Embarrassed to be transferred after one month..

[EwokRN]

Hi. First of all, let me introduce myself. I'm an older 2nd degree BSN graduate, who just graduated and passed her boards in late Janurary 2009. I was hired on this Medicine unit in February, and I started orienting on the floor on March 2nd. Unfortunately, as of Friday (Apr 10), I was asked to be transferred to another unit, because I have problems applying what I know. Around March 22nd, I found that I pretty much had the same problem. I talked with my mom, a retired RN, and my sister-in-law (SIL) who's worked as a nurse for 20 +years along with her nurse educator friend, and they pretty much told me to eat humble pie, and say that I have a lot to learn. 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.

MY manager and her boss told me that they think I have what it takes to be a nurse, and to not even think about quitting. I'm a little discouraged just because I came through an accelerated program that unfortunately didn't have a high passing rate for boards, and consequently not a good clinical program. Plus, it seems like the recurring theme is that many people received their critical thinking skills through Nurse Aide or Externship programs they received while in Nursing School. I did not.

In the meantime though, I'm still on the Medicine Unit's payroll without pay, so that I can have more access to jobs to look for. My manager asked me to keep her in the loop about what positions that I'm applying for, because it'll ultimately come back on her. Plus, my manager's boss also told me to keep her in the loop as well, which I thought was really nice. I have 30 days to look for a position.

Right now, it looks like some of the LTC facilities through what's called Lifecare is the best option. I'd be working as an LPN under the supervision of an RN. MY manager said right now, the key is finding some RN who's willing to take me under her wing to mentor me. HR actually agreed to phone the manager of Lifecare and see what positions are available.

My mom and my SIL told me that this is nothing to be embarrassed about. Trying to stay positive, but yet at the same time, wish I didn't apply for this Medicine unit, but unfortunately, I was running out of time, and it seems like that there weren't that many positions available in Jan '09.

Sorry just had to vent. Was wondering if anyone could offer any encouragement or similar stories. Thanks.

[EwokRN]

Thanks for all your comments. I actually have another question, and I don't know if anyone can answer it. I actually was able to get an interview at another hospital that offered an extended orientation. The hospital I'm technically employed at offered only a 6 week orientation, while this other hospital (offering the interview) offered a 12 week orientation that consists of 4 weeks classroom, 4 weeks orienting on other units, and another 4 weeks orienting on the unit you're orienting at. The recruiter from the other hospital said that I should expect a call from a Telemetry unit manager within the next couple of weeks. In the meantime, I'm hoping to read "Your 1st year as a Nurse" book by Carillo, and also to get some clinical volunteer experience if possible?

I was told a LTC facility volunteer might be good..if I can arrange with the facility to have me look at how nurses apply critical thinking. I checked into the local volunteer rescue squad, but it turns out they only offer the opportunity to volunteer 4 times/month. Does anyone have any ideas how I can improve my clinical application besides just going over my notes from my last job and reviewing case studies with my mom, the retired RN?

Thanks for any input!

[TX_TeleRN]

The hospital I'm technically employed at offered only a 6 week orientation, while this other hospital (offering the interview) offered a 12 week orientation that consists of 4 weeks classroom, 4 weeks orienting on other units, and another 4 weeks orienting on the unit you're orienting at. The recruiter from the other hospital said that I should expect a call from a Telemetry unit manager within the next couple of weeks. In the meantime, I'm hoping to read "Your 1st year as a Nurse" book by Carillo, and also to get some clinical volunteer experience if possible?

I was told a LTC facility volunteer might be good..if I can arrange with the facility to have me look at how nurses apply critical thinking. .... Does anyone have any ideas how I can improve my clinical application besides just going over my notes from my last job and reviewing case studies with my mom, the retired RN?

Can you make arrangements with your family members to see if they can have you shadow a nurse at their current/former employment entities? You won't be able to do hands-on things due to liability issues but it is possible for you to observe procedures/tasks. Continue to review your notes and case studies. They will help you familiarize your thinking process and anticipate/plan what needs to be done.

Our school had us use "Clinical Nursing Skills: Basic to Advanced Skills" by Smith, Duell & Martin that provided an inventory list and broke down step-by-step on procedures. It helps cover the basics before actually performing a task, if you feel nervous that is...

On occasions, I flip through my NCLEX study guide: "Illustrated Study Guide for the NCLEX-RN exam" by Zerwhekh & Claborn. If you are a visual person, this book may be a good tool. I use it as a quick reference to refresh myself when I come across a case that is not familiar to me.

If you are considering telemetry, make sure you study your EKGs and know what needs to be done, as some rhythms are lethal and/or require immediate actions. Your 12-wk orientation will cover this, but it helps to be prepared before class. Class portion will likely be fast paced, so review, review, review! before you get there. During your clinical portion, take advantage of IV starts or anything you can observe or get your hands dirty while you are under the tutelage of a preceptor. ASK QUESTIONS!

As for critical thinking... You may have your book-smarts: symptoms = X diagnosis = Y interventions. Most likely, your patient will have multiple things (current problems as well as predispositions/histories) that are wrong with him/her, and that's where your critical thinking comes mainly into play (i.e., CHF, legs edematous, anemia with h/o MI, DM and ESRD. How do you help this pt???). When in doubt, ask questions from other RNs or charge nurses and learn from it.

Watch how RNs work (i.e., their routines, time management, how they talk to pts/family/docs, how they assess, how they deal with difficult pts/family/docs, etc.). Observe several RNs because each one works differently. When you get a chance, try their methods and see what works for you. Time management is a BIG thing as a floor nurse.

Good luck!

[EwokRN]

Thanks for the advice. Actually, I called some of the other LTC facilities yesterday and left a message with the managers about shadowing, and observing a typical RN day. Hoping to contact them again this AM. My mom called another LTC facility which I remember looked pretty much like a hospital from one of my clinical rotations. One of my mom's friends retired from there years ago. I'm hoping to shadow over there if possible.

I looked into that big 800 pg book on Barnes and Noble website--looks pretty good. I'll check it out today if I can. Thanks again for the great advice.