Am I being "dumbed down" in my current dept?

[proudnurseRN]

I don't know if I'm looking for advice, others that have experienced this, or just rambling... but here goes.

I'm smart. Now I don't mean to brag about it, but it is what it is. I'm not trying to say that makes me super-nurse by any means. However, I graduated in May 09' with a 3.96 (stupid French class) and studied half the time that others did. I passed NCLEX with 75 questions and under 30 minutes. I know my nursing stuff. At least book wise. Or at least I used to. Here's my situation.

I work a general medical floor that specializes in ortho-uro-neuro. I have worked here since May 09' I chose this unit because I personally don't think new grads should work ICU, ER, critical care units to begin with. Now I realize there are some new grads that make excellant nurses in those specialities, and I'm not downing you. It was important to me though to get my basics together before worrying about needing even more hands-on knowledge.

The other day I float to a telemetry floor and I am way out of my element. ECGs look like a paper with scribbles. Chest pain protocals? Angio-caths? Where to these leads go? I am thrown off guard, out of my element, and truthfully kinda scared. Fortunately I have good nurses by my side, interpreting ECGs and writing notes on my patients.

The problem is, I could do this a year ago. While I don't consider myself an expert in any sense at my current job, I do consider myself proficient. Another important consideration is that I'm looking at going into a NP or PA program in fall 2011.

So, do I stay where I am comfortable, with co-workers and patients I really do like- a good unit with decent management, or do I move on... to increase my knowledge base and refresh my memory on those things learned? Or do I go into unknown water and hope for the best. If I move on I'm looking at an ICU type setting, as I cannot do Peds often. That eliminates the ER.

I keep remembering a discussion I had with one professor... telling her that I studied for a test 2 hours beforehand. That I could study for hours and hours days before, but I really did my best with retaining information and applying it when the pressure was on. Her words were "that makes for a great ICU nurse"

Any suggestions or advice is greatly appreciated.

[llg, PhD, RN]

Pay attention to Moogie and ukstudent. They wrote great posts.

... And as others have pointed out, it's natural to lose some of your knowledge and skills as you focus on one area for a while. That happens to all of us. There are certain populations I have not worked with since college over 30 years ago -- and I know very little about the nursing care of those patients anymore. And yet, I am a true expert in the field I have been working in for the last several years.

Each time we move to another job ... another specialty ... another role ... etc. we gradually lose some of the expertise we had in the precious as we gain expertise in the one we are focusing in at the present. I used to be an expert Neonatal Nurse ... but I left that field a few years ago. So, while I still have considerable knowledge of that field, I am not as up-to-date in it as I used to be. It's not really "dummying down," it is a normal process of shifting focus and the exchanging of one type of expertise for another.

I am now an expert in Nursing Professional Development -- the development of nurses AFTER licensure as they move through different stages of their careers. If you'll study Benner's model (as suggested by Moogie), you should recognize that you are exhibiting behavior quite typical of the "competent" stage of development. You have mastered the basic skills of your staff nurse job and have a strong sense of compentency in that role. That usually happens about 1 year after graduation.

So ... the question for the nurse in the competent stage is often, "What next?" Do you stay in that area and learn more indepth material about that population/role and become truly proficient and maybe even an expert? (which requires a flexibility of thinking and a movement beyond the usual protocols that you have not yet achieved to develop more depth of expertise. Do you become a "leading expert" in that field?) ... or would you rather move laterally to another area/population to develop more breadth? Do you move to another role and leave the staff nurse role behind? All of those choices are OK.

Personally, when I was in your situation many years ago ... I chose to stay in my then current field of Neonatal ICU and develop greater expertise in that fied. After 2 years of being a staff nurse, I went to graduate school and became a Neonatal CNS. Over the years, I gradually moved into more of a staff development and research role (got my PhD) and now have a professional identity as an expert in Nursing Professional Development, research, and evidence-based practice in the hospital setting. That was a natural progression from my role as a CNS.

I knew one person who started as a staff nurse on a surgical unit. She focused her Master's Degree work on the care of the post-op patient. By the time she finished her PhD program, she was one of the county's leading experts in "wound healing" -- and that was how she thought of herself.

I hope I am giving you some things to think about. Do you want to be a "jack of all trades and a master of none?" ... or ... Do you want to be a great expert in one or two things? Do you want a broad focus (like a FNP or PA might have), or do you want a more narrow focus (as an expert in a specific population)?

There are lots of good choices. I recommend keeping an open mind -- and not investing too much money in further education until you have a pretty good idea as to the general direction you wish to take.

Good luck to you!

[SummerGarden, BSN, MSN, RN]

to answer your question op. yes, your current unit is dumbing you down, at leats in the area that matters most to you!!! i worked such a unit last summer as a float and went from having no trouble titrating cardiac drips myself (i worked a step down and chest pain unit prior) to being scared to do them when i floated back to the cardiac unit! i had only been out of practice for two months prior to the switch... as a new nurse i noticed that skills and knowledge will leak out my ears when i did not use them daily! in fact, i felt robbed by the less complicated patients i had on a general medical surgical floor because when it was time for me to move back to what i wanted at the time (cardiac traumas so that someday i could be an er nurse) i was a dumb new nurse all over again! the key to being "smart" as a nurse is repetition!!! thus, if you want to be a critical care nurse you need to work a critical care unit!!! you may get away with working a step-down and gain a lot instead of an icu. however a general medical surgical floor is a huge waste of your time.

did you know that once you transition over to a critical care unit, your general med surg background will mean nothing to your new icu co-workers???? i know you were told the lie to start med surg because it build a foundation blah blah blah..... but what you were not told is that critcal nurses do not respect general medical surgical floor experience due to the lack of exposure to critical care skills and knowledge base. some icu nurses prefer new grads that are blank slates to new icu nurses with a general medical surgical background. so be prepared to be humble if and when you transfer!!!

you will be the little peon on the totem pole!!! however, if you are willing to learn anything and everything others will teach on your new icu unit you may be fine.... otherwise... it will be a painful ride to gain back what you lost! gl! i moved out of med surg last fall... i am still trying to shed the veil of having worked a general medical surgical unit... it is not easy.... i know a lot and learn fast, but to some people i am still just a medical surgical nurse.

[Preeps]

Sorry but it smacked of bragging to me as well. And I agree with another poster that smart people don't brag. But then again there are many form of intelligence; social, emotional, book smart etc.

And I too agree that GPA doesn't necessarily gage intelligence. But at least you admit you were out of your comfort zone. I don't think you are being "dumbed down." You made a decision to start on a medical floor and now are a bit surprised that a more acute floor put you out of your comfort zone.

Only you can decide but really, what could it hurt if you try another floor. Good luck.

[rnto?]

to answer your question op. yes, your current unit is dumbing you down, at leats in the area that matters most to you!!! i worked such a unit last summer as a float and went from having no trouble titrating cardiac drips myself (i worked a step down and chest pain unit prior) to being scared to do them when i floated back to the cardiac unit! i had only been out of practice for two months prior to the switch... as a new nurse i noticed that skills and knowledge will leak out my ears when i did not use them daily! in fact, i felt robbed by the less complicated patients i had on a general medical surgical floor because when it was time for me to move back to what i wanted at the time (cardiac traumas so that someday i could be an er nurse) i was a dumb new nurse all over again! the key to being "smart" as a nurse is repetition!!! thus, if you want to be a critical care nurse you need to work a critical care unit!!! you may get away with working a step-down and gain a lot instead of an icu. however a general medical surgical floor is a huge waste of your time.

did you know that once you transition over to a critical care unit, your general med surg background will mean nothing to your new icu co-workers???? i know you were told the lie to start med surg because it build a foundation blah blah blah..... but what you were not told is that critcal nurses do not respect general medical surgical floor experience due to the lack of exposure to critical care skills and knowledge base. some icu nurses prefer new grads that are blank slates to new icu nurses with a general medical surgical background. so be prepared to be humble if and when you transfer!!!

you will be the little peon on the totem pole!!! however, if you are willing to learn anything and everything others will teach on your new icu unit you may be fine.... otherwise... it will be a painful ride to gain back what you lost! gl! i moved out of med surg last fall... i am still trying to shed the veil of having worked a general medical surgical unit... it is not easy.... i know a lot and learn fast, but to some people i am still just a medical surgical nurse.

wow, i feel like this post was incredibly condescending to med surg nurses. critical care nurses do not respect med surg? i know quite a few icu nurses who were floated to med surg and couldn't deal. med surg nurses are not smarter than icu nurses, and vice verse. they are different, that's it. i know this is the attitude some critical care nurses have, and it sickens me. i'm not saying we should all hold hands and sing kumbaya, but my goodness, we all had the same basic education, and we're all equally qualified to work in either icu or med surg. i personally think, as previous poster pointed out, that starting off in med surg would give one a good handle on time management. it would certainly be difficult to be a new grad not knowing how to get everything done and also having to learn all of the extra material you need to work in icu. but then again, i'm just a med surg/sub acute nurse so i guess my experience means nothing.

[proudnurseRN]

Thank you again for everyone that gave their advice. I won't be responding anymore to the thread, because I don't think it was interpreted as it was meant. I was not trying to brag. I wasn't trying to pit Med-Surg via ICU. I was just trying to see if anyone else had my experience, and I foulnd out not only have others experienced this, but there is a theory based upon it.

.

BTW: I learned basic ECG skills. I took a basic ECG class prior to graduation. Last year I could read an ECG strip. Since I haven't had to in close to a year, I can't now. I think I can still tell what is normal rhythm and what is not, but that's about the extent. In case you couldn't tell, that was the whole reason for the original thread.

[XB9S, BSN, MSN, EdD, RN, APN]

Thread Closed at OP's request