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Fire and Fury

As a nursing student my favorite rotation was in the ICU. The complexity of the cases there was the draw for me. I'm an analytical person, so the interplay of multiple comorbidities coupled with the nurses' autonomy in this setting were very appealing. However, a handful of nurses and instructors warned me that it was impossible to get an ICU job as a new grad. Furthermore, I knew gaining experience on the floor could only benefit me before transitioning to ICU. At least, that's what more experienced nurses seem to think.

Fast-forward to my current situation: I'm working on a med-surg unit with a specialty in colorectal and bariatric surgeries. I still see opportunities to learn. Unfortunately, as I have a full assignment a lot of these opportunities are missed. My areas of personal growth are more in my time management and performance of skills and tasks.

I feel very discouraged. I am in an incredible residency program that features a 6-month orientation with a RN preceptor and Physician Mentor. I chose this pathway thinking it was the best opportunity to develop competency as a new grad. However, my best assets are not being used.

Veteran nurses roll their eyes at some of my questions regarding labs and pathophysiology. I've been told I shouldn't worry about these things because it's not really pertinent to my tasking. I disagree; I think considering the data is crucial to making judgement calls as a RN (an inexperienced one at that).

I feel like I'm out of place. As much as I love nursing, why am I not satisfied in this role? To make matters worse, I do have to complete six more months on this unit after orientation before applying for a transfer to ICU.

Advice would be much appreciated. Should I stay and try to push through? Should I pay the $5000 to be released from my contract and seek other employment? Med-surg feels like baptism by fire and frankly, I'm furious.

Thank you.

kalycat specializes in CVICU CCRN.

I too am a pathophys geek who loves the interplay of the body. That said, it sounds like you're in a pretty amazing residency - physician mentor? Rad. I'm not one who is totally convinced that med surg is mandatory to be successful in critical care, but I do believe that being established as a good employee with your organization sure helps.

I would continue to pursue your learning - but independently. If you're getting the big eye roll, etc, jot down your ideas and questions. Find a good resource - I use Medscape - and look things up on your own time if you aren't able to at work. Grab a critical care text (I have one on kindle which is searchable) and spend some time reading.

While they may be guiding you toward tasking and time management at the moment, the development of a depth of knowledge and context is what will ultimately inform your independent judgment calls as a seasoned nurse. Having that knowledge base as a foundation is what makes all that autonomy possible. Make it happen for yourself, even if your focus at work is a little different. It may also help keep you engaged while you're slogging through your residency.

I say stick it out so you can distinguish yourself as a valuable and proactive employee - when the time comes, that transition to critical care will go more smoothly, particularly with excellent recommendations from your mentors.

Good luck!!

Thanks, Kalycat, for your encouraging advice. I really appreciate that you took the time to read my post. You are right -- I wouldn't want to damage any positive recommendations I might need in the future from the unit I'm on. :)


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