Asked to Move to Another Floor?

MrNurse(x2), ADN · Oct 18, 2016

Did your NM give you constructive criticism or just that suggestion? I suggest going back to your NM and stating that you want to grow in this position and ask for specifics that you can work on. Ask for a mentor that you can refer to on your shifts, someone with experience that won't be put off by your questions. I feel like a broken record, but I need to tell you that the NCLEX system puts new nurses at a disadvantage. Employers see you as a licensed nurse, not a new nurse. That means teachable moments become disciplinary issues and you are forced to fake it until you make it. Mistakes are to be expected when you are new, and putting you on FT nights, with little direct oversight, is on them, not you. Nursing is a career, and despite what nursing agencies tell you, you are really not experienced until you have three years, preferably the same type of nursing, under your belt. One night does not define your career and sometimes even a seasoned nurse may not be spot on. Don't beat yourself up.

KatieMI, BSN, MSN, RN · Oct 18, 2016

If you were told what were the concerns, areas of improvement and what to do, then just do your very best, follow directions and give yourself at least a year to grow and learn.

If not:

- call your NM and ask for a meeting. Leave day/time choice for her "so that it would be comfortable".

- state that you thought a lot, you love what you are doing, you know that as a new grad you have a lot to learn, blah, blah, blah

Then:

- ask directly what you did wrong, what were concerns, etc. Ask for details and expectations

- state that you understand what you missed and know how to improve

- propose something to help yourself; ask, for one example, about being paired with experienced RN. Leave choice for NM "as she knows who is the best teacher"

- ask what they can do to help you.

If you get constructive criticism, substanciated responces and help, then just do your best. If not, dust off your resume and submit your 2-weeks note. It sounds terrible, but helping a new grad is a part of NM job, and if she refuses to do it, it means that they gave up on you already and just waiting for you do make a mistake or make things up. At least you will avoid termination with all its sequela and be able to honestly say that the place was not a good fit for a new grad. It is better to look as job hopper than to go through full-blown "building of paper trail".

If you go the latter way, avoid any setting where you will be expected to be alone in the field. Hospice (as well as home cate) is NOT a good place for a new grad with no experience. You may do just fine on less acute or specialty med/surg floor. Other alternatives are subacute rehab, non-acute LTACH and LTC (providing you will not be a single RN on the floor).

aurora119 · Oct 18, 2016

Thank you for the feedback. I was told the expectations earlier, and their primary concern is that I'm not comfortable with the high acuity level of the patients they get up there. The ratio is typically 6:1, while I can usually do fine with 5, depending on each patient's level of care needed. I was told that they think a less acute floor would be better for me, and that's why they brought up tcu and hospice... But like KatieMI said, hospice might not be a good fit for a new grad with no exp... It just feels like a huge blow to me that this happened, but I appreciate their honesty. I'm just very unsure what to do. When I try to get help on something I'm not familiar with, it usually takes some time for the other nurses to come show me how. I think another area that was identified as an expectation by this point is that I would have gotten in the habit of looking up protocols and stuff on my own. I keep forgetting to do that, but now I definitely will make that a standard part of my practice. It's just my first instinct (and I'm not sure if this is a new grad thing or not) is to ask for help instead of looking up things on my own, which I guess I did too much of, and that's something my colleagues have pointed out to the NM, hence why this meeting occurred.

OCNRN63, RN · Oct 18, 2016

While some people with no->minimal experience may flourish in home care/hospice, that is not the norm. I've worked in both, and they can be stressful...extremely stressful. Hospice can be a very highly charged environment. Patients can have have crises with symptom management; family dysfunctions can become even more dysfunctional than ever...and you're out there working without a net if you're doing home care hospice. Add to that, not everyone lives in the best of environments. One of my hospice patients lived in an apartment complex where there was constant drug trafficking and muggings/robberies.

You've got to be very confident in your abilities to work independently to work in home care/hospice. If you think this is an area that you could do well in, then by all means, try. But make sure you are well informed before you make the leap. Don't jump from the frying pan into the fire.

aurora119 · Oct 18, 2016

What about transitional care? I was told that the pt acuity is generally less than the floor I'm currently in, it's like a SNF but a part of the hospital. I know that most likely means more patients per nurse however. Does anyone have any feedback or experience on TCU units?

Been there,done that, ASN, RN · Oct 18, 2016

"I was told that they feel that I may do better at a unit with less patient acuity" You still have a job, management is trying to find a better fit for you. You just need a little more time to succeed, management know this.

It is a POSITIVE move on your managers part. S/he realizes you have great potential, and they want to keep you on. Thank your manager, ask if you can shadow on these units, in order to make the best decision . I would also ask, where is the greatest need and where does management feel you are the best fit .

Deep breaths, you have excellent support. Let us know how it's going.

nutella, MSN, RN · Oct 19, 2016

Hospice:

it is a very different focus and still requires a lot of critical thinking, great communication skills, and some med/surg skills.

Some people do well with minimal med/surg experience but it is a steep learning curve even with prior good experience. An inpatient hospice or palliative care unit would be only a good fit for you if you have the support to make a good transition and if you feel that this work with patients who are closer to end -of -life is meaningful to you in this stage of your career and age. It can be a difficult fit for anybody and for younger nurses who are just not at a point in their life where this main focus on terminal illness works for them.

Transitional Care Unit :

Did not take a job in TCU but I was offered one years ago. It is less acute and is more like a rehab unit where patients go when they are not that acute and have to learn some skills before they move on. I turned it down because I did not feel it would be a good fit for me.

I wonder if those are the units in your hospital that are hard to staff because both are areas that are not that popular within a hospital.

If you work on a telemetry unit and it is too much perhaps there are other options like non tele floor. Other less acute areas in a hospital are clinics.

There is also a different between being overwhelmed by multitasking / organizing/ time management as a still newer graduate but otherwise great critical thinking skills and generally struggling with all aspects of acute care. If you have great skills generally but struggle with 6 patients because of the organizing, multitasking and such - other areas where you focus on less patients at a time might be also a good option for you like OR, critical care (because less patients), or anything that is more like a functional area.

If you feel that it is more an all around struggle in acute care, less acute settings might be where you are happier. I would not recommend home care though because that is also an area where you have to organize and multitask constantly and most nurses struggle with that aspect a lot ...

It sounds that your manager is giving you the change to transfer instead of potentially terminating you. If you feel that her concerns are valid ask her if you could shadow both possible units and display a positive attitude. There is no law that says you are only a successful nurse if you can survive in acute care med/surg. It is like everything else in life - people have different skills and different interests. Every nurse in any setting works to the benefit of the patient and is equally worthy. I have worked in all kind of settings and you use different skills in different settings. In my job now I mostly talk, hardly ever anything hands on beside using my stethoscope and some assessment. Sometimes I reposition or get some water - but that is it. I am still a "real nurse" as much as I was in critical care or community. I use different skill sets - which is totally fine with me.

Good luck with whatever you decide.

Lev, MSN, RN, NP · Oct 19, 2016

They value you as an employee. Good thing you are not being fired because many new grads would be if their employer did not like them. They want you in your company but not on your current unit at this particular time. I would ask for the opportunity to shadow on both units but I would lean toward "transitional" care over hospice. One you get 6-8 months of experience in the new unit, transfer to a different med-surg or tele unit. I personally would not want to back to the same unit. In my experience, transitional care is especially sub-acute rehab. It will be manageable because it is in a hospital setting and tied to the hospital. You may have more patients than on your current floor but they will be less acute with no tele. As a nurse coming with a med-surg background you will be poised to advocate for your patients if they do need to be transferred back to the hospital.

I started off on a tele floor just like you. It was the unit I worked on as a tech with no issues. I too was asked to transfer to a "transitional care" type unit. I learned a ton and got great time management skills. After about 6 months, I started picking up extra shifts on one of the med-surg units and after 8 months, I transferred there. I stayed on the med-surg unit for a year and I got a job in a different hospital in the ER and I have been there for 18 months. I will be precepting a nurse new to the ER starting tomorrow.

When I was first "let go" I felt very dejected. I felt like a failure as a nurse. I didn't see it coming. My preceptor didn't give me regular feedback and I only heard about issues when it was too late. An "action plan" had been constructed but I never saw it. I was given the option to transfer to the "subacute" unit which I was so grateful for, that I wasn't fired. I had an awesome preceptor on the new unit who taught me so much with so much patience and I had a wonderful understanding manager who took me under her wing. I loved where I was but I had goals in mind which required acute care experience. So I transferred to the surgical unit where I grew tremendously as a nurse. I have been a nurse for almost 4 years and I would not change my experience. If I never was kicked off that tele floor I would probably still be working there and miserable, because looking back it really is a dysfunctional unit. I would probably not be working at my current hospital in the ER.

NurseGirl525, ASN, RN · Oct 19, 2016

What are you having issues with I guess would be my question? Assessment issues? Are you still asking questions about how to admisinister meds or what are implications or varying vital signs? I think me and the rest of are wondering what you are having issues with.

I'm newly off orientation, but, there are things I'm comfortable with, and things I am not. I've got the basics completely down, but certain things, I'm still asking questions on. You kind of have to find that middle ground. Your issue may be that you have no confidence in yourself and you are portraying that to charge. It's ok to ask some questions, but to constantly be asking for every little thing, may be the problem.

TriciaJ, RN · Oct 19, 2016

"I was told that they feel that I may do better at a unit with less patient acuity" You still have a job, management is trying to find a better fit for you. You just need a little more time to succeed, management know this.
It is a POSITIVE move on your managers part. S/he realizes you have great potential, and they want to keep you on. Thank your manager, ask if you can shadow on these units, in order to make the best decision . I would also ask, where is the greatest need and where does management feel you are the best fit .
Deep breaths, you have excellent support. Let us know how it's going.

I'm with BeenThere. Don't take it as a blow; take it as a break. If they didn't like you, they'd put you on a work plan or just terminate you. They're offering you a lower acuity; take it. You'll still be gaining valuable nursing experience, including time-management skills. But hopefully get a bit of breathing room, too.

In a year or two, if you want, you could probably find your way back to med-surg. By that time you'll have gained skills and confidence.

Seems to me like your employer sees your potential and doesn't want to lose you. Good luck.

AutumnApple · Oct 19, 2016

"I was told that they feel that I may do better at a unit with less patient acuity" You still have a job, management is trying to find a better fit for you. You just need a little more time to succeed, management know this.
It is a POSITIVE move on your managers part. S/he realizes you have great potential, and they want to keep you on. Thank your manager, ask if you can shadow on these units, in order to make the best decision . I would also ask, where is the greatest need and where does management feel you are the best fit .
Deep breaths, you have excellent support. Let us know how it's going.

That's about where I am with this. It is a pisitive.

OP: My impression is that your employer took the high road. They identified a problem with how you are meshing in with your current environment and think a different specialty would suit you better.

It would make too long of a post to discuss how unique this is. Your manager used a compassionate decision making process instead of the 'for profit' approach most use. I will say this though: This manager took the high road despite the fact that this is a mark against them (for most institutions, that's how it's viewed). Managers are graded in part by how well nurses new to the hospital perform there. Your manager admitted things weren't as ideal as they should be and suggested a change in environment for you. Many managers would have tried to save face and would have insisted that you were the problem and a change in scenery wouldn't help.

So, don't get caught up in worrying about why it was a bad fit on a unit you will no longer be at. Focus on how to make your new opportunity a good fit.