help!

[8781RN]

Hello,

I need some advice on a decision I need to make. I will try to make this short. First here's my background:

I've been a nurse for 8 years. I have been away from the hospital setting for about 3 years. I remember the dread at the start of my shift just wishing I could find an 8-5 job. I was disgruntled, I knew I wasn't getting paid well. Also I had a newborn so I wanted different hours. So I left and did 2 years as an RN Case Manager in a Supported Living Facility for disabled individuals. I didn't like the lack of structure and the attitude towards nurses was awful. I left and became a Coumadin Nurse for 1 year. That was really cool but as our clinic grew they wouldn't get me help, I had 270 patients! So I left. My previous boss where I worked at the Supported Living Center offered me the job I have now. It's hard to explain what I do. I work with mentally/physically disabled individuals (love my patients by the way). I have several patients whose care I oversee on group homes, and another handful in foster care, and some live on their own. It's very unstructured. No offense to my boss she came in and started trying to make things better but she doesn't even know what we are supposed to be doing. She's called the State Board to get clarification on things and they keep referring her back to the website. I have 50 plus people on my caseload and I haven't seen them all. So it's a liability and I don't like not knowing what the State Board of nursing requires of us. It's 8-5 and on call once a month. One nurse left and they decided not to refill her position. So I panicked and looked for a job elsewhere and got one! I haven't told my boss yet, i'm going to give her two weeks notice so I have a week to tell her. The thing is, NOW after I've accepted a new position, my current job is now going to fill the nurses position that's leaving with an LVN so that's good. They are going to hire on-call people so we won't have to be on call. So things are looking up. Although I don't trust that the positive changes will stick. SO HERE IS MY CURRENT DILEMMA I NEED ADVICE ON:

The new job I accepted is at a Specialty Hospital, it's med-surg LTAC. It's only 3 12 hour shifts a week. (I chose this floor because there's not a revolving door of admits and discharges). I know at heart i'm a hospital nurse. It's what I'm used to and everything you need is right there (most of the time). In these 8-5 jobs that I once longed for, i've always ran into the same problem, LACK of structure and not always having the means to do the job, IF i was lucky to know what my job was. So maybe I needed to do all of that to realize I need to be in the hospital? I dunno BUT I'M SCARED!!!! I've forgotten so many things. I'm going to read, practice my med calculations, and ask lots of questions but i'm still scared. I've had patients crash on me before but i've never been in a code. This place has codes, the patients are sick. I'm afraid I will forget what I need to do. I think the pay is going to be good for what I'm doing but it will be about 270$ a month less than what I get now. So i'm having second thoughts!! The fear of all of this, and the possible changes they are going to make at my current job are making me think about staying.

Do I take this big risk and go back to the hospital and get paid less but POSSIBLY be happier? Or do I stick with my current job, get paid more, get weekends/holidays off, and just HOPE that they stick to their guns with these positive changes? (even still I don't know how much better it will be).

Any advice?

[HouTx, BSN, MSN, EdD]

A hundred years ago, I had a wonderful mentor who helped me develop a great process for making 'hard' decisions. She introduced me to the concept of a "Risk Budget". Basically, this is the amount of risk you are willing to expend to achieve an outcome. We will risk much more for a highly prized outcome that is very obtainable. So, the three variables are: 1) how much do you reeeeaalllly want the outcome, 2) how likely is it that you will obtain that outcome & 3) the nature of the risk -- how bad are is worst-case scenario? Just to make things easier, give each one a score from 1-10 (1= low, ).

We can't define these for you. Although we could probably come up with some likely scenarios... such as #3 associated with rigors of fast-paced, more stressful acute care environment .... but only you can figure these out. Keep in mind that you will probably master the LTAC environment in 3 months or less, so it will be less stressful at that point. Would the weekend/holiday thing be damaging to your family?

Have you talked to your family about this change? How do they feel?

[8781RN]

Wow that's great advice. I'm going to sit down tonight and evaluate everything and do the Risk Budget!

My daughter is almost 4 now. If i'm going to have 4 days off a week, i think working some weekends will be okay. Yes, i've discussed it in length with my hubby and he's very supportiveof what I decide. He thinks my well-being is worth a paycut. I get to the point where I'm dead set on going to LTAC, but then my boss talks about how much better it's going to be at my current job. Another issue is that if I turn this job down after accepting it, if I change my mind and decide to apply again I don't think they would want to bother with me again.---and I've worked everywhere else in the city I live in and don't want to go back.

But i'm going to sit down and try doing the Risk Budget and see if i can acheive any clarity. THANKS!!!!