Advice on where to go from med-surg?

Editorial Team / Admin · Apr 13, 2017

I think you need to stick with a job. There is a huge reality shock when transitioning from nursing student to licensed nurse, and many feel overwhelmed and like they want to quit. But the thing is, if that happens, especially more than once, that nurse is not going to be able to get the basics mastered because of constantly starting over. Each new job is going to be like starting from scratch- now the 1-2 years to become fully competent turns into more. Perhaps if you gave actual examples of the working outside of your scope we could provide advice.

RNperdiem, RN · Apr 13, 2017

Is going back to SICU a possibility? ICU skills can be useful. Monitoring patients in PACU, doing conscious sedation for procedural nursing, working in radiology are things ICU skills can lead to. Many of the nurses I know who work in those positions are long-term, satisfied nurses.

You never fully escape the mahem (people are unpredictable), but there are areas where it is less of a problem.

As a new grad, in an entry level position, stick around long enough to qualify for a transfer.

Been there,done that, ASN, RN · Apr 13, 2017

SICU and med- surg would combine towards that golden one year of experience. You could consider another transfer within your facility.. or go somewhere else.

I agree nights are an additional stress level, so you think dayshift would help?

Nobody knows how hot the next frying pan will be. Always ask to shadow, observe the flow of the unit and talk with other nurses during interviews.

Agree with RNperdiem that PACU could be a good choice for you.

Take some time , don't jump into that next frying pan.

Best wishes in your next endeavor.

danedsel · Apr 17, 2017

Yes, I do think days would be better because of the 10 shifts I've worked here and there. The difference is - well - like night and day. =| Sorry, couldn't help myself. On this particular floor, there are more resources and fewer meds to give during the day. The pervasive mentality that 'night shift doesn't do anything' is probably what influences some of this, but it's like that in almost any business. Only 1 day shift position ever opened up since I've been there. ...thanks for the reply, btw.

danedsel · Apr 17, 2017

A wise and well-constructed response. I agree with everything you and the others have stated. I'll likely stick it out for as long as possible. Thank you.

Purple_roses · Apr 17, 2017

One of my instructors gave me some advice for interview questions to ask that may give you a feel for how well the floor is doing. I know you've already obviously accepted this position, but maybe this can help you avoid understaffed areas for your next job? I felt that these questions were great for finding out whether or not the floor is understaffed, how much would ultimately be expected of me, and whether nurses on that floor actually enjoyed the floor enough to stick around for a while.

Questions I asked during job interviews were: What is the normal nurse to patient ratio on day and night shift? What is the highest nurse to patient ratio that could possibly happen on day and night shift? How often has the high nurse/patient happened within the last few months? How many aides working day and night shift? What's the staff turnover rate on this floor? What's the normal patient acuity?

These questions helped me decide which job offer I wanted to take. One of the hiring managers was extremely transparent and honestly told me that they were understaffed at the moment and that the nurse patient ratio often went higher than what had been posted on the job application. I felt like this wasn't the best environment for me to start in as a new grad.

Of course, hiring managers and recruiters can fudge numbers, but I feel that these questions can give me a general feel for how the staff is doing on the floor. You can also get a feel for this stuff during team interviews. I actually asked to shadow during night shift at a hospital I was unsure about so that I could get a real feel for the floor (I'm not sure if it's common practice to do this; I'm assuming this was an acceptable request because I'm a new grad). I'll find out in June if my manager was honest with me in answering these questions. :wideyed:

Again, I'm new at this, so I can't offer you any advice on how to handle the position you have right now. I can only imagine that it's overwhelming. You've already dedicated 5 months to this floor. Do you feel that you can stick it out long enough to make it a year? I can't offer you advice on what unit you should go to after this, but I can offer you the same advice that several of my instructors offered me: what makes or breaks your job isn't necessarily the floor you'll be on, but the team you'll be working with (and how well-staffed that team is).

Again, I hope I helped at least a little. This isn't really my advice, but advice I've received from instructors and mentors (whom I put a lot of trust in). I have yet to find out if their advice was accurate!

Oh, forgot to add--wishing you the best! Your post hits on every anxiety I have right now about starting my new job. Just thinking about how much anxiety I feel without even having started yet...I honestly hope you find something you love.

Boston RN · Apr 17, 2017

Being fairly new, working the night shift can be daunting because - like you said - there are limited resources. If possible, switch to days or evenings. I worked nights early in my career and didn't feel quite comfortable either but thanks to amazing co-workers, I was able to get through it. One of the greatest things I have learned from my nursing career, is that it's all about the teamwork.

danedsel · Apr 18, 2017

Wow, thanks purple! Those indeed are good questions to ask!

One of the previous commenters mentioned 'shadowing.' I didn't know that some facilities allowed that sort of thing, but then again, I never asked about it, either. If I can, I may apply and test the waters elsewhere to see if shadowing another nurse provides any insight.

The unit manager on my floor is constantly pressed to be more transparent and honest to slow the speed of that revolving door. I interviewed with her twice and didn't get the slightest impression at all that the floor was understaffed and ill-equipped. So, yeah, I guess that is a common dilemma on floors in general.

The question you asked about 'sticking it out 'til I reach the 1 year mark' is currently what I wrestle with the most. Sustaining the physical and psychological demands is no problem - assuming we're still talking about the 1 year mark and nothing longer. It's the severity of patients, assignments, and subsequent impact the two may have upon my license that I'm worried about. A tech told me the other night that they were giving me and another nurse the more difficult patients likely because we don't take breaks or a lunch and patient satisfaction is high with us. Also, I seemed to have rubbed a few people the wrong way, so there's that...

Everyone has such a big mouth - I can't believe it. I can get virtually any information willingly from someone else.

What you and Boston said about teamwork is really important. I currently don't have this. Sometimes, we don't have a tech and so we're having to get vitals, I/O's, etc. in addition to other things. The techs that are there have virtually no presence, so I often wind up doing everything myself anyhow.