Could Not Make It Through The Orientation Of My First Job

[frenchxtoast]

Graduated in May 2016, struggled with the BRN and NCLEX for about a year. Started my first job at an acute care hospital in CA in September. Spent about 4 weeks in the ICU before being transferred to "med surg" (used to be a PCU, still has patients with drips, etc and some straight up ICU overflow), where I had 6 weeks before being told by my final preceptor that he was not going to recommend me to be on my own because I was still struggling too much. This is the end of the orientation, I'm out of time and have been given the option to resign rather than be terminated.

I'll minimize the details of the experience being understaffed, not giving me the promised full time hours for training, poor resources, and having 4 different preceptors over 10 weeks.

I tried to get my foot in the door in acute care by driving about 90 minutes each way to work 12 hour night shifts, and have come to the conclusion that this is not something I can manage safely.

I'm pretty sure its too late for me to get into any new grad programs (I've applied to many), but in spite of this setback, I feel I learned a lot in a very short period of time. I do not want to give up on acute care nursing, but need a less chaotic environment with a slower pace to learn in. My senior preceptorship in school was on med surg, and my preceptor told me he was confident I was prepared to work on a med surg floor, but the private hospital I precepted at seemed much better managed than this one. Unfortunately, I have been unable to even get an interview at such a hospital so far.

Are there any options anyone can suggest for learning at a slower pace? I wouldn't mind being paid less for a safer learning experience, I just want to build a strong foundation for my career at this time.

I've had long term acute care (LTAC) facilities suggested to me as a slower paced learning environment than normal acute care. Can anyone offer experience about the truth of this? Would it look good on a resume to a regular acute care hospital or would it be more like long term care? If long term care becomes my only option, any suggestions for how to maximize my learning experience to give med surg another try?

Thanks for reading!

[Gary Mendoza]

What are you struggling with? Time management? Medication calculation? Something else? What you're struggling with would be helpful in making a recommendation.

[CharleeFoxtrot, BSN, RN]

I've had long term acute care (LTAC) facilities suggested to me as a slower paced learning environment than normal acute care. Can anyone offer experience about the truth of this?

In my experience, the LTAC is not a slower environment at all as far as learning the ropes and has a far higher patient load with fairly high acuity once you are cut loose on your own.

[KatieMI, BSN, MSN, RN]

"Acute" LTACH is med/surg on high dose steroids and not a place I would recommend for start. "Subacute" (also known as "acute rehab") is a possibility.

Figure out what exactly you struggle with and what you do good and play from there. The aforementioned acute rehab will give you time management skills for lifetime, for one example. Try smaller facilities if you are not comfortable with constantly changing preceptors and faces.

[SaltySarcasticSally, LPN, RN]

4 weeks isn't nearly long enough training for a new grad on an ICU floor. I got 8 weeks as a new grad on a Tele/MS floor with the option of 12 weeks if needed. And we do not take ICU overflow but we do manage lasix, cardizem, and heparin gtts.

I was an LPN for 8 years before my RN and I really struggled in orientation the first 4 weeks. Mainly because I had a different preceptor every week and just because our floor is rough at times. Once I had a steady preceptor and had consistency, things got much better. I'm a person who likes variety but I need consistency during training when in a new environment. Having so many different people teach me in so many different ways the first 4 weeks was too much. It sounds like you had similar issues. I also did much better once I was on my own because it was then I could see the big picture of my whole routine.

If you can't get back into a MS position any time soon then I would try a SNF. I worked in SNF as an LPN and many now are similar to MS units (sans a few things of course) because people get kicked outta the hospital so early now. It will build your skills and confidence plus the patoents will (hopefully) be less critical. The ratios can be high but the charting not as involved. You have the same residents weeks at a time so your not learning a new patient every shift.

Try that, build your skills 6 months-1 yr and re-apply to acute care. I think yo7u will be surprised at how much more comfortable you will be in the hospital after some time in SNF.

[Crush]

4 weeks isn't nearly long enough training for a new grad on an ICU floor. I got 8 weeks as a new grad on a Tele/MS floor with the option of 12 weeks if needed. And we do not take ICU overflow but we do manage lasix, cardizem, and heparin gtts.

I was an LPN for 8 years before my RN and I really struggled in orientation the first 4 weeks. Mainly because I had a different preceptor every week and just because our floor is rough at times. Once I had a steady preceptor and had consistency, things got much better. I'm a person who likes variety but I need consistency during training when in a new environment. Having so many different people teach me in so many different ways the first 4 weeks was too much. It sounds like you had similar issues. I also did much better once I was on my own because it was then I could see the big picture of my whole routine.

If you can't get back into a MS position any time soon then I would try a SNF. I worked in SNF as an LPN and many now are similar to MS units (sans a few things of course) because people get kicked outta the hospital so early now. It will build your skills and confidence plus the patoents will (hopefully) be less critical. The ratios can be high but the charting not as involved. You have the same residents weeks at a time so your not learning a new patient every shift.

Try that, build your skills 6 months-1 yr and re-apply to acute care. I think yo7u will be surprised at how much more comfortable you will be in the hospital after some time in SNF.

A SNF would be a good option as stated above. Same patients so you eventually have your pace down pat and when you get a new patient you may have more time. Maybe even doing part time at a SNF and part time in another area for even more experiences? If your interest is in acute care only then try different floors and areas before going into ICU might be a good option.

[Guest716906]

Hello,

I can relate a little to this. My advice is try med surg first. It's VERY chaotic but not quite as anxiety provoking as the patients are not quite as sick as tele/icu/stepdown. Work your way up so you feel comfortable. Also ASK ASK ASK nurses at other hospitals what is it REALLY like to work there. Find a hospital that seems a little decent. A lot of places I have worked at are just straight up dangerous and I barely survived. I have been doing tele for 3 years now and super burned out, but ready to switch to ICU or ED. I hope this helps

Also* I would not advise LTC or SNF, I have heard you can get up to 20 patients.. my hats off to those nurses. I couldn't make it 5 minutes

[frenchxtoast]

I was struggling with both time management and nursing skills. My strengths were communication, SBAR calls, charting, and basic care (I was a CNA for 4 years.) I really want to improve in both time management and skills, that's why I wanted to start in med surg, but the manager flat out told me they just don't have much time to train, they pretty much need skilled nurses right off the bat, which is frustrating because my school always told me my first job would teach this stuff.

[frenchxtoast]

Thank you for the feedback, I'll look for subacute rehab then!

[frenchxtoast]

Yes, the license risking patient overload is a fear of mine in SNF as well. I worked in a few as a CNA. I guess it depends heavily on which SNF you go to. Will this look decent on a resume for a med surg position?

[rkitty198, BSN, RN]

I just want to say that I am proud of you. Proud of your humility and your passion for patient safety. I have seen many new nurses who are not ready for acute care continue because of the money, their friends are there or they are not humble enough to know that they are placing their patients in danger.

One nurse in our facility had a patient with an NG tube for 2 days for a bowel obstruction draining white foam. They were flushing it with water and meds, the patient would cough. The patient was struggling to breathe and I went in and said I was calling a code blue. He yelled at me "get out of my patients room!" I called the code blue. Patient quit breathing and had to be intubated. Patient had 4 liters of bile in his stomach, was aspirating silently, the NG was in his lung.

The patient did not have a good outcome.

This nurse quit a few months later to work in the ER because he was "bored." I shudder to think about those patients. All he received was education we all had to take about NG tubes.

I wish he was as humble as you are.

With this post I can see that you are going to make a great nurse, maybe not a critical care one right away, but a thoughtful, humble one.

[canoehead, BSN, RN]

I think you will make it as a nurse, but you will need more time to get all the organization skills under your belt. You can organize, you were busy as a CNA, but this is a different set of skills and priorities, with more at stake. It's a lot more pressure to do the right thing. Probably you're putting extra thought into everything you do, and it takes more time. That's a good quality to have, but it's tripping you up when there are so many new things to digest.

You may not be ready for critical care for years, if ever. Took me twenty years to get competent enough to do ER, so that's not a put down, we just digest things differently from those new grads that skate into the trauma room their first day!

Ask during your interview about the supportiveness of your coworkers. That's going to be the saving grace, no matter what type of nursing you decide on.