Advice please

allnurses Guide · Oct 29, 2018

Hi everyone, this is my first post on here and I am hoping for some positive and constructive feedback. Thank you for your time.
I am in my early twenties but have been working for almost 2 and a half years all inpatient on tele/medsurg units. I recently transferred to a new hospital but still in the same system due to better patient to nurse ratios and it is a lot closer to my house. I have been at this current hospital for about 5 months and I am hitting a crisis. I skipped normal orientation due to just being a transfer. This new hospital has their nurses do blood draws, start IVs, Be ACLS certified and a few other minors things just for medsurg floors. While I am sure this sounds dumb to a lot of you. I am coming from a large hospital where I had a code team, 24/7 phlebotomy and IV team. As a normal medsurg/tele floor we never worried about this or was trained to do it in school. Now being 5 months in I am expected to become ACLS certified and magically learn everything with no training. There are classes but all at unmanageable times due to me being night shift. In addition, the new nurses that attend this orientation explain how useless and unhelpful it is. I am finding many of the other nurses are very judgemental and expect me to know how to do all of these things. It is to the point I am embarrassed to ask for help. There are many other minor issues I'm sure we all relate to that are piling up that is making me question if I even want to be a nurse or step out of bedside nursing. I am just at an overwhelming spot in my life and it is especially difficult because I have never felt inadequate as a nurse until now. I have been looking at multiple other positions but I am unsure if I am ready for a needed change or if I am just being dramatic and need a reality check. I understand the issues I've talked about are probably the norm to many of you.
I would love some support or feedback to my current situation. Also what are other areas of nursing that you would recommend someone moving into?
Thank you!!

I don't want to sound unkind so I'll start with the positive first. There is nothing that you listed that you cannot learn to do. You say you can't take the classes offered due to your working night shift but you surely don't work every day. You are going to have to take classes one way or the other. If you can't do the classes offered at your facility then look for classes at the local college that will help you build your skill base.

That being said it's hard to comprehend that you have been working med-surge for 2.5 years and never started an IV. In every hospital except psych this is a core competency, When I was in Nursing school we practiced IV starts and venous access on each other in skills lab. Is there a person at your facility who is competent in this skill who you can shadow and work with. Starting IVs is not generally too hard, still some people never really get it, but you won't know until you try.

I would suggest watching YouTube videos, but starting IV's is as much about feel and intuition as it is about technical skill. Still you should give it a try. Mastering this will only help you in the future.

Hope this helps

Hppy

Just-floored · Oct 29, 2018

First of all given yourself a break and realize that this has nothing to do with being a good nurse or not. You need some training and that is to be expected if you have never needed the skills before. I would suggest you talk to your manager and see if you can get the training you need. I would also hope that you can find someone on your unit to be a mentor for you. It sounds as if you need a safe person to run questions and issues by. It may be embarrassing to ask for help but it must be done in order to move forward. In nursing school we were frequently reminded to get comfortable being uncomfortable. Don't let embarrassment derail you or stop you from providing the very best for your patients. You both deserve the best. I think that it may be premature for you to look for another position. If you were to get another job you would likely have new skills to learn for that one too.

JKL33 · Oct 29, 2018

Work with your manager to create a schedule that will allow you to attend the relevant classes. Also inquire about other ways you can gain the necessary skills - perhaps your manager will work out a way for you to spend time in the outpatient lab and ambulatory areas working on your venipuncture and IV skills.

With regard to ACLS - is there no organized code response at your new place? I'm wondering if your perspective is a little skewed right now due to the stress of the normal adjustments required when changing jobs.

It's not unreasonable for bedside nurses to be asked to develop and use these skills. Both of your experiences (jobs) have pros and cons, I'm sure. But the fact that you are now being asked to learn things or perform skills that are within the RN's trained role and capabilities shouldn't indicate to you that something is backward here or was better at the bigger place by virtue of these issues alone.

I hope it gets better for you soon, and I think that will best be accomplished by rising to the occasion... :)

brownbook · Oct 29, 2018

Please take a deep breath and exhale. First of all "this" doesn't sound dumb. But you are overwhelming yourself and "freaking" yourself out, now that is dumb, human but dumb.

When is the ACLS certification due? That may be the first priority. If it is mandatory for you to be ACLS certified the hospital has to pay for you to take the class, they have to schedule you time off.

The new nurses said ACLS was useless and unhelpful, or orientation was useless and unhelpful? Your post was unclear. The answer to that question is a whole other post.

As others posted YouTube videos are great for learning IV and phlebotomy skills. If you put starting IV's in the Allnurses search box you will get 1,000,000 responses. I, and many nurses, were not taught IV skills in nursing school, many excellent nurses have never been good at starting IV's, don't let that become a big issue.

Take baby steps. You can do this. Lately my favorite mental kick in the head is, "this is a challenge, challenges help you grow".

psu_213, BSN, RN · Oct 29, 2018

My first job, the IV team only did PICC and that sort of thing--they did not routine peripheral starts. That was 100% on the floors. Another place I worked, the IV team did almost every start. Personally, I think it is foolish to not have floor nurses start the majority of IVs, all but the really hard sticks, but no one really asked me.

For the OP, I agree with working with you NM to work on a schedule with you manager that will allow you to take these classes. I know from working nights, there are going to be some less that ideal meeting/class times, but it is a sacrifice that has to be made. Also, ask if you can shadow someone in the ED to help build proficiency with starting lines. Monday afternoon/evening in the ED would be a good time to gets lots of practice.

llg, PhD, RN · Oct 29, 2018

I hope everyone who reads your OP learns a valuable lesson. Never skip the regular orientation of a new job unless you have carefully reviewed all of the job expectations and are truly comfortable with them. As you have painfully learned, hospitals vary in their expectations -- even within the same multi-hospital systems.

Now that you have discovered that the job roles, duties and expectations are different from one hospital to the next ... you need to have a sit-down talk with your manager to discuss how to get you scheduled into some of those orientation classes that you skipped. It doesn't mean you are a bad nurse: it just means that this job has different expectations than your first job -- and you are going to have to get the training you need if you want to continue in this job.

Good luck to you!

LovingLife123 · Oct 29, 2018

ACLS is not that big of a deal. They teach you absolutely everything in the class. It's not that hard to push 1mg of epi. You should know how to run a code whether or not you are on a "code" team.

I work at a big teaching hospital. We have no code team, no phlebotomists, and no IV team.

It's not a big deal. You learn.

Been there,done that, ASN, RN · Oct 29, 2018

I have been there done that, years at the same place without having to start my own IV's or draw blood. Then, the powers that be decided to cut the IV team and phlebotomy.

I don't think orientation would help you learn IV starts and phlebotomy. These are hands on skills. I asked to spend a day with an IV nurse, and a day with lab. They taught me well. Your manager should provide the time for this.

Never checked out you tube for training, can't hurt!

As far as ACLS... you will get the material in advance and be able to study. The practical is two days, that should be paid by your facility and the two days should count as your scheduled time.

However, no matter how proficient you become, starting IV's and drawing blood are additional, time consuming tasks that make the job even harder.

You have three years of experience... you have many other opportunities than hospital nursing.

ert01479 · Oct 29, 2018

Thank you for your response!! I agree I think following a unit that does IVs frequently as ours fortunately does not have much opportunitiea for it.

ert01479 · Oct 29, 2018

Thank you!

ert01479 · Oct 29, 2018

Sorry for the confusion. They said the IV and phlebotomy classes were useful! But I agree that ACLS is the first start. Thank you!