getting back into patient care

[brtnremtp]

Greetings,

I am an RN/Paramedic and want to get back into a direct patient care role and continue my education. I started in the ER at a local level 1 trauma center as a paramedic before I became a nurse. In that role I could do 95% of the things that RN could do but was paid less. While at this hospital I completed my RN. I was working at 7a-7p shift as a medic, I was going to have to change to 5p-5a as an RN. This was going to present a conflict with my wife and I. I was able to transfer to the ER of a hospital in the same town run by the same corporation. I worked 7a-7p, 10a-10p or 1p-11p, so, not too bad. However, I did not like this hospital. It was basically a shell of a hospital (no OR, OB/PEDS, CT scanner would be broken for days, lab instruments broke frequently) and patient care was not organized at all (a nurse would pick up a chart carry out the orders, iv, meds, etc. and not write anything on the chart). I had a personality conflict with one of the charge nurses and his "pet" nurse. They would not listen to reason and I was wrong no matter what the situation was. Neither had worked in a trauma center to the best of my knowledge but you couldn't have guessed it by the way they acted (greater than thou attitude.) While I was working at the hospital I started at an ASC first as a tech (while I was a medic) and later as an RN, all PRN. While in the ER my shift slot was pulled away and give to the "golden child" of the ER that got his RN license about a month before I did. This was a due to an that was on FMLA. She was going to give 2 weeks notice after FMLA and leave. She decided to come back. Therefore, they gave her the 7a-7p that "golden child" was in and gave him my shift. I would have to go to 5p-5a (presenting same problem as at the trauma center.)

As luck would have it the ASC called the same day they dropped the shift change bomb on me and offered me a full time PACU slot. I took it and liked it for awhile. It was very difficult to get 40 hours there and OT was out of the question. I had to scratch and claw to get 40 hours. It was for profit and owned by a group of physicians. You had to walk on eggshells there because of them. I am a very outgoing person (never met a stranger) and I was once scolded by the PACU charge nurse for "talking to the doctors too much." Also, I was the only male in the PACU and I felt under the microscope if you will. I was let go there from there because I was told "I didn't have enough experience." Funny thing is they knew my experience when they hired me. I bust my butt everywhere and am always the one to take on extra responsibility. Perhaps, you could consider me a "yes" man.

Sorry I'm so long winded...After the ASC fiasco,I landed a job in a commercial plasma center as a Physician Substitute. I had been an RN since March 2008 and this was in July 2008. I would do screening physicals on potential donors and take care of them if they got ill during donating. So, patient care/contact but in a different scenario. I was quickly promoted to an assistant manager. I was loving this job until we changed center management. Our director left and the other assistant manager was promoted upward. She is consistently tardy, sick, etc. Takes lunches/breaks with her GIRLFRIEND who works there. However, she is untouchable and never gets in trouble. Also, our donor base has decreased due to a multitude of factors (that I won't get into), our production is down and we laid off 2 people this month. The company plans to remodel our building but I'm not convinced our company will survive. I think the company might survive but our center wont. I feel the writing is starting to appear on the wall.

Therefore, I started looking at jobs back in patient care due to the company stability. I also want to get my BSN (have a prior BS in psych.) I can do that going 1 night a week for 1.5 yrs. I want a schedule that is more flexible to go to school. I feel if I stay at the current job the director will prevent me from going to school (we alternate opening/closing weeks so 1 night a week she would always have to close and she works hard to get out of anything she can.) I interview for a nurse quality manager job with another hospital corp (i.e. not the one I previously worked for.) I didn't get that job, but, I guess I can sorta see why (perhaps, not enough pt. care experience) So, I decided to try to go back to the ER where I first started as a medic. I knew the people, the hospital, it was "home" so to speak. I talked to a couple of the nurses I had worked with before and they thought I would not have a problem getting back on. I talked to the ER manager (who was the there when I left, always got along excellent with her) about my intentions and she told me to put in an application. I had discussed the whole thing with my wife and she was fine my wanting to get another job (she encouraged it) and was fine with my the prospects of going to night shift shift. Well, I had an interview yesterday with the ER manager and one of the ER education members (who was a nursing student when I was there.) I thought everything went great. I was told there was 5 total interview for 3, possibly 4 slots. Well, I was notified by email today that I didn't get the position. I can't understand why. I have 2.5 yrs. in as RN, 9 years as a medic and 2 years managerial experience. I have all the ancillary course (ACLS, etc.) except for TNCC which is not a prerequisite. A TNCC is being held next month at that hospital. Strangely, an ER RN position posted today after I was told I wasn't accepted. This was for a 7p-7a job. I had applied for a 7a-7p OR a 7p-7a slot and told the ER manager that either would be fine (I did say 7a was preferred but not a deal breaker.) Should I apply for this new slot?? Should I contact the ER manager and find out why I was not chosen. I am afraid she will say it was because I have been out of direct pt. care for so long. If this is the case then how can I get back in?? After I left my interview I noticed that the nurse for the small ER that was the charge nurses' "pet" was working there now. Did she or another former employee slice my throat?? They have new grads with no experience now in the ER. I know the system and don't think it take long to get back up to speed. Also, in December they will be losing 6 nurses (5 on day shift) because they will finish up their FNP program. I do not want Med/Surg, ICU is a possibility but prefer the ER. I want to go back to where I was but don't see how now. I want to continue my education and get an MSN or MSN/MBA. I need the flexibility of a hospital job but I upset and not sure what to do next. I still work on the ambulance 1-2 days a month.

I apologize for the length but I have a long story to tell. I should have stayed at the trauma ER to begin with, worked 5p-5a and would have gotten to move to days eventually. I tried to do what I thought was best for my wife and I and didn't. Please give any and all advice/criticisms/comments/etc. ASAP!!

[NurseLoveJoy88, ASN, RN]

WOW ! long post .

[brtnremtp]

I know, I know...I apologize!! I just needed to get everything out on the table. I need advice and quick. The BSN program starts in January.

[Faeriewand, ASN, RN]

Yeah I would apply to the new position. They can only say no. Do you have any nurse friends in the department that can pull for you? That's what you need. Hook up with them and get them to lobby for you. :) Good luck!

[roser13, ASN, RN]

I'm going to take you up on your offer and be as honest with my comments as I can: Do you feel that any of your interpersonal skills/relationships caused you to lose any of your previous positions?

I only ask because when I skimmed your long post, you seem to have strong opinions (complaints?) about alot of your (ex)co-workers. One is a "golden child," another is the "charge nurse's pet," you have to walk on eggshells in the next facility from which you're let go for a seemingly bogus reason (lack of experience after you'd already worked there), and your current manager is " consistently tardy, sick" and takes "lunches/breaks with her GIRLFRIEND" (whatever that is meant to imply).

Now, you are not offered a position that you expected to be offered in a facility where you have employment history....just wondering.

[brtnremtp]

I had asked my contacts to speak up for me. Both of them are in FNP school (part of the soon to be mass exodus) so they may have forgotten with everything else they've got going on.

I understand the complaint/opinions post. I guess I am somewhat of a meek person and often those people are pushed around. The ER where I am trying to get back on at was the best group of coworkers I every worked with. I seldom had an issue with anyone there. I thought I would be a shoe in for getting back on there. I am sure everyone has worked with those that can do no wrong and are untouchable. The hospital has a strictly no spouse/partner/relative policy when it comes to working in the same department. Where I work know doesn't, that was what I meant.

[brtnremtp]

Need more advice please!!

[GreyGull]

please give any and all advice/criticisms/comments/etc. asap!!

i am going to take liberties with your request and point out what i get out of this very long post. i hate picking apart a post like this but that is the only way i can clearly point out your comments from that very long post so you might see how they stand out. whatever other points you might have been trying to make take a backseat to these very prominent statements.

a paramedic before i became a nurse. in that role i could do 95% of the things that rn could do but was paid less.

here you feel like you are just the same as an rn but without the education of one.

i had a personality conflict with one of the charge nurses and his "pet" nurse. they would not listen to reason and i was wrong no matter what the situation was.

(greater than thou attitude.)

give to the "golden child"

they gave her the 7a-7p that "golden child" was in and gave him my shift.

i noticed that the nurse for the small er that was the charge nurses' "pet" was working there now. did she or another former employee slice my throat??

in the above quotes you feel picked on and your perception of your co-workers are more 2nd grade level than that of a professional.

i was the only male in the pacu and i felt under the microscope if you will.

you also seem to have a problem with the male nurse thing. that is so 1970s.

i was once scolded

i bust my butt everywhere

everybody gets scolded at some point in their careers. your perception of "busting butt" may not be the same as others.

takes lunches/breaks with her girlfriend who works there. however, she is untouchable and never gets in trouble.

again you display a grammar school attitude rather than that of a professional.

why the caps on girlfriend? if this is her "girlfriend" do you have issues with that? i can see having a complaint about not doing one's job but stop there instead of taking it to a personal level.

i was let go there from there because i was told "i didn't have enough experience." funny thing is they knew my experience when they hired me.

you don't have much experience but you may have talked a good talk and they gave you a chance. the "no experience" reason might also have been easier than saying you were an _________. i'l let you fill in the blank but i think you get my drift.

after the asc fiasco,i landed a job in a commercial plasma center as a physician substitute. i had been an rn since march 2008 and this was in july 2008.

later as an rn, all prn.

essentially you don't have much experience as an rn.

i am a very outgoing person (never met a stranger)

i guess i am somewhat of a meek person and often those people are pushed around.

which is it?

i seldom had an issue with anyone there. i thought i would be a shoe in for getting back on there.

hindsight is always better but since you felt you were equal with an rn and should have been paid at such but without the education at that ed, i find this hard to believe.

i have got to ask why you became a nurse. you don't seem to be happy as one and whatever you have done you are using your wife as an excuse. you seem to think everyone is against you for some reason be it because you are male or you aren't the golden pet child.

you also may be trying to sell yourself as an experienced rn and you are not.

try being honest with yourself first. if the hospital environment is not for you, try to find an ambulance job as a paramedic that fits your needs. good luck in your pursuit of a job and co-workers that meet all of your standards.

[2shihtzus]

Hmmm.....sounds like you have a reputatation that you are going to have a hard time getting rid of.

Statements like:

...In that role I could do 95% of the things that RN could do but was paid less

...I did not like this hospital. It was basically a shell of a hospital (no OR, OB/PEDS..)

...patient care was not organized at all (a nurse would pick up a chart carry out the orders, iv, meds, etc. and not write anything on the chart).

... had a personality conflict with the charge nurse

...Neither had worked in a trauma center to the best of my knowledge but you couldn't have guessed it by the way they acted

...I was once scolded by the PACU charge nurse for "talking to the doctors too much." Also, I was the only male in the PACU

...I bust my butt everywhere and am always the one to take on extra responsibility

...I have 2.5 yrs. in as RN

... I do not want Med/Surg, ICU is a possibility but prefer the ER

truly make me wonder. It seems to me that you thought you were too good for the "shell" of the hospital you were at. Criticizing other nurses and how they chart (or do not chart) isnt something you should be doing. You need to watch YOURSELF, not others. A personality conflict with the charge nurse shows that maybe you have a problem with authority. The fact that the charge nurse and his "pet" nurse hadnt worked in a trauma center really seemed to bother you...just because you were a paramedic doesnt make you more qualified than them. You "always" take on extra responsibility makes it sound like you have a persecution complex. 2.5 years as an RN is not that much experience when you take into account that you have only worked a short time in the ER, was let go from PACU, then acted as a "substitute physician" at a blood donor clinic (never heard of a substitute physician). Also, if you are really wanting to get back into patient care, med/surg is a good place to start.

Granted, this is just what I am gleaning by your post. Im not trying to be mean or harsh, but this is the impression I got.

I would apply on a different unit and use the opportunity to start off on a new foot.

[evolvingrn, BSN, RN]

if they had 3 positions and only five interview and you weren't selected with all of your connections..........i don't know if would bother applying without talking to the NM first. My guess is your significant job hopping may have caught up with you, its tricky but there is no great way to explain it and ensure it will be well received. (as you have seen Good luck!

[leslie :-D]

instead of asking us for advice, i would seriously encourage some solitude and self-reflection.

the truth will set you free.

best of everything.

leslie

[brtnremtp]

Thanks for the input. I realize that there things that I need to improve on (everyone does.) However, I think some comments are abit harsh and perhaps, closed minded. I would like to address some of them to see if it sheds new light on things.

-In my current job I am in a authorative position (assistant manager). How could I have a problem with authority when I am in a position of authority? Hmmm..

-It is not a "subsitute physician" but a "physician substitute." All commerical plasma centers have them. There authority and use is defined in the FDA CFR (Food and Drug Adm. Code of Federal Regulations.) Plus, I use nursing skills at this job administering tetorifice and hep b vaccines. I also administer immunogen RBC's IV which can only be done by an RN.

-When I was referring to the fact that started out in the ER as a paramedic I was only giving some background about myself. I never said that I expected to be paid as a nurse. However, in the ER as a medic I gave all the meds that an RN did, took room assignments and functioned primarily in a nursing role.

-In regards to my wife playing a role in my decisions I believe that other than God my family is the most important thing in my life. I feel many people would take their family into consideration when taking a job.

-Sometimes a person fits better into one job versus another. No one, I feel, hits it off with everyone, everywhere.

-In regards to comments about charting (or not charting), would you not be upset if someone did something for your patient but not chart it? What happened to "if you didn't chart it, it wasn't done."? I am still ultimately responsible for the patient even if someone else does or doesn't document.

-Sexism is still alive and well. Granted, it is not as prevalent as it once was but it does happen. Not just in nursing but other profession. It is not right no matter if it is directed towards men or women.

-If feel you can be outgoing and meek. I am outgoing but try to avoid conflict/confrontation (though it may appear otherwise.)

-My job now is not too bad. I have 2 primary reasons for seeking another job. One, I want to continue my education and need a more flexible schedule (M-F now, versus 14 days/mth in a hospital.) Second, our company is not stable right now. We went from 1200-1300 donors/wk. this time last year to 500-600 donors/wk. this year. I don't want to go down with the ship. I feel any reasonable person can understand that.

-In regards to my boss and her girlfriend what she wants to do in her personal life is her business. I had multiple employees complain about their lunches/breaks, etc. being taken together. When this was brought to her attention I was told that I was trying to undermine her. Far from the truth, I was trying to protect my employees, I don't play favorites to anyone, everyone is treated equally. However, I realize that no matter what my Center Director does she will never be disciplined. Spouses, relatives, domestic partners I feel are just a bad mix in the same department, unit, etc. I have seen it before with cousins

-Hasn't anyone every went back to a former employer?? I know of at least 3 nurses that have and could probably think of more.

-We are know or should realize that some people get further than other without the merit to get there. I don't deserve anything that I don't earn.

-To me taking on extra responsibility is by no means persecutory. I believe and was raised to believe if you work hard, you will be rewarded. This is how I got the position I have now.

I know I may sound ranting or defense, but, this is not my intent. I just want friendly advice. I feel the "nurses eat their young" is still alive and well. I am no better than anyone else in God's eyes and shouldn't be in anyone else's eyes either. Also, I called and spoke with the nurse manager where I applied and she told me the reason I didn't the job was HR has temporarily placed a "hold" on those positions (the ER is remodeling and has alot going on.) She said it was nothing to do with me or the fact I have been out for awhile. In fact, she said I was the most qualified for the position and that she would call me when the position was released. Thought I might let everyone know!!