Changing directions at age 46

[sweetydarling]

I've been a RN since 1998 and obtained my BSN in 2000. I worked in telemetry/PCU/step-down units, took some time off in 2003 (four years) when my second son was born. I returned to work in a PCU and then landed a job in outpatient cardiac rehab. Cardiac rehab has served me well, especially with raising young kids. I took a pay cut when hired at cardiac rehab. The manager stated, "I can't pay you that much for taking blood pressures." I agreed because I wanted the job. In retrospect I should have negotiated. It took a long time to work back to where I was and currently only make 3 dollars more than my PCU hourly rate.

I have worked in cardiac rehab since 2007. For about six months I was working in both cardiac rehab and PCU and decided to transition to cardiac rehab only. I've been breezing along in cardiac rehab ever since -- 11 years of full-time cardiac rehab.

Cardiac rehab is a desirable job in many ways. 8-hour daytime shifts, no weekends, no holidays. I work 7a-3pm Mon, Wed, Fri and sometimes work pulmonary rehab on Tues, Thurs 9a-1p. I work in a private hospital and while we are busy we don't have a lot of employees. The few employees we have tend to stay for years because cardiac rehab is allegedly a highly coveted position where nurses come to "take it easy". We have three employees that have worked for over 25 years in cardiac rehab, one of these employees recently retired.

I mostly work the "floor" of cardiac rehab and my job duties are to hook patients up to tele, take BPs and pulse ox, and assist patients on exercise machines. We address patient complaints of pain, SOB, BP changes, rhythm changes, etc. We also call new referrals and set up appointments and do a lot clerical stuff.

Mostly our days are uneventful with the random rhythm change or c/o chest pain or dizziness or lightheadedness. The majority of our patients are s/p CABG or PTCA/stent, many have heart failure, some have LVADs, some have multiple medical problems. It does require some brain power and I have learned a lot in the cardiac realm, but it's mostly easy stuff and uneventful. Mostly all of our patients are stable and well, or they wouldn't be in cardiac rehab.

I haven't hung an IV or gave a med in over 11 years.

Cardiac rehab is a friendly and low-key environment. We get to know our patients because it's a 12-week program. It's fulfilling because I enjoy getting to know my patients and seeing them improve their fitness and confidence after a cardiac event.

My manager has been sort of spiraling in the last few years because she is burnt out and doesn't want to work. She's disorganized and hyper and doesn't manage the department very well from a clinical standpoint. She goes through the motions and focuses on productivity. She counts herself as an employee but often is so distracted that I pick up the slack.

Most cardiac rehabs have several employees that work on a given day. Usually 4-5, at a minimum three. We have only two each day. It can get hectic and quite busy. With practice I have learned to handle the chaos and I'm pretty good at it.

I have had a desire to change directions in nursing. The older I get the more I feel like I can do anything. Sometimes I want to go back to school and work towards a NP or CRNA. Sometimes I want to try to work ICU or the Cath lab (or maybe the ED) but I don't know if I can get back into these units with my lack of floor experience for the last 11 years. I don't know if I'll regret it.

The cardiac rehab lifestyle is wonderful but I don't work that much and my paycheck isn't that stellar and my kids are getting older (ages 15 and 18) and I'm thinking of making a change. I'm feeling a bit burnt out and feel the need to challenge myself a bit more and make more money -- possibly even doing something PRN and keeping my cardiac rehab job. I have a great work ethic and people skills and I feel like I am a quick learner. My manager says I can have her job when she leaves but I'm not too interested in proving that I'm making money each month and endless meetings. I don't know if I'm cut out for management.

Thank you for reading this long story. Would you willingly return to the floor or ICU? Any advice on what paths to follow? Maybe something else I'm not thinking about? I know the grass isn't always greener, and healthcare can be understaffed and frustrating just about everywhere, but I'm been feeling this desire to switch things up and challenge myself a bit. Thanks for any advice or suggestions.

[cleback]

I'd personally wait until your kids are grown and then see if you still like acute care. You likely won't be able to get a prn acute care position as prn since orientation is usually during the week, likely full time. I'd maybe keep your cardiac rehab job prn of you decide acute care isn't for you. It's a big change, with nights, weekends, and holidays... something that I wouldn't want with school aged children.

Once you get into acute care, then you can evaluate going back to school. For an acute care np or crna, you'd need acute care experience... and honestly for primary care, you may need acute care to accommodate clinical rotations.

Good luck to you.

[Workitinurfava, BSN, RN]

Honestly, your job doesn't sound too bad. Stay put. Most of the places you mentioned require blood, sweat and tears to work.

[guest464345]

I don't have as much nursing experience as you do, but I'll say this: there is no way I would go back to hospital bedside setting. I started out as an ED nurse, switched to public health and loved it, but then started having the same thoughts as you (I need a change! I need to start IV's! I'll lose my skills! The pay is crappy here!) and went back to another ED. The second one was a much better fit than the first - I loved the patients, I liked the variety and my coworkers, I did well there - but it also reminded me very clearly that hospitals are machines that move bodies around to bill insurance, and nurses are as disposable as thermometers.

If your post said, "I always had this lifelong passion to be an ICU nurse, and I'll never be happy until I try it" - that's different. "I'd like something different, and I'd like a little more money," to me, is not enough to sustain you through sleep-and-diet-destroying 12 hour shifts working at nearly your maximum physical and mental capacity all the time, for the months or years it'll take to become proficient.

I'm 48 and I certainly know nurses in the ED and ICU at this age - it's possible. I'm in great shape, I run and lift weights, and I have a high level of energy; I managed it and probably so can you. But the thing is, do you want to put other stuff aside to work that hard? There are rewards but....It is really. Hard. Work.

My thought is to challenge your mind or change the setting in another way. (for me, I love public health but was in an epidemiology position in an office, and I wanted to see humans - I became a high school nurse). Research nursing, occupational health, travel medicine, maybe an outpatient clinic in a different specialty, home care, public health....there are other jobs out there with reasonable hours and working conditions. I don't think you need to make such a huge jump unless it's really your passion.

[sweetydarling]

Thank you for answers and advice. I’m still contemplating going back to school.