Has anyone else been asked to transfer units in first 6 months?

RN34TX · Feb 12, 2006

I guess I'm not understanding why they feel that moving you to MICU or CCU is going to be a more successful experience than what you had in the ER.

What "progress" are they referring to when they say that you're not progressing as well as expected? What are you lacking in (in their opinion)?

I'm just not getting the logic behind sending someone to ICU if they aren't doing well in the ER. It definitely won't be any easier.

On the other hand, maybe it's not the specialty that needs to be changed, maybe it's the preceptor. You feel that he/she was too clingy and overbearing and didn't let you spread your wings enough?

Perhaps moving to ICU might be a better experience for you if you just get a new preceptor that you are more comfortable with and allows you to be all the nurse you can be.

If you really don't want to go to ICU, ask if you can get a new preceptor in the ER, because 90% of how you are evaluated by your manager when you are new is from the comments/opinions of the one who is training you and maybe a second opinion is in order here.

nurseingeorgia · Feb 12, 2006

Hi All,
I am four months into my 6-month nursing orientation in an Emergency Dept, and a couple of days ago I was told that "I wasn't progressing as much as they had hoped" and that I would need to switch to a "different service within the institution." The manager had already discussed with the nurse managers in the MICU and CCU about my interviewing to transfer there. She felt that the ICU would be the best environment for me, since I like to really give involved care and think critically and do a really good job. However, this decision came as devastating news to me and I felt really blindsided by it, as I hadn't met with the nurse educator for a month prior to this decision being told to me. I know that switching units will require an entire new orientation (perhaps not as long as for a brand new grad...since I have developed many basic nursing skills in the ED). But still, each unit has their own bureacracy, and different charting, and I know there will be lots of new things to learn in the ICU. I feel so ready to be on my own in terms of being sick of being in orientation. I feel like I had a preceptor in the ED who was often rather overbearing, always sticking to my side and feel that this "hurt" me. I have thought a lot about talking with the nurse educator and nurse manager about somehow changing things to keep me in the ED, as I feel like things are really coming together now. However, I'm also feeling like treating this as water under the bridge and going to ICU, knowing that the experience will be great preparation for nursing anywhere (ED or elsewhere) in the future. Also, I kind of have the attitude "If they don't want me, I don't want them." I also know that a lot of ED nurses have previous ICU experience. My question is ... is there anyone who can commiserate with the disappointment of being asked to swich units during their orientation? How did it turn out? Also...the coast isn't entirely comfortably clear yet, as I haven't been offered a job yet. I have two interviews next week. The ED has talked with both ICU managers and I don't think I have too much to worry about, but still....it's uncomfortable not knowing the future.
Unhappy and disappointed RN.

Hello,

I am so sorry for the current situation you are facing...I know this is hard now for you...Do you enjoy the ER? Is that truly your passion and are you happy with the care you can give your patients? I am also a new grad (May 05) and I began my career in the ER as well. I was troubled by the lack of time I had to take care of my patients....My manager told me "hand holding is just not an option in the ER." I wanted to give the care we learned about in school...Being with the patient, comforting pt. and family, just more general hands on care.....The ER is so fast paced and as a new grad we tend to really want to give all we can to our patients. I personally hope I NEVER lose that feeling and drive. I am rambling I know but I just want to tell you that this is up to you as well.....Soul search and find out why you want to be in the ER......What we learn in school we frankly do not have time to apply in the real world very often....If that "bond" and extra attention with your patients is what you seek then do not see this as a setback, but rather as a good thing....You have something special to share with another area of nursing.....Compassion, time, care, and extra attention to detail are assets.....Please do not let this discourage you....

A side note: I chose to move on from my ER job after 7 weeks. I am now on a cardiac floor and I am enjoying my experience very much. It is hard to be a new grad, I have challenges every day but I have much more "control and continuity" with my patient load. I get to know them and their families, develop a connection, and that allows me the ability to give the care I want. Wanting to give "involved care" is hardly a negative!!! You sound like a caring, competent, and dedicated nurse and switching units is not something to be ashamed of.....It may be a blessing for you.....Please know that I was in a similar situation and I have licked my wounds and bounced back.. Right now I know you are discouraged but keep your chin up and examine what "you" really want. Nurses are in demand!!! This is your choice to make! Take care!!!

Mags4711, RN · Feb 12, 2006

RN34TX, my assumption (based on what OutdoorLovinRN said) is that perhaps the preceptor thinks ODLR is taking too much "time" with, and spending too much energy on, each patient (can we ever take too much time?). The biggest differences between ICU and ED nursing is time management (in the ED you may have 4, 6, 8, maybe 10 patients versus 1, 2, or 3 in the ICU), and critical thinking skills (not that one is better than the other, but the focus is different in how you use those skills). In the ED you are sorting out why someone is there and fixing or patching the problem until their own clinician can more fully address and follow-up on the issue, or you are focusing on getting the patient through the ED and up to their bed, or the OR where another team of clinicians can delve deeper into what needs to be done.

ODLR, I have a good friend who was asked to switch units about two months into her ED orientation, for what sounds like similar reasons. She's an excellent nurse, and is very thorough and perhaps could be called a "perfectionist." She also prioritizes somewhat differently that what would be needed in the ED. She had a very similar reaction to yours (a completely normal reaction), and decided to go ahead and leave the ED instead of requesting a different preceptor. Should she have stuck it out? I don't think in her case that would have made a difference, her focuses in giving care are not ED oriented, the pace wouldn't have suited her. She likes delving deeper into a diagnosis. She enjoys being able to take time with a couple of patients and she enjoys the relationship she makes with them, she loves the involved teaching, not merely the giving of a sheet of instructions. The constant turnover isn't really her style, nor would she have been happy with that.

That having been said, if you LOVE the ED and you feel that the short term care and the constant patient turnover and the ED pace is really your style, then absolutely, I'd talk to the ed coord and ask for another preceptor, perhaps on a different shift (it may make a huge difference).

I wish you the very best!

RN34TX · Feb 12, 2006

RN34TX, my assumption (based on what OutdoorLovinRN said) is that perhaps the preceptor thinks ODLR is taking too much "time" with, and spending too much energy on, each patient (can we ever take too much time?). The biggest differences between ICU and ED nursing is time management (in the ED you may have 4, 6, 8, maybe 10 patients versus 1, 2, or 3 in the ICU), and critical thinking skills (not that one is better than the other, but the focus is different in how you use those skills). In the ED you are sorting out why someone is there and fixing or patching the problem until their own clinician can more fully address and follow-up on the issue, or you are focusing on getting the patient through the ED and up to their bed, or the OR where another team of clinicians can delve deeper into what needs to be done.

Ahhh, I get it now. Good point.

That reminds me of a nurse on my partner's med/surg unit who isn't "cutting it" and they want to transfer her as well.

I suggested transferring her to my ICU and start orientation from the ground up. (I felt that part of the problem was that she never had a good orientation to begin with.)

The nurses on this med/surg unit looked at me like I was crazy and said, "Well if she can't cut it in med/surg, she certainly won't make it in ICU!"

I disagreed. She stayed late almost every day, had bad time management skills, (which I believe can be corrected with training) and seemed constantly pulled in different directions with her 6 patients.

I thought that having her concentrate on two patients that were much sicker and more involved might be just what she needed and she could pick up the ICU-specific stuff (swans, A-lines, pressors, etc.) along the way in orientation just like a new grad.

Every nurse isn't cut out for every kind of nursing, but it irritates me to see that the orientee themselves are often blamed for not "progressing" into independent nurses, which is why I suggested that the OP get a different preceptor first before the drastic measure of being transferred to ICU, since she seems to have her heart set on being an ER nurse.

When I precept new people and things aren't going so well, I begin trouble-shooting by first exploring where I might be failing them, not the other way around.

We all know that great nurses are made, not born.

kwagner_51 · Feb 12, 2006

OutDoor Loving RN,

Thank your lucky stars that they want to keep you in the hospital!! After I worked 89 days in rehab, they flat fired me!! Told me that they would NOT recommend me for any other unit in the hospital.

Basically, they ruined my chances of ever getting hired ANYWHERE in this town!! If I want to work in home health, I have to apply to the hospital that fired me!!

If I want to work in a drs. office, I have to apply to the hospital!!

I have been unemployed since 12/06/05. I CANNOT find a job in this area.

BTW, I NEVER missed a day.

Good luck to you and consider this move a blessing in disguise!!

__________________________________________

In His Grace,

Karen

Failure is NOT an option!!

Noryn · Feb 12, 2006

Most nurses dont recommend that you go straight into an ER or critical care setting after graduating hence the old deal about getting a years worth of med surg experience. I honestly am not sure how I feel about this. I had a year of long term care experience then I went into a critical care unit. After working the critical care unit for a couple of years I went to the ER.

I often joke that it is just as big of a change going from long term care to CCU as it is going from CCU to the ER. The ER is just tough--you have to be physically strong but even stronger mentally and emotionally. I had a great nurse show me the ropes in the ER and what was important. In the ER it is just hard to explain--I am not saying you neglect your patients although at times it seems a lot do get neglected but you have to get in the mode that your priority is saving lives. Yes this even comes over giving good care. I have seen new ER nurses give some patients a bath while there are others in pulmonary edema waiting on Lasix or ones with chest pain waiting for Nitro, Asa, Morphine, Heparin, etc. It is horrible that there isnt enough staff to give great care and to provide emergency treatment but the sad fact is there just isnt and almost all ERs are at the breaking point with few resources and they are taking on so much.

Of course you remain caring but learning your priorities is just so important. Honestly if they want to move you to a critical care unit they obviously think you have potential. Working in critical care does take a lot of knowledge although you can focus on one area whereas the ER you have to be a jack of all trades but master of none. Critical care experience is just as attractive I think to employers as ER experience.

Ultimately this comes down to what you want. If you have no interest in CCU then perhaps try it but start looking for other jobs. You still have a lot to learn as we all do and the ER is just not an environment conducive for learning. Usually critical care areas are because you only have 2 or 3 patients although 1 critical patient can often keep you busy generally it isnt choatic like a floor or ER can be.

I think going straight into the ER is setting new grads up to fail but none of my hospitals have offered a 6 month orientation either. One was 2 weeks and the other I think was a month.

If you really want to stay in the ER have a meeting with your manager and tell them that you feel you should have been given constructive criticism much earlier than this as you felt blindsided by the whole thing. Ask to come in extra to orient, ask to take ER classes such as trauma, etc. Ask for your weaknesses so you can try to address them. A different preceptor may be great. If you are working day shift, then night shift can be slower at the end.

I am not putting anyone down in their first year of experience but there is just so much you have to learn about patient care, prioritization etc. In the ER you have to rely on what strengths you have and really in your first year you probably havent developed many. If it had not been for my critical care experience I would not have made it in the ER plain and simple. As a new grad I couldnt even think of the ER.

Anyway keep moving forward. Keep a positive attitude and with time, experience and the desire to learn you will be able to work anywhere you want.

sanctuary, BSN, MSN, RN · Feb 12, 2006

OutDoor Loving RN,
Thank your lucky stars that they want to keep you in the hospital!! After I worked 89 days in rehab, they flat fired me!! Told me that they would NOT recommend me for any other unit in the hospital.
Basically, they ruined my chances of ever getting hired ANYWHERE in this town!! If I want to work in home health, I have to apply to the hospital that fired me!!
If I want to work in a drs. office, I have to apply to the hospital!!
I have been unemployed since 12/06/05. I CANNOT find a job in this area.
BTW, I NEVER missed a day.
Good luck to you and consider this move a blessing in disguise!!
__________________________________________
In His Grace,
Karen
Failure is NOT an option!!

Well, listen, there are lots of towns that need nurses. If you can't work in that town, mayhaps 'tis a message. Say thanks and move on. :nurse:

EDGRADNURSE · Feb 13, 2006

I can commiserate as I am a new grad in the ED (2 months into orientation). What was I thinking? It is so difficult to learn tons of skills in such a fast paced area. Sometimes I wish I had started in another area to just get the skills down before starting in the ED. But, I wanted to work in the ED and just couldn't wait...sigh.

Whatever you do, please don't think that you "didn't cut it" or aren't "good enough". If you decide to move to another unit for a while, you can always go back to the ED or maybe you'll like another unit better.

Keep us posted

Kim O'Therapy, BSN, RN · Feb 13, 2006

Ahhh, I get it now. Good point.
That reminds me of a nurse on my partner's med/surg unit who isn't "cutting it" and they want to transfer her as well.
I suggested transferring her to my ICU and start orientation from the ground up. (I felt that part of the problem was that she never had a good orientation to begin with.)
The nurses on this med/surg unit looked at me like I was crazy and said, "Well if she can't cut it in med/surg, she certainly won't make it in ICU!"
I disagreed. She stayed late almost every day, had bad time management skills, (which I believe can be corrected with training) and seemed constantly pulled in different directions with her 6 patients.
I thought that having her concentrate on two patients that were much sicker and more involved might be just what she needed and she could pick up the ICU-specific stuff (swans, A-lines, pressors, etc.) along the way in orientation just like a new grad.
Every nurse isn't cut out for every kind of nursing, but it irritates me to see that the orientee themselves are often blamed for not "progressing" into independent nurses, which is why I suggested that the OP get a different preceptor first before the drastic measure of being transferred to ICU, since she seems to have her heart set on being an ER nurse.
When I precept new people and things aren't going so well, I begin trouble-shooting by first exploring where I might be failing them, not the other way around.
We all know that great nurses are made, not born.

I really hope I get you (or someone like you) as a preceptor when I'm finished with school!

liebling5, MSN, RN · Feb 14, 2006

Yes, it happened to me. When I first graduated, I wanted to work on the floor where I did my 4th semester clinicals, HIV/Oncology. Oriented 4 weeks on days, 2 weeks on nights. Nights did not go well at all. I was expected to be able to manage 5 pts. by the end of the 6 weeks. Needless to say, I was doing so-so with 4. In hindsight, my night preceptor was very hard on me (and it wasn't a good match, either) and she griped about my "lack of progress" to the NM. By the end of the 6 weeks, I KNEW I was having problems, but thought I'd be asked to do another week of orientation.

That NM called another NM (Neuro-Stroke) and, praise the Lord, I got the position. Yes, I did have to do another six weeks orientation, but in the long run, I really appreciated it. The acuity of the pts on this floor is MUCH easier for me to handle than the first one.

So, like another poster said, maybe another preceptor is the answer for you. As for me, I truly enjoy working where I am now. I feel so much more successful and WAY less stressed. :rolleyes:

OutdoorLovinRN · Feb 23, 2006

I just wanted to thank everyone who replied to my post so quickly after I wrote it about two weeks ago. I was so upset about being asked to transfer out of the ED into ICU. I did e-mail my nurse educator with my concerns, but she said they thought it would be best for me to get the ICU experience at this time. I still feel angry and a little betrayed by the whole ordeal, as my department checklists are just about complete, and I am taking care of my full-load of pts independently (which has just come about in the last 3 weeks). I did not get my pediatric orientation (was supposed to start last week) and I can't do trauma independently, so I would not venture to say I'm completely independent. However the orientation was supposed to run six months and I'm 4 months in. I think people might have started worrying about me at three months, and so after just a couple more weeks, they decided to ask me to transfer. I'm not sure where other new grads are in the ED after 3 months. I know for me, there always seemed to be new things coming along that would take just a little bit longer. And now, as I finally know how to run most meds, access and deaccess a portocath, order that meal tray off the computer, document my restraints, deal with the blood bank, the paperwork, the doctors, radiology, and have been getting my Ivs and art sticks on the first shot, it's time to leave! The ED is making an expensive mistake.

The ED had recommended me to the ICU managers at my hospital and I did two interviews and got two offers (MICU and CCU). I decided on CCU, thinking that I'd enjoy learning about cardiac, and also the unit gets a lot of overflow patients from the medicine service. Both units seem to have good management.

I keep trying to tell myself that this is a blessing in disguise, as I know that the ICU experience will be invaluable for my career and that as a "new grad" (+4 months ED experience), this is as good a time as any to get comfortable in ICU. I know that I can work ED later. The CCU is going to give me a six week orientation, which I think will be adequate considering I have some nursing experience now and also that I did my culminating preceptorship for school in a MICU. I'm going to make sure that there is more communication this time between my preceptor, myself, and the nurse educator, about what's working and what's not.

Thanks again for everyone's posts!