Bored in ambulatory care

[Lizabeth1115]

I am a RN 5 years now, started out in Med sure/rehab for 1.5 years and then got job in ambulatory care in NYC. I was so glad to come to city but I hate to say it, ambulatory care has made me lose all my clinical skills. All I do is telephone triage and clinic visits. I have now been in it 3.5 years and am scared to go back to acute care because I am worried it will be a drastic jump. I loved the excitement of it but had bad anxiety before. I miss learning however and sometimes I think I assimilated into ambulatory care too soon. I am thinking of possibly taking the jump and switching my hospitals urgent care, its not like a typical ER, we are a cancer institution and it would only be our own patients, so hopefully less crazy than an ER. I am 32 and want to gain more acute care experience while i am still fairly young. I am lacking a lot of confidence however and feel scared. Anyone else made this type of transition?

[theRNJedi]

Ambulatory nursing is a unique nursing specialty with it's own clinical environment, schedule, patient population, and workflow. Even among ambulatory settings, they range widely in scope of services and operations with varying patient populations. The beauty of the nursing profession is that it is vast with a specialty and niche for every person. I would suggest that your role as a triage nurse and clinic is STILL nursing...and it possesses its own set of clinical skills too; albeit they are different than providing bedside care in an acute care setting. Neither is better or inferior to the other, it's just different.

However, if your interests lies in acute care, then make the jump. You may need some orientation but in time you will be surprised how fast you'll acclimate back to that environment.

-theRNjedi

[dishes, BSN, RN]

I think you are underestimating the value of critical thinking skills and overestimating the value of clinicals skills. You can make a lateral career move back into acute care, but it is not the only way to rejuvinate your interest in your career. Consider gaining a deeper knowledge of ambulatory care, become certified, join an ambulatory care nursing association, attend conferences, network with nurses who are experts in the field, it will give you a new perspective on your practice.

[JimmyDurham9]

I can see where you're coming from, but like it was said before, you may be underestimating the value of critical thinking skills. I may be in the minority, but I think a nurse with strong critical thinking skills can easily overcome a perceived lack of clinical skills, so long as they don't let anxiety get the best of them. With those critical thinking skills, you can figure your way out, and in a safer manner than a nurse who is purely rote clinical skill programmed.

TheRNJedi is absolutely right, ambulatory care is an incredibly unique specialty. I LOVE ambulatory care settings because they offer me the nice balance of somewhat stable, but also anything could happen at anytime situation. BUT that depends on your setting. If you work in a call center for an insurance company doing nurse advice line work or primarily function to triage phone calls for a clinic or hospital, then yeah, I could see your boredom. Sidenote- telemedicine is making strides - those telephone triage skills you're honing may come in handy in the future.

Urgent Care and Minute Clinic settings are good places to find a nice balance that isn't too overwhelming like acute care or even an ER might provoke. You get your primary care type cases, then you get someone who has a gnarly laceration, then someone comes in with chest pains and nausea x 3 days, or someone unexpectedly drops in the waiting room. It's a grab bag of interesting variety. I love working urgent care and primary care.

You might also want to consider occupational health nursing. Many corporations/factories have clinics for their employees and sometimes even the employees' family members. Depending on the industry, you could see anything from heart attacks, sinus infections, to amputations. I also loved occupational health. I found my occ health experience to be far more autonomous than any other nursing position I've ever had. I tend to work well independently and know my limits and how to follow protocols, so I had no problem assessing and stabilizing potential heart attacks and controlling bleeding from amputated fingers until the patients could be transferred to higher acuity care.

[MsBruiser]

I actually did something similar to what you did. Found myself working ambulatory and then taking a detour into administration. After 3.5 years, I was bored to tears. I managed to talk my way into a PRN job doing critical care transports (my background was ICU/PACU before ambulatory). By the time 5 orientation shifts were over, I felt pretty confident about taking care of critically ill patients in a little bouncing box racing down the road. Your inpatient skills are still luring inside of you - they just need a few shifts to make their appearance. Stop doubting yourself and give it a whirl - if it doesn't work the chair / telephone wills till be waiting for you at the ambulatory clinic.