Advice for New Med Surg

[m0ckingbird]

So I'm a new grad nurse and I am looking for some advice on the direction I am going, because I'm feeling a little uneasy about some of the choices I have made and whether they are helpful for me in the long run.

I finished my ADN and took the first job I was offered, at a small rural hospital, after I was turned down by the first three jobs I interviewed for. I live in an area that has lots of big teaching hospitals, but none of them hired me. Most of the other students I knew had NA jobs already and got jobs in those hospitals, but I had done food service work through school. I think my lack of nurse work on my resume was a big factor in that.

So I'm almost done with my orientation at this small country hospital. It's been kind of disorganized and it seems like they are inventing this orientation program for us and testing it out with us. It's 10 weeks and I feel like I'm being rushed off of orientation while the people in ICU and ED get longer orientations than I. They say I am doing great, but I am nervous about being able to do everything that is expected of me. Their census is very low currently, so I only take care of maybe 3 patients at a time right now.

The med surg floor is staffed almost entirely by travel nurses who talk about leaving and not renewing their contracts. There is no charge nurse. There is very rarely a nursing assistant on staff. Some of the travel nurses have been very disgruntled there and outspoken about low satisfaction scores since they were taken over by a private corporation and the full time nurses all left.

I'm just worried I've joined onto a sinking ship, and that I won't have mentorship there. I'm wondering if I should keep applying for jobs at bigger hospitals. I never thought I would do med-surg I thought I would do ED or labor and delivery, but it's very difficult to get new grad positions in those fields unless you had a preceptorship in them.

I'm feeling a little restless and worried that maybe I should have stayed unemployed longer to look for "the right" nursing job at a bigger hospital with more resources. I've seen nurses cut a lot of corners there and sometimes it feels like no one is steering the ship or watching what is going on there. Is it disloyal for me to apply to other places while I work there? Is it ok to explore other options or does that look bad to other orientation programs?

Thanks for any advice.

[Jerrysdogmommy]

"So I'm a new grad nurse and I am looking for some advice on the direction I am going, because I'm feeling a little uneasy about some of the choices I have made and whether they are helpful for me in the long run."

Congratulations on making it through nursing school!!

"I finished my ADN and took the first job I was offered, at a small rural hospital, after I was turned down by the first three jobs I interviewed for. I live in an area that has lots of big teaching hospitals, but none of them hired me. Most of the other students I knew had NA jobs already and got jobs in those hospitals, but I had done food service work through school. I think my lack of nurse work on my resume was a big factor in that."

Teaching hospitals are teaching residents. I worked at a teaching hospital after 9 years of experience but never before. Reason: residents are learning and seasoned nurses are extremely valuable to them. Picture it like this: new lieutenant versus a seasoned NCO. A good 2LT depends on his seasoned NCO.

"So I'm almost done with my orientation at this small country hospital. It's been kind of disorganized and it seems like they are inventing this orientation program for us and testing it out with us. It's 10 weeks and I feel like I'm being rushed off of orientation while the people in ICU and ED get longer orientations than I. They say I am doing great, but I am nervous about being able to do everything that is expected of me. Their census is very low currently, so I only take care of maybe 3 patients at a time right now."

ICU and ER are different worlds, which is why they need longer orientations.

Nervousness is common. They'd tell you if you were falling behind.

While it may appear to be disorganized, it differs from school, which is very structured. This is just different.

"The med surg floor is staffed almost entirely by travel nurses who talk about leaving and not renewing their contracts. There is no charge nurse. There is very rarely a nursing assistant on staff. Some of the travel nurses have been very disgruntled there and outspoken about low satisfaction scores since they were taken over by a private corporation and the full time nurses all left."

I'm sure those in the ivory tower love you (but don't say it) for being full time because it's expensive to have travel nurses. Plus travel agencies are horrible to deal with (mine is anyway, which is why this is my last assignment!!). Yes, you need a charge nurse. CNA...depends.

"I'm just worried I've joined onto a sinking ship, and that I won't have mentorship there. I'm wondering if I should keep applying for jobs at bigger hospitals. I never thought I would do med-surg I thought I would do ED or labor and delivery, but it's very difficult to get new grad positions in those fields unless you had a preceptorship in them."

No...you're not on a sinking ship; you're learning how difficult healthcare is with little money to juggle with. Travel nurse's have a lot of experience in many, many facilities who can be your best mentors since they've seen so much. Try not to discount med-surg as of yet. You're learning so much there (wound vacs, NPH, traction, ACHS, etc). I started in the ED but after being on the med-surg floor, I realized, it's just different. I love med-surg/tele because I can manage a patient for one or two shifts (sometimes it's the same patient) rather than turning the beds. Again, that's my view.

"I'm feeling a little restless and worried that maybe I should have stayed unemployed longer to look for "the right" nursing job at a bigger hospital with more resources. I've seen nurses cut a lot of corners there and sometimes it feels like no one is steering the ship or watching what is going on there. Is it disloyal for me to apply to other places while I work there? Is it ok to explore other options or does that look bad to other orientation programs?"

No, staying unemployed for the "right" job is a bad idea because the "right" job never comes. Bigger hospitals have their own set of problems. And please, do not cut corners. Be the example. Take the blood sugar right before giving insulin; blood pressure right before giving the blood pressure med. Ensure your tele leads are on right (you'll be shocked at how many aren't). While you may be miserable there, bigger facilities aren't always the best. Metrics are always managed more strictly; med times are managed tightly; patient satisfaction scores are the pie in the sky. You could provide the best care and hug the family yet, if a family member doesn't like your shoe color, you will be spoken too, guaranteed. It can be that petty.

It sounds like growing pains to me. Transitioning from student to new nurse is tough. Look to your travelers for advice, do the right thing, do lots of CE's to keep yourself learning and learn how to make an effective nurse "brain". Then, when you move on in 24 months, you can have a solid resume started.