Hating this new job. Good opportunity vs quality of life vs

[RNTEE]

Hi,

I'm wondering if there is any good advice out there for me. Here's my situation. I graduated a little over a year ago. Got a job in ambulatory care for 3 months (which I loved but it wasn't acute care), left after three months because I was offered a new-grad program in a high acuity trauma ER that lasted 6 months (my dream job). After 6 months in this ER, both my preceptors and I admitted I was not qualified with the knowledge and confidence to be on my own. Still, I loved the ER and plan to return. I left in excellent standing and told I could come back anytime when I felt I had a solid base. Everyone I worked with agreed it was a very tough place to start as a new grad, and I humbly accept that. The managers were so supportive and advocated for me by finding me a job in the Med-Surg dept at the same hospital. The problem: I am failing miserably in Med Surg. My new manager gave me two weeks training to get up to speed and start on my own. The first week I had no computer access, and shadowed my preceptor. The computer program/interface is completely different than the ER. After my second week, the manager was disappointed that I was not further ahead. I was only up to 2 patients due to all the extensive charting required and still trying to figure out the program/flow/new job. This Med Surg dept is 5:1, I'm also not used to the multitude of meds, and all the orders and taking verbal orders (we didn't in the ER). He gave me an ultimatum (in a nice managerial sort of way) So I have 2 more weeks or, as he put it, we'll say this isn't a good fit.” I've never been let go in my life. But admittedly, I gave so much to my first job, then so much to the ER that I just have no more energy for med surg. In short, I feel overwhelmed by this new job, and despise the unit. It is run well and the staff are very nice, but I have panic every time I go to work thinking about the long list of meds, patients with so many co-morbidities, and all the endless charting which is so time consuming. I respect and admire the nurses in this department but it is a tough, tough job. I am an incredibly hard worker, and try to see every day of this job as a great opportunity, which it is, but either my brain is either too burnt out, or too old, but I simply can not retain all the orders, meds, and patients . For two weeks I have been completely miserable and the thought of having two more weeks before my fate is decided just makes me sick to my stomach. I felt from the very first day that this was not the right place for me. Having 3 new jobs in less than a year has burned me out and now my confidence is also at an all time low. I have too little experience to get another job, too much experience to get a new grad internship. And since my ER managers helped me get this job, I don't want to burn my bridge by quitting. But I am so unhappy and panicked at the thought of returning. Has anyone been in this situation? And have any advice?

[DUDERNGUY, BSN, MSN]

I like you, have found myself in a situation where 2 weeks may make or break me. I would suggest sticking it out, even if you do not make it. I have been a preceptor to several new grads before. I find that when their systems of organization are broken, they really struggle to manage the shift. I think there needs to be a basic structure to your shift as a nurse.

First is report, as a new nurse drill the nurse to make sure you are getting all the info you need before you start your shift, cause i m sorry, no a NEW NURSE does not have time to sit through the chart at the begining of the shift to find info on a patient. also in report critically think about your patients and it is a good time for both nurses to think about patients/find issues/work together.

Make sure from report your are getting this info from the leaving nursing:

How the patient came in? (found on floor at home, pox 82% when ambulance came, etc..)

PMH (DM, HTN, CVA, Cabg, etc..)

Diagnosis: this is important, why the **** is the patient actually here, and make sure it is the actual reason, lots of times nurses do not even know this, but this is usually important. This could be a UTI, CVA, 10/10 back pain, etc.. Make sure you know why the patient is there i can not stress this.

--and also what are they doing for the reason why the patient is there (here with uti, so on antibiotics) here with cva (on ASA, on coumadin etc))

also important diagnostic test (here with UTI, on vanco, urine culture +Ecoli) w/e it make be, here with TIA MRA + stendosis >90% Left ICA (related and significant diagnotistic test always important)

-then make sure you are getting all basic info in report (code status, where they live (snf, home alone, home with family, 24hr care giver), etc..)

Then assessment (neuro, resp, gi, gu, skin, etc) should get and over view on assessment

then plan (pt here to finish abx then d/c to snf)

this should cover most of a basic report

then after report, run in and check on ur patients for 30seconds each (make sure bed alarms on, safety maintained, etc.. do not run an get them crackers, make sure they are stable and bed alarms on if needed)

then you go through the chart, look at your meds and orders and note whatever is important that you do.

then start to pass meds to patients (pass meds on your sickest patient first) while you are passing meds, do your assessment on these patients.

if you have any orders to do on these patients (dressing changes, lotions, creams, repositioning, etc) do it now too. Call docs when needed, determine how important it is that you speak to doc right away, if not that important write it down and complie a list of stuff you need to go over with doc.

do this on all your patients (easier said then done), get all there needs met, delegate, everything else that comes in between

and then chart.

sorry just trying to s hare with you the basic structure of what i think new grads should be focusing on. May help you, may not, some may agree, some may not.

Stay strong.

[TheCommuter, BSN, RN]

My opinion might be wildly unpopular, but perhaps it is time to take a break from acute care hospitals for the near future. Managers in both the ER and med/surg have voiced similar concerns about being on your own.

To be fair, your orientation to the med/surg floor was miserably short. However, how were you performing in ambulatory care? If you could keep up with the pace, is there a possibility you can return to that type of setting?

Insanity is doing the same thing over and over while expecting a different result. If you obtain another acute care hospital job, do you have a plan to address the issues that have caused you to not catch up to speed in two different acute specialties?

Again, this is not a rain on a parade. Instead, it is a call for an honest appraisal of one's strengths, weaknesses, and learning processes. The cheerleaders will shout for you to "never give up on your dreams." This isn't about giving up...it is about honest introspection to find your optimal fit. Good luck to you!

[nutella, MSN, RN]

Not easy ...

perhaps you will be able to turn everything totally around but somehow I feel that acute care is not a good fit. They prob picked up on your anxiety and perhaps that makes you unorganized and so on and forth.

You must have learned something in the ER - I can not imagine you did not learn anything in 6 months. Perhaps it is better to take the skills you have right now and apply it in a setting where you can be successful!

The orientation you are getting in med/surg is very short and I feel may be setting you up for failure. Acute care is not the only setting and it is not the non-plus-ultra.

It is better to thrive in a setting that fits your personality and needs in general.

[RNTEE]

You are right and exactly on track of my thinking. I did great in my ambulatory care job and it paid twice what I'm making in the hospital. It isn't my ideal job but it built me up. The hospital setting has done the opposite, probably due to my own insecurities that I let get the better of me. In terms of organization it is my anxiety that is holding me back and causing me to inwardly freak out at all the information being thrown at me. I'm on the older side of nursing and have already had great success in my previous career. Do I really need the stress of acute care? I'm 50. Maybe its time to focus on my family and quality of life. But the question then becomes: how do I quit gracefully without looking like "a quitter" and burning my bridges after my managers went to bat for me to get this other job?

[nutella, MSN, RN]

You know what - I am only a few years younger but quit med/surg bedside nursing in a busy teaching hospital years ago. And I would not go back to that anymore - I am too old for drama, 12 hour shifts, constant pressure and such.

Nothing wrong with finding something that is the best fit for you !

It is not about quitting - to be honest - I wonder if the ER manager somewhat knew that med/surg would not be a good fit for you. As long as you resign and give proper notice you should be ok.