How do you know when it's time to move on?

VANurse2010 · Dec 17, 2013

I think your problem, OP, is night shift. Night shift can get boring and sometimes it *does* feel like you're just giving meds and changing people all night. I get it.

Try going to days - you'll be more involved with the overall plan of care with rounds, case management, family etc. It'll give you more perspective.

nursej22, MSN, RN · Dec 17, 2013

While you are doing your new job search, perhaps you could do some more in-depth pathophysiology study or more advanced pharmacology. I used to take for granted the meds I gave as ordered, but I learned more about drug metabolism and neurotransmitters it opened a whole new world for me.

Instead of automatically hanging that D5 1/2 NS with 20 KCL at 125/hr, do you ever question why? What effect will this have? Are there any contraindications? What labs will I watch? Why am I giving this antibiotic or that beta blocker? And why that dose?

SHGR, MSN, RN, CNS · Dec 17, 2013

I worked med-surg for about eight years and we only had a couple of real codes in all that time. There were some of what is now called rapid response, but very few real codes.

One thing you might challenge yourself with, OP, is the process on your unit. Some units have implemented things like MEWS early warning systems to help determine who is more likely to code, and then transfer those patients to a higher level of care prior to when they would have coded- effectively intervening prior to a code. This is the kind of challenge that I like, though-- looking at process improvement and prevention.

Sun0408, ASN, RN · Dec 18, 2013

If you're bored after a year on Med/Surg, you're not doing it right. Med/Surg is probably one of the most difficult specialties -- there are so many different disease processes/ surgical interventions that get lumped into "Med/Surg", it would take a lifetime to master all of them. So the issue seems to be not that you're not being challenged, but that you're not challenging yourself.
Everything you've said in your post makes me believe that you're just going through the motions. You're getting the tasks done without thinking about how each task relates to the health of the patient as a whole. And THAT makes me believe you're NOT ready for ICU or ER.

I couldn't agree more with these two paragraphs... 3 codes in a short period of time is a lot for one nurse to have. Most pts show signs of crashing before they code. Many will show signs 8 hours prior. Give yourself more time to advance in your role and master your assessment skills. Understanding the why's is very big in the ICU.

Oh and in the ICU we do A LOT of basic care ie: turning, cleaning, mouthcare etc...

liberated847 · Dec 18, 2013

If you are bored, move on, pay your dues in critical care nursing, gain experience and then go for a flight nursing position, I've never being bored in that position. Down time can be used studying, watching the game or sleeping, yes, sleeping!! Once dispatched to a flight, then is 0 to 60 in no time flat!!

taydian · Dec 18, 2013

Maybe because I'm on a psych facility, to me shifts are meaningful....evenings and nights are WAY less stressful than days. You mentioned "night". Do you work night shift?

If you're a night shift person, then move to day or evening. (or day if you're 12 hour)

I think the fact that you get a rush from hectic events does validate your boredom. At the same time, you don't feel 100% confident. I'm in psych and have zero experience in medical so I can't relate (different type of "rush" in psych). However, if it were me, I would spend enough time in med surg to feel 100% confident before I went onto to the more busy stuff...because the busy stuff needs the 100% confidence. There's no time for thinking. It's knowing exactly what you need to do to get **** done. If you don't have that 100% in med surg where the pace less acute, then I don't think you're ready for the hectic stuff. Granted, there are new grads who go straight into ED or the ICU.....but they were there from the start and were trained accordingly. But you admitted being not 100% confident in med surg. Spend more time in med surg and learn as much as you can.....then move on. Nursing in any new position can take up to 1 or a little more to feel comfy. You admitted that you've only been where you're at for just over a year. Chill out....enjoy what you got and keep learning. The butt wiping, the sitting, etc...we're all pros at. We are working with staff shortage. We all know. We're all doing it. Just keep learning and deal with what you got.

Caffeine_IV · Dec 19, 2013

Move on when the opportunity is there. You may not like med surg but it shouldn't be boring. Some nights can be quite routine but I'm always looking up which drugs are syringe compatible, side effects of new drugs, finding things to educate patients and family on. There is always something to do or a coworker to assist.

At my other hospital, we would float to various floors....tele, stepdown, ICU. Yes there are some finer details to those but the patients still poop, take meds, are confused etc. Only you can decide your path but no need to put down med surg nurses on the way.

VANurse2010 · Dec 21, 2013

I think everyone chastising this nurse for having 3 codes in that time should step back and think a minute. We don't know what kind of floor she's on, what kind of hospital, or what kind of patients they take. It's certainly possible that this hospital dumps inappropriate patients (who need to be on a PCU or a unit) on the floor. Likely? Maybe not, but since we don't know then perhaps some reserved judgment is in order.

boogalina, ADN, ASN, BSN, MSN, LPN · Dec 23, 2013

If the OP dislikes Code Browns, then the ICU is the wrong place to be. In the ICU where I worked as a CNA, vented patients couldn't be turned w/o the RN in the room. And guess what? ICU patients sometimes require more frequent cleaning because of their conditions (hello, hepatic failure, high ammonia levels and lots of Lactulose!); many are on tube feeding and/or lots of antibiotics, or have C-diff. And in many situations, rectal tubes don't work b/c these folks may not have the rectal tone needed for the device to stay in.

I have participated in many, many codes (and now referring to Code Blues) as a CNA, and I can tell you that no one "likes" them b/c it means something has gone really badly for the patient.

A great deal of nursing is trying to monitor for, and detect, patient instability before it gets to a code. To me, there's the real challenge of nursing, and that challenge is readily and constantly available in all nursing settings - LTC, ALL acute care areas, and outpatient care.

The nurses I've worked with in ICU who do charge nursing, Rapid Response Team, etc, and often have the "interesting" (this = scary) assignments (IICP, CVVH, Alsius, complex trauma, Rotaprone, IABP, etc, etc) are the experts in detecting changes in patient condition and avoiding codes. Something to ponder, I guess.

As a new RN, I care for pts from Med-Surg to ED to stepdown critical care, and some days, it can be hard to tell the difference. Why? Because your seemingly stable Med-Surg patient's condition can change any time.

2k15NurseExtern4u, BSN, RN · Dec 26, 2013

I dont get why everyone is attacking the OP because she is bored with her job? Yall are a bunch a crybabies.

I think if this area doesnt excite you or you dont feel challenged that maybe you should go back to school to be a NP?? Im sure thats a much more challenging profession.

Ruby Vee, BSN · Dec 26, 2013

I dont get why everyone is attacking the OP because she is bored with her job? Yall are a bunch a crybabies.
I think if this area doesnt excite you or you dont feel challenged that maybe you should go back to school to be a NP?? Im sure thats a much more challenging profession.

Thank you for your thoughtful and articulate contribution to the conversation.

If the OP is bored after such a short time as a nurse, it's because the OP isn't thinking things through. She hasn't been a nurse long enough to learn it all, or even very much at all. If she's already bored, it's a red flag. Most likely, she's just hurrying through her list of tasks for the day without thinking about how these tasks relate to her patient's health and wellness, without thinking about why she needs to do the tasks or what her assessment means. Someone who is bored with nursing after so short a time is a very poor person to become a NP. If they don't care enough to understand what's going on when they're at the bedside, how likely is it they will suddenly care just because they have more initials after their name?

2k15NurseExtern4u, BSN, RN · Dec 26, 2013

Thank you for your thoughtful and articulate contribution to the conversation.
If the OP is bored after such a short time as a nurse, it's because the OP isn't thinking things through. She hasn't been a nurse long enough to learn it all, or even very much at all. If she's already bored, it's a red flag. Most likely, she's just hurrying through her list of tasks for the day without thinking about how these tasks relate to her patient's health and wellness, without thinking about why she needs to do the tasks or what her assessment means. Someone who is bored with nursing after so short a time is a very poor person to become a NP. If they don't care enough to understand what's going on when they're at the bedside, how likely is it they will suddenly care just because they have more initials after their name?

Touche. I just figured since she wasn't feeling challenged enough and her current position seems so "beneath" her then maybe she should reach for higher educational goals and broaden her professional horizons. But if anyone is butthurt over HER opinion, then they should definitely relax :)