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!
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.
Sounds like they are either too busy themselves or rude, selfish, and unfriendly. Maybe they feel like they're not getting paid to teach, so why should they? Or maybe they are malicious dogs who forget how it was when they were new. Or ??? is there a Charge Nurse you can turn to for occasional help?
I can't say which path you should choose, but I do wish you the best.
Do look up the protocols and procedures/policies. Read these manuals thoroughly and repeatedly. Memorize them.
Sounds like they are either too busy themselves or rude, selfish, and unfriendly. Maybe they feel like they're not getting paid to teach, so why should they? Or maybe they are malicious dogs who forget how it was when they were new. Or ??? is there a Charge Nurse you can turn to for occasional help?
I can't say which path you should choose, but I do wish you the best.
Do look up the protocols and procedures/policies. Read these manuals thoroughly and repeatedly. Memorize them.
Malicious dogs? The other nurses are too busy to "come and show OP how". As charge nurse, I would help anybody, anytime, anywhere... but I had to prioritize.
Reading P&P thoroughly is not feasible, in real time. "Hold on Mr. Smith.. while I read P& P as how to bag and instill to relieve that mucous plug":sarcastic:
It's a see one, do one, teach one world . OP needs to get more hands on experience at a slower pace.
There isn't a specific transitional care section. Many poster in the LTC forums speak about these kinds of units. There is also a rehabilitation nursing forum but I find it is quieter than the LTC forum and seems more like people post about acute rehab settings there. I enjoyed my days in TCU, and even though I was last there over 4 years ago I still enjoy talking about it :-)
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?
Everyone's feedback so far has been nothing short of supportive and informative. I've done some research on TCU, but I still would like to have someone be able to sort of list out the main differences between that and medsurg. I know that ms is more fast-paced, dealing more with pt in their acute phase of illness, are generally unstable (tho not as critically unstable as icu), and pt stay is usually less than 3 days. But I would like to know some more of the key differences between that and TCU, because so far, my impression is that TCU has more patients per nurse, yet it's somehow considered 'slower paced' and 'less acute'? I also thought about patient load, and so I briefly thought about OR (one pt at a time!), BUT I want to keep getting chances to do skills like wound care, dressing changes, feeding tubes, etc that you would normally get to do in M/S (one of the things I absolutely LOVED during M/S), but putting it all together, it kind of sounds like TCU would be equally as acute as m/s?? And that is what my NM was concerned about, is that the floor's acuity level is not a good fit for someone like me, hence why they suggested a transfer to another unit?
I'm sorry for all the questions. I just really want a clear picture of the key differences here. :S I am grateful for everyone's feedback on my previous questions. This thread's replies have helped me get some confidence back in myself.
Everyone's feedback so far has been nothing short of supportive and informative. I've done some research on TCU, but I still would like to have someone be able to sort of list out the main differences between that and medsurg. I know that ms is more fast-paced, dealing more with pt in their acute phase of illness, are generally unstable (tho not as critically unstable as icu), and pt stay is usually less than 3 days. But I would like to know some more of the key differences between that and TCU, because so far, my impression is that TCU has more patients per nurse, yet it's somehow considered 'slower paced' and 'less acute'? I also thought about patient load, and so I briefly thought about OR (one pt at a time!), BUT I want to keep getting chances to do skills like wound care, dressing changes, feeding tubes, etc that you would normally get to do in M/S (one of the things I absolutely LOVED during M/S), but putting it all together, it kind of sounds like TCU would be equally as acute as m/s?? And that is what my NM was concerned about, is that the floor's acuity level is not a good fit for someone like me, hence why they suggested a transfer to another unit?
I'm sorry for all the questions. I just really want a clear picture of the key differences here. :S I am grateful for everyone's feedback on my previous questions. This thread's replies have helped me get some confidence back in myself.
I understand the desire to know as much as you can and I think you should. But though you can gather some information from the experiences of others, no one except the nurses who actually work in your TCU will be able to address your concerns adequately. All TCUs will have some differences in the way that they operate which may not apply to your situation, so you would be doing a disservice to yourself to make a decision solely on the experiences of anyone who has not worked in your TCU and then find that the information that you relied on was not accurate.
I understand the desire to know as much as you can and I think you should. But though you can gather some information from the experiences of others, no one except the nurses who actually work in your TCU will be able to address your concerns adequately. All TCUs will have some differences in the way that they operate which may not apply to your situation, so you would be doing a disservice to yourself to make a decision solely on the experiences of anyone who has not worked in your TCU and then find that the information that you relied on was not accurate.
I see your point. Then the best action is to try see if it's possible to shadow or go see the unit, and then make my decision. I don't really want to make the decision on the spot, so I'm praying that management will allow me to go to the unit and observe before I have to make a decision on where to go.
I see your point. Then the best action is to try see if it's possible to shadow or go see the unit, and then make my decision. I don't really want to make the decision on the spot, so I'm praying that management will allow me to go to the unit and observe before I have to make a decision on where to go.
Yes! But since the TCU is actually part of the hospital (?) you work for, there shouldn't be a need to do a formal shadowing at this point if you aren't ready to make a decision. Me? I'd just visit the unit for a half hour or so when you won't be interrupting the workflow and just talk to the nurses without anyone on your floor knowing you are going. Do it on nights so management won't be there. Or go during a lunch break if possible. If you still have questions or if it's too busy for the nurses to talk to you, maybe one or two of them would consent to talking to you on the phone outside of work to answer questions. If you still have an interest in the unit after that, ask to formally shadow someone. There's more than one way to skin a cat!
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??
My facility actually has 2 transitional care units, each with 16 beds. During the day, two nurses staff each unit with a max of 8 patients while at noc, there's one nurse to the 16 residents. Now, the evening med pass is a breeze--the first SNF I worked at, I was the only nurse for 48-53 residents, so I got pretty efficient at the med passing business--16 is easy peasy. But, at night, there's little to no back-up for emergent situations, which do occur. We are getting people sooner from the hospitals, so they are sicker and more delicate. Most get stronger and go home, but there are some who experience respiratory or cardiac issues, infections, complications r/t the emergency surgeries that they went to the hospital for originally, so you have to be pretty on top of your assessments and dressing change knowledge, and be willing to actively advocate for your patient if you see something amiss. During the day, there's another nurse, the unit manager, and others around in case something occurs, while at night, you really don't have a lot of backup. Our facility requires that all the nurse managers, and all of the nursing administrators (from DON down) to take call, so you can always call them, but it's not quite the same as having another nurse in the building with you.
As far as less acuity at noc because all the patients/residents are asleep--that's kind of a running gag with noc shifters. It can be quite busy, especially since you generally have fewer people to answer lights, help people to the bathroom, deal with outbreaks of Noro-virus and other such things. I actually prefer nocs partially because there are fewer managers around, getting in the way of me doing my job, but probably at first, I'd recommend a new nurse stick with days--you'll get more exposure to the different jobs that the PT, OT, ST folks do, deal with more of the dressing changes, so you'll see more wound care (which I find fascinating), and not be alone in crises.
If your facility has an in-house hospice facility, that's worth checking out too. I'd love to do hospice, but right now with my Dad dealing with stage IV lung cancer, his chemo not working well anymore and me looking at going through hospice stuff with him, I don't think that's the place for me yet. It's a special privilege to be part of someone's last days, to help make that terrifying event less terrifying to the patient and the family, to be part of easing fears, finding solutions to difficulties as they come and finding ways to truly be a patient advocate. Sometimes that means wading into icky family dynamics, going toe-to-toe with providers, and encouraging the proper use of pain medications--which many people don't want for fear of becoming addicted. Even as they lay dying. It may not be med/surg, but it really encompasses the full range of nursing skills and is an honorable use of your days/nocs.
Kooky Korky, BSN, RN
5,216 Posts
Sounds like they are either too busy themselves or rude, selfish, and unfriendly. Maybe they feel like they're not getting paid to teach, so why should they? Or maybe they are malicious dogs who forget how it was when they were new. Or ??? is there a Charge Nurse you can turn to for occasional help?
I can't say which path you should choose, but I do wish you the best.
Do look up the protocols and procedures/policies. Read these manuals thoroughly and repeatedly. Memorize them.