I'm new to nursing and I've been off orientation for about a month. I started out on a med-surg with tele floor, and so far, I have had shifts where the night went ok and then I've also had nights where I just feel overwhelmed. I have been taking about 5-6 patients, all different acuity. I have asked for and received help from senior nurses, but I recently been contacted by my NM and I was told that they feel that I may do better at a unit with less patient acuity, like hospice or transitional care.
I'm still shell-shocked because this news came after a particularly difficult shift last night. I'm really scared about possibly not having a job anymore, because I'm new to the area (location-wise).
I'm also very disappointed in myself and ashamed that I have not been progressing as well as I believed. I do love what I do and taking care of my patients and educating them, but I also get overwhelmed when multiple things need to be addressed at once, and I'm still working on prioritization and time management. I get mild anxiety before work, but once I get into the groove of my routine, then generally I can do fine.
I guess I am just extremely fearful of what's going to happen to my job... like I said, I moved to this area, so I am unfamiliar with most other places here to work, and right now, I'm the only one with income. Have you ever been suggested to move to another unit? Where and did you take the offer? I am so torn between sticking it out, or going to the other units because I don't know for sure if they have job openings at this time... I'm just so worried sick, I don't even have an appetite right now after missing lunch...
Also, can someone who is either in or has been in transitional care unit or hospice, and also had experience with medsurg, please explain to me the differences? I need to let management know very soon what my decision is and I am just so lost right now!
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.
"It is a pisitive." Is that a typo , or a Freudian slip?
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?
Hi Katie,
I'm sorry this happened, but try not to be too discouraged. I've been a nurse almost 10 years and still have to remind myself sometimes to look things up instead of asking someone else. I think it's natural to ask, partly because it seems quicker at times, and partly because we were trained to "ask for help" if we need it. It's a bit ironic because others have been criticized for NOT asking for help at times. The trick is to know when it's something that you need another nurse for and when it's something that you can go to another resource for, such as a book or online.
Given the information you have provided, it does seem a bit unfair that they don't recognize that nurses in your position need more guidance. It also seems short-sighted to suggest that you leave the floor when they have already invested in you and it appears as though you would come along just fine if given time to grow into the position. It bodes well for you that you have claimed your faults and have asked for guidance.
I worked in TCU as new nurse with less than 1 year of experience. It is less acute and in that respect less stressful. However, less acuity means more patients. I don't know how all of them operate but I could have as many as 10 or 11 patients in the TCU where I worked. Although it may reside within the physical building of the hospital, it is a separate entity and is run under the same rules and regulations of a nursing home, but there are no long-term patients, only "transitional" patients that are either waiting to recover enough to go home or for placement in a nursing home, with the greater percentage being the former.
Now, having stated that TCU is "less" acute, some of them do take some pretty sick patients so that description doesn't always hold true. If you do seriously consider moving to TCU, you should go to that unit and talk to the nurses there to get their perspective before making a final decision.
"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.
Thanks for the positive support and feedback! I didn't expect so much encouragement...I feel better now after reading everyone's input. Please keep it coming!
To GM2RN:
Is the 'routine' for TCU the same for medsurg floor? (like med passes and such?) I don't know what to really expect, so I would like to know more about the kind of patients you took care of in TCU. Did they have drains? Feeding tubes? Chest tubes? I know that long term antibiotic therapy is going to be something I'll likely encounter, but I really want to know what all else I'll be dealing with. I know that our TCU unit has less than 30 beds, if that helps with any information. How many beds did your TCU have, GM2RN?
Thanks for the positive support and feedback! I didn't expect so much encouragement...I feel better now after reading everyone's input. Please keep it coming!
To GM2RN:
Is the 'routine' for TCU the same for medsurg floor? (like med passes and such?) I don't know what to really expect, so I would like to know more about the kind of patients you took care of in TCU. Did they have drains? Feeding tubes? Chest tubes? I know that long term antibiotic therapy is going to be something I'll likely encounter, but I really want to know what all else I'll be dealing with. I know that our TCU unit has less than 30 beds, if that helps with any information. How many beds did your TCU have, GM2RN?
It's been at least 7 years or so since I worked there, so I don't remember exactly how many beds we had but it must have been in the mid to upper 20's. Also understand that all TCUs will operate differently in terms of what type of patients they will take. When I worked there, we saw a lot of post-op ortho patients who weren't quite ready to be discharged yet because they didn't have the support required at home. Also some other types of post-ops so drains would be a possibility, as would feeding tubes. We didn't get chest tubes but I wouldn't rule that out for all TCUs. I would say that in general the routine would be very much like M/S, but if you worked days, expect that patients will also have rehab. Again, please visit your TCU so you can be certain of the types of patients you would be likely to get, the nurse/patient ratio, and how that unit will function. Please don't rely solely on what I've said because it might be very different for you. Good luck!
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?
I'm currently working transitional care. I started my career in psych, moved to long term care--which I very much enjoy--but because of the need for full time hours, moved to the transitional care unit. I'm working nights, which I wouldn't necessarily recommend for a new grad. The unit I work on, during the day, has 2 nurses, each with up to 8 patients, dealing with a wide variety of medical issues. Lots of hips and knees of course, but also CABGs, back surgeries, wound care, respiratory issues, dealing with PICCs, catheters, IVs, feeding tubes, new colostomies, etc. I very much enjoy it. You get to build more of a relationship/rapport with the patients than you can in med/surg but unlike LTC, the goal is for them to get better and go home.
On a side note, I've not yet found the transitional care "specialty" section here on allnurses--or is it lumped in with LTC?
I'm working nights, which I wouldn't necessarily recommend for a new grad. The unit I work on, during the day, has 2 nurses, each with up to 8 patients, dealing with a wide variety of medical issues. Lots of hips and knees of course, but also CABGs, back surgeries, wound care, respiratory issues, dealing with PICCs, catheters, IVs, feeding tubes, new colostomies, etc. I very much enjoy it. You get to build more of a relationship/rapport with the patients than you can in med/surg but unlike LTC, the goal is for them to get better and go home.
How many beds does your TCU have? And generally, how many nurses are there on nights? I don't know which shift I would get, but is the rationale that nights might not be for new grads because they assume pt/residents require less interactions at nights, hence a greater patient to nurse ratio??
One thing to consider about transitional care and/or hospice is if they're run as a SNF, they might not be 12 hour shifts but rather 8s. I'm not sure if that would effect you and your current situation, but it's something to consider.
I was originally offered a transitional care unit in an acute care hospital where I would be working with up to 8 pts, 5 if they had IVs and IV antibiotics. I was going to take it until I found out that the RNs were pulling 5 days a week, and you were not given days off together. Additionally they were floated to the hospitals SNF at another location about 60% of the time...It will definitely hone your assessment skills because you won't have them on monitor/etc and will have to go off symptoms and signs.
One thing to consider about transitional care and/or hospice is if they're run as a SNF, they might not be 12 hour shifts but rather 8s. I'm not sure if that would effect you and your current situation, but it's something to consider.
I was originally offered a transitional care unit in an acute care hospital where I would be working with up to 8 pts, 5 if they had IVs and IV antibiotics. I was going to take it until I found out that the RNs were pulling 5 days a week, and you were not given days off together. Additionally they were floated to the hospitals SNF at another location about 60% of the time...It will definitely hone your assessment skills because you won't have them on monitor/etc and will have to go off symptoms and signs.
Yes, good point about 8 hour shifts. That's the way it was for me and I didn't care for it. The only time I got 2 days off together was my weekend off. We had no SNF to float to but we might have been asked to float to another unit/floor in the hospital if staffing required it.
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?
I worked on a TCU within a SNF right out of school and loved it. Loved it so much that I actually stayed for four years before going to acute care. While the acuity/interventions needed to do were less, they were still sick patients & your suspicions are correct that it means more patients per nurse. I typically had between 8 & 12 patients that I was responsible for. Not sure if that would be different in a hospital based TCU. You still need to do frequent assessments and are still handling a lot of medications and treatments and I found that it helped my time management a lot. Maybe it would be a good opportunity for you, provided your NM also explains what her specific concerns about your performance are. Good luck!
Been there,done that, ASN, RN
7,241 Posts
"It is a pisitive." Is that a typo , or a Freudian slip?