Fairly new nurse needs advice

[nurse1045, BSN]

I graduated last Spring with my BSN. Since then I’ve had 2 nursing jobs. One was working on a med-surg unit for 3 months and the other was working as a Covid vaccinator for 2 months. The first job I was terminated from on the last day of my orientation because I couldn’t handle the work load and I made some med errors. My second job was only temporary and ended about 2 weeks ago.

I don’t know what to do now. I’m unemployed and not completely sure what area of nursing is right for me. I do know that I hated my med-surg job, but it could have just been that hospital. What I didn’t like about it was the unit was understaffed and I ended up having too many high acuity patients to take care of at once. Sometimes there wouldn't be any secretary or nursing assistants on the unit so I would have to do their jobs, too. I also didn’t like the constant phone calls from doctors, family members, lab, etc. 

As far as the Covid vaccinator job, I actually liked it a lot more than my first job. It was fast paced at times, but I was only dealing with one person at a time.

So I’ve been thinking a lot about what I should do. I have less than a year of experience and most job listings require more than a year. For my area, this mostly leaves me with choices of home care, long term care, and med-surg.

At one point I was considering long term care, but then I interviewed for a position and they told me their nurse to patient ratio was 1:25. I can’t see myself taking care of that many patients at a time and it doesn’t seem safe. I also know I would be miserable and way too stressed.

One option I’m considering is going back to college to get my school nurse certification. This would take 3 semesters though and I’m not even completely sure if that’s what I want to do. Some other areas I'm interested in, but not yet qualified for are: post-partum, nursery, and doctor's offices/clinics.

I feel like I’m all over the place and I need some advice. Thanks to anyone who responds!

[MyAimIsTrue, BSN]

You might like night shift on med/surg. It's definitely a slower pace and you're not having to deal with families, doctors, etc.

[DavidFR, BSN, MSN, RN]

Have you considered occupational health if you liked dealing with people as they came in one at a time? I certainly vaccinated a lot when I was an OH nurse! In the right structure it can be very stimulating. I was in a very dynamic team which took on health promotion and prevention campaigns wthin the organistaion as well. It's  certainly not the fast, full-on pressure of a busy hospital. 

[subee, MSN, CRNA]

You couldn't have been introduced into a new nursing job at a worst time.  Was your hospital innudated with Covid patients?  If that was the case, I'm sorry that had to happen to you.  That would be  compared to working in a war zone.  But I think MAIT's post about the night shift is a great idea if you want that med-surg experience.  Despite having trouble sleeping during the day (but I can't sleep at night, either), it was soooo much calmer and I had time to speak to the patients if they couldn't sleep.  I worked in CCU and we took every precaution to keep the floor dark and quiet for the patients.  It's a better learning environment without the extra stress of family and rounds.

[JKL33]

You have options.

Review what all went wrong in your hospital experience. It may have had a lot to do with "them" and the next place will be a better fit for you and be more prepared to provide supports. But...it may not have been mostly that. Review your part in it, whatever it may have been--such as, did you make basic errors, careless errors, errors that were technically deviations from policy but not necessarily objectively wrong? Were you treated poorly? You don't have to answer here, just think it through. Did you have problems organizing yourself/prioritizing/time management, etc. Review.

If you feel that you could be successful in a hospital, no harm trying it again.

I think you are qualified to learn the routines in a clinic/office setting. Occ health is a possibility, too, as someone already mentioned.

A word of caution about night shift; it certainly isn't a cakewalk. You may not have some of the types of busy-ness that day shift has, but you WILL have more patients, possibly a lot more. I had 12 acute care patients as a new grad on nights. It was a med-surg specialty floor and the patients were sick. In addition, you have to adapt to that sleep/wake routine which is okay for some people and not okay for many others.

[JBMmom, MSN, NP]

52 minutes ago, JKL33 said:

A word of caution about night shift; it certainly isn't a cakewalk. You may not have some of the types of busy-ness that day shift has, but you WILL have more patients, possibly a lot more. I had 12 acute care patients as a new grad on nights. It was a med-surg specialty floor and the patients were sick. In addition, you have to adapt to that sleep/wake routine which is okay for some people and not okay for many others.

Holy cow, 12 patients on a med surg unit?! Our unit had 8 on nights and that was busy enough, I can't imagine adding four more.

I also recommend night shift for better opportunities to learn. Without some of the interruptions of families, PT/OT/ST, doctors changing orders, discharges, etc. there are nights where there is downtime to read notes, test results, and get a better handle on what's really going on with the patient. Dayshift can be putting out fires all day so you don't get as much time to dig into the backstory on patients and their progression of care.

OP good luck figuring out what you want to do next, you've got a long career ahead of you, you'll figure out what works best for you. Take care. 

[JKL33]

1 hour ago, JBMmom said:

Holy cow, 12 patients on a med surg unit?! Our unit had 8 on nights and that was busy enough, I can't imagine adding four more.

Yep. 30 bed floor staffed with 3 RNs at night; Charge had 6 (whichever ones were up independently) and we other two RNs had 12 each. To be fair, we two each had an LPN with us whom we could assign to help us with half of our patients (???). I won't deny it was obviously very helpful, but they couldn't touch IVs/CVCs, couldn't draw my labs, etc. If anything was going on with their patient they still had to report to us. They could chart their assessments (which I needed to verify and sign off) and help their 6 patients with ADLs/toileting and the rare po med.

Funny thing...this all took place before the exploding dumpster fire that acute care has become in recent years. And I loved it. I learned so much and felt supported despite an assignment that would have otherwise been very overwhelming. The difference is that I had a lot of patients but almost none of the meddling and nit-picking and dehumanizing stuff coming from admins and business people in recent years.

[Been there,done that, ASN, RN]

Consider community health.

Good luck.