Career advice?

[R*Star*RN, BSN, RN]

So to start off I'll tell you all a bit about myself.

I started working in the medical field as a CNA at the age of 16. I worked in LTC as a CNA for 9 years before I became an LPN and then continued to work in LTC. After another year in school I had achieved my ADN and RN license but could not find work as an RN in acute care, so took a job as a camp nurse for the summer after graduation.

Finally I found an RN Residency for new graduates and moved 2,000 miles away from home to accept this position. I worked swing on a surgical unit, and loved it! We took patients preparing for and returning from many types of surgery including lap-appy, lap-chole, hernia repair, bowel resection, fem-pop, etc. After a 1.5 years on this floor, my family and friends were pressuring me to "advance" my career as an RN. I had already returned to school and started a BSN program but this was not enough.

And so I moved to a cardiac step-down unit. Pre/post CABG patients, acute MI, post-cath, pacemakers. I was in love with this job during my orientation (3 months on day shift) but then things changed.

Firstly, our scope was broadened to exclude the word cardiac -- so while we still get cardiac patients, we are now an ICU overflow and get anything they don't have room for. So sometimes I am taking care of patients who should be in the ICU but instead of a 2:1 ratio we have a 4:1 ratio. Secondly, I am now on night shift. I have been on nights for 1.5 years, and it has made me ill -- in the past 1.5 years I have had every illness known to man, gained 40 lbs, can't sleep even with Ambien 10mg, and worst of all I feel like my mind is rotting. I had to cut back to part time because I am just not adjusting to nights, and I have tried all the tips and tricks I could find to make adjusting possible. I have tried to switch to day shift however there are none available for someone with as little seniority as myself. I have even had to stop going to school because my grades were dipping -- I couldn't stay awake during classes or concentrate on homework when I got home.

My main issue, other than feeling sick and tired, is that I don't feel I am making a difference in people's lives. I am watching them sleep, taking care of toileting needs and the occasional pain med. I became a nurse to help people and maybe see a patient smile once in a while. . .

I've been an RN for 3 years. I've been in patient care for 13 years. I am not sure if I'm burnt out on night shift, burnt out on nursing/patient care in general, or just need a change. I'm beginning to wondering if moving to day shift will change the way I feel (I know I'll sleep better), though within the hospital there are no day shifts available that I am qualified for. I've been applying to various day positions for over a year with no luck.

So, I am not sure where to go from here. Do I look for a position outside the hospital? Maybe in home health or clinic nursing? Do I hold out for a day shift why may take a very long time? Or do I simply resign to my lot in life and stay "stuck in a rut"? I feel trapped.

Any ideas or suggestions, tips, comments ,etc are much appreciated.

~R

[martymoose, BSN, RN]

omg I had to check to see if I wrote that!!I am in the same situation, except on nights we get 7!!!!and yep- some of these guys should stay in the unit.

As to what to do- maybe if you like the critical care aspects, maybe put some time in the icu- since you are practically taking care of those types of pts- and then maybe transfer to the cath lab- thats mostly days, but some on call responsibilities. my friend does this and has a fairly normal life. I didnt do this as i am not cut out for critical care. maybe its worth a try for you. good luck

[ikarus01]

I wasn't clear from the post---so did you finish your BSN that you started?

Have you looked at other fields within nursing to get away from patient care? Are you stuck in the same geographical location, or can you move to another area?

I was in a similar type of position 5 years after being in nursing and i decided to get a different degree all together. I used my nursing experience to work part time and support myself, but i stopped working the 40-60 hours a week, and went down to at most 20, and that made such a big difference in my life.

I believe nursing gives you a lot of options and is not good for your health to feel stuck in a rut. I know i felt that same way a few years ago, but that experience gave me the inspiration to get the hell out of the rut, and find something better. At least nursing gave me the chance to work weird shifts so that i could go back to school.

Definitely, consider other alternatives as life is too short to be stuck in a rut.

[R*Star*RN, BSN, RN]

Thanks for your replies :)

Unfortunately all ICU positions are night shift as well, and when I spoke to the manager she said (as expected) that staff who want to move to days go in order of seniority.

I didn't finish my BSN -- I have about three quarters left. But the lack of sleep has really gotten to my concentration and focus so I took time off with intention to return sooner rather than later.

I've been asking around, but everyone has vastly different opinions on the subject of what I should do next. But I'll let you know when I figure it out :)

[HouTx, BSN, MSN, EdD]

This is a terrible situation for such an obviously conscientious and caring nurse. After re-reading the OP, it would appear that the 'root cause' was most likely due to poor leadership. Organizational changes that affect the patient population of a unit MUST include some carefully planned staff education and training. Otherwise, you end up with the very real possiblity of completely eroding the underlying quality of patient care. Perfectly competent cardiac nurses do not automatically become competent generalists without adequate preparation and training. Although it is very popular, "Just suck it up" is not a good management strategy. I am NOT laying blame at the unit manager level... this was probably a strategic (high level) change and she was not able to refuse.

I would advise the OP to approach her manager with a logical and well-reasoned request for additional training and opportunities to improve competency on the new types of patients they are now taking care of.... better late than never.

As far as working nights.. that may a bit tougher. There is a lot of literature out there on the best way to adapt to nights, but not everyone can do it. Talking to HR would be a good idea. I am sure they don't want to lose such a good nurse.

[martymoose, BSN, RN]

This is a terrible situation for such an obviously conscientious and caring nurse. After re-reading the OP, it would appear that the 'root cause' was most likely due to poor leadership. Organizational changes that affect the patient population of a unit MUST include some carefully planned staff education and training. Otherwise, you end up with the very real possiblity of completely eroding the underlying quality of patient care. Perfectly competent cardiac nurses do not automatically become competent generalists without adequate preparation and training. Although it is very popular, "Just suck it up" is not a good management strategy. I am NOT laying blame at the unit manager level... this was probably a strategic (high level) change and she was not able to refuse.

I would advise the OP to approach her manager with a logical and well-reasoned request for additional training and opportunities to improve competency on the new types of patients they are now taking care of.... better late than never.

As far as working nights.. that may a bit tougher. There is a lot of literature out there on the best way to adapt to nights, but not everyone can do it. Talking to HR would be a good idea. I am sure they don't want to lose such a good nurse.

OMgosh- thank you for validating my exact thoughts! This is exactly what has happened in my unit. We used to be very specific- postt pci, all cardiac, intermediate CARDIAC pts. Then they got a new ED director and he says we have to take everything now. Stuff we don't have experience in , because we used to have a fairly routine cardiac population. So now we are taking things we are not familiar with, and esp. on nites its hard to get training. was just saying to my self last night- well, as much as I hate critical care, since we have to take these types of pts , I might as well just go to the ICU and be properly trained. If you can't beat 'em, join 'em.

[CrunchRN, ADN, RN]

Go for day shift outside the hospital. What do you have to lose?