with my lipids!! -which I did today:( )I struggle with panic attacks and high levels of anxiety/ stress over my job. I even had a miscarriage this year and I do not think it’s a coincidence that it happened on a very stressful day at work.

The days where I love my job I have feeder growers on the “feeder grower” separate unit. But again, I lose my skills and again the cycle continues.

Now that im nearing 2 years I want to give up. I want to stop trying to be an ICU nurse. I should know more than I do by now but am not progressing! I either want to find a NICU elsewhere that values teaching and is a SUPPORTIVE staff or just give in and stay a feeder grower nurse. But by the looks of it all of the units around my area are lower acuity and have MAYBE one vent, some bubbles, and mostly feeder growers. Oh and another thing- surrounding units are cancelling nurses all the time due to low census- my unit never has that problem.

What do y’all think? I am not the type of person who has to have high acuity excitement- I’m a very chill person. But I also don’t want to be a quitter and wonder “what if?”

[sirI, MSN, APRN, NP]

Topic moved to NICU forum.

[NICU Guy, BSN, RN]

You might try sitting down with management and discussing your need to be given sicker babies more frequently to keep up your skills. If that doesn't solve the issue than you have several choices: suck it up and endure the status quo or start applying to other Level IVs to find a better work environment. If you have no ties and are willing to move, you should be able to find a job fairly easy. If you are willing to move to the Midwest, we have openings frequently due to having a very large NICU (103 bed) and a continuous stream of nurses graduating with their FNP or NNP.

[llg, PhD, RN]

I agree with NICU Guy. It's time for a "sit down" meeting with your supervisor. If you want to progress in your comfort level with the sicker babies, you'll need to make an educational plan to GRADUALLY move up in acuity. It sounds like, right now, you get thrown into the deep end occasionally and are having trouble handling that. You make mistakes -- which makes them hesitate to give you sicker babies on a regular basis. It sounds like you are being given sicker babies only when they have no other choice, not when they are sufficiently staffed to give you some support.

Have that conversation and listen carefully (and with an open mind) about what your leadership team has to say. If they seem willing to work with you on a plan to increase your skill level, great. But they also might say some things you don't want to hear -- like maybe, they simply do not have the resources to give you additional training right now. If that is the outcome, then you'll need to decide whether or not you want to stay with "level 2" babies at that hospital or at another hospital .... or seek employment at maybe a "level 3" NICU that would give you a chance to advance a little in acuity on a regular basis in an environment that wasn't quite so intense as the busy level 4 unit you now work in.

[grobertson10]

Thank you for the advice! Unfortunately me, and all of the nurses I was hired on with, including the nurses who started after me, have all had the SAME discussion with our supervisors and managers. We tell them we need more consistency with high acuity. They simply don’t listen and give all the high acuity babies to the nurses who have been there 10+ years. Then, the nurses who have been here 10+ years complain because many of their coworkers are not “competent like them”. We can’t learn if they don’t give us a chance! And no, the mistakes I’ve made are minor and have not been brought up the management so no- they don’t restrict me due to that. If that was the case then every nurse who has been on our unit 2 years or less are being “punished”.

I came from an Adult ICU residency and it was very different. They gave us high acuity right away- and supported us along the way. THATS how I progressed at a good pace. This whole “give them low acuity until they are ready” is for the birds. You simply don’t learn that way. Repetition in high acuity is key and I can’t have that if I’m always bottle feeding.

Sorry in advance for my ranting. I get so frustrated. It feels like what I need/want is just not at the unit I’m on. I think it’s time to move on and maybe pray they let me stay PRN just for job security since they never cancel nurses.

[llg, PhD, RN]

If you have tried and failed to get support from the leadership ... and are so unhappy with your current situation ... then yes, it is time to move on. Decide what level of acuity you wish your patients to have and find a nursery that comes close to matching that.

[Hoosier_RN, MSN]

Do you have staff meetings? If so, enlist one of the experienced nurses to help you: "Judy, I hear ya, all of us newbies feel the same way and are so frustrated, too! Maybe we can bring it up together in the next staff meeting to see if we can get some brainstorming from staff to work toward a solution." At least with that, you can show that you're proactive as well show the experienced nurses that you're willing and open to the learning experience. It can work for any area of nursing, actually any job. All of the advice before was spot on