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?
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?[/Quote]
In my experience, COMPLETELY untrue. Did the people suggesting LTACH ever work there? I have worked LTAC, med-surg/floor, ICU, PCU, subacute... LTACH was faster, more complex, higher acuity than PCU. My hospital discharges pts to LTACHs when they no longer need the ICU, but are too sick for the PCU. Many pts are still on ventilators and on tele. All of us nurses were required to be ACLS certified as well -- not so on any floor I've worked on. Plus, many of these pts had spent weeks or even months in the ICU. Google "chronic critical illness" if you haven't heard of it; it refers to the many complications that develop from such prolonged, serious illness/injury. It results in a level of medical complexity that you generally don't see in med-surg.
My LTACH experience helped me land my current SICU job -- current acute care experience was required. It isn't anything like LTC...the "A" is for "acute."
There is a ton to be learned in LTAC. But slower than med-surg it is not.
Med surg in a small hospital seems like the best choice. Smaller hospitals wont have the sickest of the sick, or the most complex patients. You can get comfortable there, then stretch yourself by crosstraining within that hospital. It will still feel overwhelming, but the first year as a nurse is always hard. Stay for a year before you quit nursing, and watch for opportunities you might enjoy.
Specializes in Psych, Addictions, SOL (Student of Life).
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.
If you are looking for a slower pace and better learning environment I would not recommend LATC. I have done it and you will only get about 3 weeks training and then be on your own often as a charge nurse responsible for the whole floor which may include up to 30 patients.
Can I ask of you got a meeting describing the areas you were lacking in? Was it time management, difficulty mastering skills, Not fitting in well to unit milieu? Four preceptors in 10 weeks looks like they were trying to find a preceptor who was a good fit for you.
If you want to work at a smaller private hospital I suggest that you saturate them with resume's and applications. If driving 90 minutes after a 12 hour shift is not safely feasible you might consider moving closer to a job once you have finished orientation and know you will stay on.
I suggest you take a really honest look at why you did not pass orientation. No matter how unfair or nasty some criticism might seem , I have found I usually own at least a part of it.
For an example; I am a very political person and would often share my views (some of which were unpopular) with anyone. I was not getting along well with co-workers and it was suggested that I tone down the rhetoric. I was initially angry and then I thought about it. I stopped talking politics and within weeks I was getting on better with peers.
Don't give up on nursing just yet - If they did not give you an exit interview then request one and really listen to what they have to say. Take any feedback to heart and make changes where you can.
Resign it is not worth the struggle. If I was you in your position, I would apply to a nurse residency program in Cali or Texas or to state that is not far from your house via a plane. This is temporay relocation. At the new program excel take your time observe and study your collegauges and the environment.
Specializes in Psych, Addictions, SOL (Student of Life).
I also agree that you should gracefully resign. When you are asked that inevitable question of why did you leave your last employer Stay positive no bad mouthing about short staffing or other issues. You can cite the size of the hospital or just say something vague like "It wasn't a good fit for either or us."
Specializes in Case manager, float pool, and more.
Thanks for the words! I just want to be competent, and any advice for how to get there.
That is just something that will take time and gaining experiences. You can watch some YouTube videos on things you feel uncertain of too. I understand that what you have been through has taken it's toll on your confidence. Do take an inventory of why you did not pass orientation. Be honest with yourself and find ways to learn from this. Find a hospital with a good nurse residency program as that can also be of help.
Here.I.Stand, BSN, RN
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