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.
I worked my first 3 shifts in the CCU this week. I really like it. There's definitely a lot to do, a ton to learn, and lots of opportunities for critical thinking. Plus, it's nice to only have two patients to concentrate all of my efforts and "caring" on. I am enjoying speaking with the pt's (the ones that can talk) and also with their families, who are absolutely craving information. I'm also enjoying being able to come home and look up information in my critical care book. With only two patients...it doesn't feel like there's an overwhelming amount of information, the way there was in the ED. I was learning so much, I didn't know where to start, so I hardly looked anything up when I got home. Now I've been reading about heart failure and the meds I'm giving and how they work (reviewing this information).
My ED experience has helped....just being a working nurse...and getting used to life as a nurse....I feel like I have a head start on the other "new grads" starting in the CCU now, who have no experience. I think the ED nurse educator and nurse manager did make a good choice in advocating that I work in the ICU. They seemed to think it would be a good environment for me. I still miss the ED and I still am bitter that my orientation was cut short, as I thought that I would be ready to be on my own, and felt like the decision was made without enough basis. But, I'm definitely happy on my new unit!!!! Also...on my first day on the unit...all of the employees were so welcoming. They even gave me a gift bag full of goodies wrapped in pretty tissue paper. It was nice to feel so welcomed on the unit!
I am soo happy for you! I hope that this ends up being a "blessing in disguise" for you! I am a new grad in an ED with a pretty long orientation period (6 months of classroom and with a preceptor).
Supposedly, I'm doing well (so my preceptor and manager say). HOWEVER, I am looking to switch. My first choice is ICU but I have a young son and have to stay close to home. So, I'm hoping that I will be offered a position I interviewed for in an ICU step-down unit.
The reason I'm looking to switch (just my two cents for new grads from a new grad) is that it is EXTREMELY difficult to learn BASIC nursing skills in an ED. Its such a very fast paced environment. It's not like all of your patients are coding or anything. You see a lot of minor illnesses (more than codes). It's just a brutal pace most of the time.
As a new grad without experience (maybe it's easier if you were an LPN or tech) you are expected to learn and perform these skills quickly without much teaching. These skills are: assessment, documentation, flow of the ED, ekgs (and interpreting them), foleys, mini caths, Iv starts and blood draws, mixing and giving meds, NGTs, casting, patient teaching etc. etc. etc.
You are giving extremely potent cardiac drugs IV and don't have time to "research" them. You may be thrown a piece of paper during a code (before your ACLS training) and be the "recorder". That means you'd better know what those dysrhythmias are. All looks like Vtach but it could be wide complex with a bbb. HUH? If you aren't recording, you may have to start a line on someone QUICKLY so they can push the drugs. Doesn't matter that you haven't been with the IV team yet and blew the lines on two previous patients.
As a new grad, you don't have experience with how people "present" or all of the possible complications you may be missing. Not because you aren't smart or aren't "getting it". You just don't have the background in pathophys and patient care to REALLY know. Feels like you are just guessing.
I just don't feel safe starting in and ED. I feel like my license is at risk and I'm potentially risking my patient's health because of a lack of experience. Also, I think it's hard on the ED staff to have new grads. The new grads have a steep learning curve and the rest of the staff have to pick up a lot of work. I think that a floor nurse with experience could probably pretty easily transition to the ED without such a long orientation
Just my opinion. I wouldn't discourage a new grad from starting in the ED. Just wanted to offer my experience and give an idea about what it is like. Be prepared to feel like a complete MORON for quite a long time.
I suggest-Ask for specifics, Ask for a learning plan, ask for measurable goals and identify who can help you nail down what your boss wants.(a care plan :-) here's why-my manager suggested this, as she was not 'seeing me progress'. it is a very busy surgical oncology floor in a major cancer center. i love it. she suggested a different, smaller unit, she manages, to help me with time management. we met- my manager and i, (who i really respect, and trust her judgement) and she listed about seven time management areas for me to focus on over 2 weeks. she appointed the daily charge nurse (same one every day) and an APN Nurse Educator to meet with me. I met the charge RN daily, the APN weekly to review and refine waht happened in the day and the week. The APN spent about 2 shifts with me refining my planning and time management techniques, showing me useful and legal shortcuts. By the end of the two weeks I was doing alot better. had my 6 month review, the Manager said I am "right where she would expect me to be". Also that she suggested the other unit so that i would not get so burned out, and quit nursing all together. Make yourself a 'care plan' like this and see if they can help you stay where you want to be.
Although I have not been asked to transfer units, I am a new grad (graduated Dec '08) and I'm not to fond of my unit (after a month and a half). I'm working mother/baby, but I'm not sure of what type of nurse I want to be. I loved OB/Peds in nursing school, but I think I'm going to get board on this unit quickly. I'm very organized, I think in a systematic way and really don't like to be interrupted while completing my tasks. I think I prioritize well, but I tend to do all of my work then chart but my preceptor didn't seem to like it to much when I was admitting a mom and had not put her vitals in the chart even though I had them and new she was stable. I'm taking care of 2-3 moms and babies, but I run around like a mad woman and almost always leave 30 minutes late. I'm also interested in Critical Care and OR nursing, but I'm quiet by nature and at don't come across and someone with the ICU or OR personality (so I've been told). Any seasoned nurses out there with tips and suggestions for a new grad who likes challenges and thinking a lot? Or new grads that left their jobs in the first six monts? Help!
Wow! I started this thread 3 years ago! What a ways I have come. I did go on to work in the CCU for 10 months and learned a great deal. The worst part about the ccu for me was all the lifting and moving and turning of such heavy patients. The best part was learning about cardiac drugs, learning about the heart, about swanz-ganz catheters, chf, MIs, cath lab, cath lab recovery, cardiac rhythms, temporary and implanted pacemakers. Being in the unit was a great experience. I immediately asked for 2 very experienced preceptors and they were great!!!! Then I left there and moved to a different state and started in an ER again. I have been in the ER for about 2.5 years. I just got a "merit raise." I get frequent compliments and just yesterday someone told me how much he enjoyed working a code with me. As a nurse of only 3.5+ years experience, naturally I still have much to learn, but since the learning comes in such small pieces now, nursing is so much easier. I am going to take the CEN before the end of this summer. Changing units perhaps really was a blessing in disguise. Or, perhaps, I would have done fine in the ER to begin with (as I had felt I would have) and be where I am now in my confidence level. I don't know for sure, but I do know that now I have had the opportunity to see and work in an ICU and have the informed decision that I really like ER nursing.
For you LoveNursing84, I suggest that you might be better suited possibly for ICU where you have 1-2 patients (probably 2 to start with) to really focus on. You can always interview in an ICU while you continue to work your present job. I think the reason the ER I was in had originally asked that I leave the ED and that they recommended me to the ICU manager is they thought that I was better suited to work with fewer patients and work more intensely with those patients. I can prioritize and handle 4-5 patients in ER now, and take the incoming medics and do the continual discharges and new patients, but sometimes still I like to be in the acute section where I only have 2 patients (who are actually sick) to care for. So I encourage you to look around if your current unit is not for you. As for the quiet personality! You can be an excellent nurse and not have a super outgoing personality---just as long as you know when to ask for help and are not afraid to call md or other nurses!
Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
wow! i started this thread 3 years ago!
i am very glad you came back to post! i went to nursing school to be either an icu or ed nurse. i was not sure which at the time but i liked trauma and critical care. by the time i graduated i was sold on emergency trauma nursing. sadly, i was not able to start out in the ed right out of school because my ed was not hiring new grads. the irony was that i have a background in working in med surg prior to graduating. i have worked other floors as a tech and as a nurse extern prior to applying to the ed so when i was told that "it is no big deal you can gain more experience on the med surgical floors in the meantime", i rolled my eyes but accepted the assignment. i, like you, worked hard and did well outside of the ed. now i am interviewing on the ed again and have been told that i have a shot to transfer. i have high ups speaking on my behalf; though i am still hesitant to celebrate (my interview the last time was outstanding).
in any case, one thing is clear... whether i get in this time or not, i will continue to be a good nurse and i will continue to build my ed skills. if i have to move away after a year or two because i will have had my license and gained working experience during that time, then i will do so! i suspect i will be able to get into someone else's ed without ed experience because my learning curve will not be as high as that of a new grad (i work on a cardiac step down unit and will be acls and pals by that time). again, i am very happy you posted an update because it shows that after 1-2 successful years on another floor, a nurse can land a job in the ed, even if it is not at the same hospital!!!!!
by the way, i think it is odd that some people start in the ed and never ever worked on another floor and do fine. thus, i agree that if you had the proper support the first time you would not have needed to take the detour through the icu to get up to speed. the positive part about your clinical nursing experience is the fact that you have some diversity and variety in a hospital setting, which makes you valuable!!! so, you were not hurt by the experience, though you may have felt hurt initially. i am very happy you!!!! i am also happy that it is working out for you as an emergency nurse! keep us posted....
Changing units perhaps really was a blessing in disguise. Or, perhaps, I would have done fine in the ER to begin with (as I had felt I would have) and be where I am now in my confidence level. I don't know for sure, but I do know that now I have had the opportunity to see and work in an ICU and have the informed decision that I really like ER nursing.
Some of my favorite coworkers in my ED are former ICU nurses ... they bring another dimension of knowledge to the table. :) I'm glad things worked out so well for you!
OutdoorLovinRN
18 Posts
I worked my first 3 shifts in the CCU this week. I really like it. There's definitely a lot to do, a ton to learn, and lots of opportunities for critical thinking. Plus, it's nice to only have two patients to concentrate all of my efforts and "caring" on. I am enjoying speaking with the pt's (the ones that can talk) and also with their families, who are absolutely craving information. I'm also enjoying being able to come home and look up information in my critical care book. With only two patients...it doesn't feel like there's an overwhelming amount of information, the way there was in the ED. I was learning so much, I didn't know where to start, so I hardly looked anything up when I got home. Now I've been reading about heart failure and the meds I'm giving and how they work (reviewing this information).
My ED experience has helped....just being a working nurse...and getting used to life as a nurse....I feel like I have a head start on the other "new grads" starting in the CCU now, who have no experience. I think the ED nurse educator and nurse manager did make a good choice in advocating that I work in the ICU. They seemed to think it would be a good environment for me. I still miss the ED and I still am bitter that my orientation was cut short, as I thought that I would be ready to be on my own, and felt like the decision was made without enough basis. But, I'm definitely happy on my new unit!!!! Also...on my first day on the unit...all of the employees were so welcoming. They even gave me a gift bag full of goodies wrapped in pretty tissue paper. It was nice to feel so welcomed on the unit!