Embarrassed to be transferred after one month..

Pediatric Critical Care Columnist · Apr 13, 2009

You've just become the embodiment of a huge issue in nursing that many people choose to ignore... that nursing school is only the first step in becoming a competent nurse. All the highly publicized methods of decreasing the nursing shortage by increasing school spots have the same problem: there isn't enough time or resources to give students a really solid education in applying the theories and the formulae and the algorithms they learn in school to what happens in real life. It's like a dirty little secret. And I for one do NOT believe that critical thinking can be taught. It's something that evolves out of a combination of education and experience. Oh, and then there's the inescapable truth of rushed orientations; we've all heard about hospitals that are counting orientees in the staffing numbers (meaning they're expected to carry their own full patient load whether they're ready or not) or units that cut orientations short when staffing problems occur... "She's already had a month of orientation, what more does she need to learn? She can take a patient load tonight. She'll be fine."

Now having climbed down off my soapbox... Medicine is about the most challenging area to start out in because all those darling patients have multiple comorbidities, a zillion meds, complex metabolic needs and special diets, psychosocial issues, difficult families and a nurse to patient ratio that borders on insane. Is it any wonder that the new nurse drowns in such a milieu? In your case, the powers that be have said they believe in your abilities but think you need more time to develop your skills. That's not a failure on your part, but it is a reality that affects lots and lots of new nurses. You're going to learn something new every day that you work as a nurse, for as many years as you work as a nurse, because that's the nature of our profession. And every day you'll put things together that you didn't know went together, and you'll find some things have become ingrained. That's how we develop as nurses. Take the opportunity to find a slower pace where you can work out the kinks. You have a lot of support, whether you feel it or not. You'll know when you're ready to move on to a more challenging workplace.

caliotter3 · Apr 13, 2009

I find it encouraging that your managers are so willing to work with you. It is far better to be transferred after one month than to be let go after one month. Take this as an opportunity to learn at your own pace and be thankful that you are being given this chance. Good luck.

rn/writer, RN · Apr 13, 2009

Should you be embarrassed? Heavens, no! You are one fortunate nurse to have managers that care about your future, even as they acknowledge that you need a bit more experience to fit in well on their unit.

Many nurses either get shown the door or go looking for it themselves as the workload proves to be too much too soon. Shortened clinical times turn out nurses who don't have the necessary experience to work safely and efficiently on a busy floor. This comes with time and practice, and there really aren't any shortcuts.

The fact that your managers have told you not to quit nursing and that they are willing to help you make the connections necessary for a slower-paced job says they recognize your potential and want to see you fulfill it. Instead of feeling dismayed, take their interest as a vote of confidence. They wouldn't waste precious time on someone who wasn't at all cut out for nursing.

My guess is that they hope you'll come back to them when your time management and critical thinking skills are up to snuff.

I wish you the best.

EwokRN · Apr 13, 2009

Thanks for both of your comments. My SIL, who's a 20 something year vet of Nursing, reminded me how helpful this board is.

You know, I just bought a book from B&N called "Your 1st year as a Nurse" by Cardillo. So far, it's very helpful. I find it kind of discouraging though how in the book which was copyrighted 2001, mentioned that orientations are 3-6 months long for new nurses. I was reminded how some nurses at this local naval hospital was telling me how orientation there is about 3 months long. In this unit though, which I'm technically still a part of, the Medicine unit's orientation is 6 weeks long! Great! Wish I could go to that Naval Hospital, but unfortunately, it's hard to get into that hospital as a civilian nurse.

Well, I just talked with one of the recruiters, and she mentioned that one of the other recruiters might have another unit where I can be hired as an RN and work at a slower pace. I'm hoping this will work out, because the other option of working as an LPN according to one of the recruiters, might make me less desirable to be hired if I decide to go for an RN position.

Trying to keep my mind off this dilemma. I'm just glad I'm close to family to help me deal with this problem. Thank goodness there's this board to help me also! Thanks again!

WildcatFanRN, BSN, RN · Apr 13, 2009

Man, I wish I had been "transferred" to another unit after 4 weeks instead of being terminated. Might have made my life easier. I just bought that book too, I should have gotten it sooner. It great that your manager is as supportive as she is. Don't be embarrased or discouraged....things will work out they always do.

SummerGarden, BSN, MSN, RN · Apr 14, 2009

in this unit though, which i'm technically still a part of, the medicine unit's orientation is 6 weeks long! great!

my hospital has varying degrees of orientation, from 6 weeks to 6 months. at my hospital the nurse educators do not get to kick you off of orientation before you feel ready. it is a hidden secret that the floors do not tell the new grads.. i found out through hr. this may be the same for you too... i encourage you to request that you be allowed more time on orientation if you do not agree that you are ready to be released. :twocents:

by the way, spread the word about the need to be a tech and/or nurse extern before graduation. i know so many new grads who have a hard time because their first hospital job on a clinical floor is as a rn! and like you they struggle with application. nurse externs are future nurses in training. they apply knowledge and have the support of a rn. so much of the critical thinking i do regarding my patients now, i did as a nurse extern first. good luck to you... you sound like you have a huge support system to include your workplace and your family so you should be able to get up to speed soon.

madwife2002, BSN, RN · Apr 14, 2009

I am so sorry that this happened to you but it is not your fault and I emphasize not your fault. The fault is with these excelerated courses which dont provide the students with enough clinical practice to be able to function. Students come to my floor and stay for half a day with an hour break at 11.30 am and at 13.30 they leave. some days these students sit talking in the back room and do their assignments. They are under such stress to perform academically. When will the schools of nursing wake up and realise students need more hands on practical care, where they are supervised in a safe environment. Some of the preceptors are poor on the floors, firstly they dont have enough experience, they have no clue how to teach, they have poor time management skills yet they are teaching our future nurses-probably because they had poor preceptorship themselves.

Real nurses need to be involved in reommending what a student needs to know on the floor, they need to be there in the planning.

HM2VikingRN, RN · Apr 14, 2009

Mentorship needs to be expanded and supported. When in doubt I talk situations over with my peers. I have 2 coworkers who are very specific resources for problem solving. I pay this help forward by having students shadow me and teaching whatever I can.

TX_TeleRN · Apr 14, 2009

Well, they gave me an extended orientation; however, after only 4 days of orientation, they said I need to be transferred to a slower unit to beef up my critical thinking skills, and my application.

I sure hope that orientation would be longer than 4 days! But irregardless, it is great that your managers and HR are willing to help you find another job rather than terminate you.

My orientation class consisted of approx. 13 GNs going into Med-Surg, Telemetry, or ICU. By the end of everyone's orientation (we all came off at different times), 2 RNs were terminated (b/c they "didn't fit in") and by end of 1 year, another 2 RNs either switched to part time or left our hospital. I don't think these departures were all appropriate, as I strongly believe these talents could have been kept if management would help them find a unit more fitting.

I myself am not a believer in the accelerated nursing programs. I too started nursing school in an accelerated program, and I ended up switching to a traditional one without any regrets. Why? Once I made the switch, I realized that I had to relearn and reapply the things I had "supposedly" learned in the accelerated program. Don't get me wrong... I retained the info long enough to pass my exams, but it was too much information in too short amount of time that the material didn't have time to set in in my brain. By slowing down, I could breathe/relax long enough to focus on the concepts and applications.

Nursing is not a by-the-book job, and you must be able to think critically. So don't let this deter you from nursing if you want to be a nurse. Slowing down will only help you focus. Take advantage of your orientation by using your time wisely to improve your clinical skills, and don't be afraid to ask questions. Once you've mastered the skills needed, you can consider going into a higher acuity. Good luck! :[anb]:

jjjoy, LPN · Apr 14, 2009

One of the many frustrating things of being "recommended" to try something "slower paced" or "less critical" is that there is almost no floor nursing out there that is "slower paced." Floors with less critical patients give you more patients to deal with. If a newbie is struggling with time management, transferring to a less critical floor means even more varied demands to keep track of. Transfer to the least acute of settings such as a nursing home and you've now got a whole wing of patients you are solely responsible for and maybe one other RN in the other wing for support. Not exactly the role you want to be in as inexperienced newbie.

It can feel pretty hopeless as you wonder how you're supposed to bridge the gap when there don't seem to be any intermediary steps.

I'd love to see something like a student extern role for nurses *WITH licenses* who could use an extended period of time "getting up to speed" without the pressure to carry a full patient load ASAP. It would pay less than a full RN position but it could be worth it to some in order to get their bearings in real-world nursing instead of it being a matter of sink-or-swim within 12-18 weeks of new grad orientation/preceptorship.

jjjoy, LPN · Apr 14, 2009

INursing is not a by-the-book job, and you must be able to think critically.[anb]:

I think nursing often uses the term "think critically" to mean "apply clinical experience" or "use one's clinical judgment" Anyone can "think critically" with or without nursing training and with or without clinical experience. A student or new grad can "think critically" all day long AND have the factual knowledge to base logical conclusions on and still NOT have the clinical experience needed for real-world application in a situation with a multitude of constantly changing variables. Just a pet peeve of mine regarding the use of the term "think critically" : )