Help! New nurse bored in critical access med-surg

brownbook · Jun 28, 2018

How old are you? If you're older, need to get acute care skills before you're to old, (not sure what that age is?) I can understand your concerns.

If you're still young I'd wait a few more months. But be a squeaky wheel, remind your supervisor to let you know if CCU or ER positions open up. Tell her you really really need, want, IV practice can you be called away from your unit for 10 minutes to start an IV on another unit, or insert an NG tube, etc.

When 6 - 8 months pass and nothing has changed at your current position then start applying at other facilities.

ativanman · Jun 29, 2018

I'm in my late 20's. My supervisors tell me all the time that they will pull me to the ER if they have anything but the never do. We had an ER position open but they refuse to hire a new nurse in the ER. They said a new nurse can't function in an ER effectively because they don't have their assessments skills down and they have to assess pt's fast.

I know I'm making it sound bad, but It really is a good place to work. I'm just concerned that maybe I'm not getting what I need as a new nurse. Or am I being impatient about learning? Also the closest large hospital is about an hour a way :/

Triddin · Jun 29, 2018

I personally feel concerned when a new grad (especially just 4 months in) says they have nothing left to learn. I'm not saying you aren't smart, or perhaps that the unit isn't an easier unit. You probably are a strong new grad. But I've yet to be in a nursing field where there wasn't something to learn. My fear is that you don't realize what you don't know yet. You say you have a routine, which is good. But are you looking beyond the routine. Are you trying to connect your asssessment data with labs and meds, do you imagine for the worst case scenario and what you would do in those circumstances. These skills, more than being able to insert IVs and foleys and NGs will serve you far better in the long run. Especially in ER. Perhaps this is more what your managers want you to develop before going to ER.

I'm not saying don't move on if you are unhappy; I transferred to icu after a year and a half of med surg for much of the same reasons- I though I had it. I knew the routine, admitted and discharged patients easily. In icu, I struggled initially because my critical thinking skills were still developing. The skills were easily learned. I learn new things all the time still and reorganize this will be a life long event.

Ruby Vee, BSN · Jul 3, 2018

I need some advice. To start I am fresh out of school and I have zero experience in the medical field. I took my first nursing job and I'm at a critical access hospital. I'm only 4 months into the job, out of training on the med-surg/swingbed unit, and I'm bored to tears 90% of the time. My job is basically assessing pt's who are not that sick and waiting to be discharged, give them meds, they sleep, I chart for an hour, and I walk around looking for things to do like turn lights off in empty rooms.
I am a very fast learning and have my routine down well. It's common for me to take 8 patients and get all my assessments and meds passed on time. By no means am I saying that I know everything or that I'm some awesome freak of nature nurse. I am new and don't know much outside of what I learned in school. My problem is I feel like I'm not being challenged or learning anything. In my 4 months I have yet to start an IV, catheter, ng tube, or even give an IM injection.
When talking with all my other nursing friends I graduated with, I feel like they are learning so much and I'm just stuck in a rut. I'm very proactive and I take every opportunity to learn. I even mentioned to my supervisor that I don't feel challenged and I'm really not learning anything as far as skills or assessments and ask what I could do to improve. They just told me I need to stay on med-surg and "fine tune my assesment skills" and then they will move me around to the ER or CCU. The problems is we have 3 or 4 patients most nights and the worst of them just barely need hospital care. We might get critical pt's that we have to stablize and ship out once or twice a month. But I never see any of that because I'm in med-surg.
Should I stay? Any experienced nurses out there have any advice? I contacted some of my nursing instructors from school. They recommended that I look for a job at a bigger hospital after 6 months or so. If I do stay our ER and CCU is not that big. Worst thing we see in CCU is a pt who needs a tele monitor but only po meds.
Am I doing myself harm as a fresh/new nurse staying somewhere like this? Or do I need to stay put? Like I said I am new and I have only worked 4 months. I dont really want to jump ship because I like my coworkers and I have heard that most bigger hospitals will hire someone with a year of experience at a critical access hospital faster than most of the other applicants. BTW my goal is to work in a level 1 trauma center, flight nurse, or cardiac CCU.
Any advice?

A new grad who isn't challenged in her first job isn't trying hard enough.

A new grad who says she's bored is downright scary! Why? Because you're so new, you don't know what you don't know and your statement that you're bored means you're not really trying to figure it out, either.

Do you know the main diagnosis of each and every patient? Do you understand the pathophysiology, the treatment chosen by the patient's team and any alternative treatments there might be? Do you understand the pharmacology of any medications prescribed, their usual dosage range and whether the patient is prescribed a higher or lower dose and why? Do you understand the side effects, toxic effects and drug interactions? Do you understand any tests the patient has had or is having, why they're having those tests and what the result means? Do you understand all of the patient's lab values and how they are affected by or how they might affect the medications prescribed? Do you understand all the patient's co-morbidities and how they interact? If the answer is yes, then I reiterate: You don't know what you don't know. And if the answer is no, why aren't you looking these things up?

It takes approximately two years to become a fully competent nurse; stay in your first job at LEAST a year and preferably two years.

Susie2310 · Jul 4, 2018

A new grad who isn't challenged in her first job isn't trying hard enough.
A new grad who says she's bored is downright scary! Why? Because you're so new, you don't know what you don't know and your statement that you're bored means you're not really trying to figure it out, either.
Do you know the main diagnosis of each and every patient? Do you understand the pathophysiology, the treatment chosen by the patient's team and any alternative treatments there might be? Do you understand the pharmacology of any medications prescribed, their usual dosage range and whether the patient is prescribed a higher or lower dose and why? Do you understand the side effects, toxic effects and drug interactions? Do you understand any tests the patient has had or is having, why they're having those tests and what the result means? Do you understand all of the patient's lab values and how they are affected by or how they might affect the medications prescribed? Do you understand all the patient's co-morbidities and how they interact? If the answer is yes, then I reiterate: You don't know what you don't know. And if the answer is no, why aren't you looking these things up?
It takes approximately two years to become a fully competent nurse; stay in your first job at LEAST a year and preferably two years.

Good answer.

ativanman · Oct 26, 2018

Ruby thank you for your answer and taking the time to respond. I think you may have misunderstood my post. By NO means do I feel like I am a competent nurse. I know very well that I am NOT and I feel completely incompetent to be honest. And yes I am looking up all of my patients labs, meds, dx, ext. Labs might be drawn once a month on swingbed pt's. But I feel like I'm not being challenged because the people I'm taking care of are people who have been discharged from the hospital and admitted to our swingbed unit. Which is just on the other side of the hallway. They are simply there for us to give them their daily meds while therapy works with them. They could easily function fine at home.

We have several old, no offense, seasoned nurses who are excellent resources. Many of them tell me nicely that I am not going to learn much here, and they have highly recommended that I consider trying to get on at a bigger (not big) hospital where I deal with actual sick people on a medical surgical floor to get experience.

I too am scared of the things that I don't know that I don't know. But when I'm taking care of patients with no iv's, no chf, no copd, no CBI's, no infections, no surgeries, and no acute illnesses...it's very hard to learn things. 98% of the patients in swingbed are in for "weakness, dehydration, and de-conditioning". Its how the hospital makes money.

However I will give you an update. Most of our nurses know that the swingbed unit is a piece of cake, and they want those patients. So I always bribe them to take those patients and let me go to the acute side. We still don't see super sick people there. (Mostly COPD exacerbation and pneumonia) but I feel like I have learned more in a month of being there than 5 months on the swingbed unit.

Also the pay is another BIG factor. I make $20.40 hr base pay as an RN. Most everyone I graduated with started at $23.50 hr +, and they get .50 hr for acls, pals, any other certs, and they get a weekend diff. Most have already gotten raises after 3 months. I get none of that. I know I want to leave after a year but I don't know if I should leave sooner or ride it out. Thank you all for your input and I'm very open to suggestions, constructive criticism or anything you have to offer me.