I Feel Like I'm in a Rut

[whitecat5000]

So like the topic says, I feel like I'm in a rut.

I've been a nurse for a year and a half and I've been a med/surg nurse that whole time.

I feel bored. We don't get a variety of patients, and they ones we do get seem so predictable. Even when they go into afib in the night, or go septic, or c/o chest pain. I know what to do and get my patient's their tests and transferred safely.

Oh, a cellulitis patient? Well lets give Vanco, dressing changes, and measure the area every shift.

Oh, a back pain? How about some morphine q 4 hours and colace BID until the doctors diagnose you with something.

COPD exacerbation? Have some Levaquin, Solumedrol, oxygen, and breathing treatments.

UTI? Measure vital signs to check for sepsis q 4 hours and here's some Levaquin.

Is this normal? I started as a new grad in a hospital that was like county. I did everything, learned a lot. Now I work at a big chain hospital and I do nothing!

Dressing changes? Call the would care nurse. Breathing treatment? Call respiratory. Central line dressing? Call respiratory. Need a new IV? Call SWAT.

Anyone have any ideas? I really love to learn, and I feel so stuck. Should I try a new specialty? Just look at things with a new attitude? I don't mean to sound snobby or condescending, I just can't figure out why I'm bored. I haven't even been at this for two years. I shouldn't be bored!!!

[HouTx, BSN, MSN, EdD]

I have a couple of suggestions.

First of all, start working on obtaining additional training/certification in areas that are applicable to the patients you treat. Have you mastered EKG interpretation? Hemodynamics? Are there any opportunities for training for PICC insertion? ACLS? Are there any department projects or initiatives in which you could become involved?

Secondly, I noticed that your post listed all the "medical" interventions you carry out - and it appears that you do have a handle on the routine medical protocols for most of those commonly encountered diagnoses. BUT - what about your independent nursing interventions? How do you feel about your patient teaching efforts? Are you maximizing physical activity so that they don't become deconditioned while in the hospital? Are you doing everything you can to ensure that there is an effective DC plan/process in place?

I'll just bet that you are also feeling out of place because a lot of your co-workers who are at the same place seem to be perfectly content... they love the stability and comfort of not having to deal with anything new. Am I right? Makes you feel like there is something wrong with you? Based on my own experience, your dissatisfaction is probably due to the fact that you are a 'happy learner' and receive a great deal of satisfaction from learning and mastering something new. You need challenges and really enjoy caring for those complex patients, right? You probably are a very quick learner.

Now that you have achieved 'competency' in your job, you'll need to create some new goals for yourself. It's time to become the expert in something - or many somethings. And get used to this situation... no matter how many times you change jobs, eventually you will always reach the "OK, what's next?" stage. You need to recognize this and initiate your own 'self rescue' when this happens in the future.

[llg, PhD, RN]

What you are experiencing is typical of the "competent" phase of nursing expertise development. You might want to review the "Novice to Expert" model by Patricia Benner.

You have mastered the basic tasks of your role and feel that you can handle the job with no special problems. That's a good thing. Recognize it for what it is and take a breather for a little bit. Then decide how you want your career to progress from here. You have several options. Take a little time and think about them carefully before jumping into something new that might be a disaster.

1. You could choose to become an expert in adult med/surg nursing. Go to some conferences, learn more about that specialty in depth. Get certified in the clinical care of adult med/surg patients. That would be a good idea if you hope to stay in adult med/surg nursing. Are there certain aspects of patient care that interest you more than others -- or types of patients? Maybe that is a clue as to what expertise you might want to develop -- or an advanced role you might want to explore.

2. Branch out and explore other roles related to your current job -- such as preceptor or charge nurse. Are there unit committees that you could join? Hospital-wide committees? Are there projects that could use your help? Participation in those types of activities are good ways to help you learn the bigger picture of health care -- while building upon the knowledge you already and adding skills that may help you later. Such activities also give you a chance to see what types of other nursing activities you might enjoy. For example, if you really enjoy precepting new orientees and/or students, you might enjoy an educational role. If you like being in charge and/or working on some sort of change project, you might enjoy a management role some day. Finally, working on these types of things expands your goups of colleagues. You get to know people better who might be able to help you find/secure your next job. Find out about their jobs (e.g. patient educators, staff development educators, program coordinators, performance improvement specialists, case managers, etc.) The more people you know -- and the more roles you become familiar with -- the better able you will be to find the right fit for you.

3. Become active in a nursing organization. You might get a lot of the same benefits as you can get from #2 above.

But don't just quit your job and jump to another specialty unless you are really unhappy with the specialty (or job) that you are now in. In a totally new specialty, you will be a beginner again and have a lot to learn. That might be interesting for a while, but soon, you will become competent there and face the same issues you are facing now. People who jump from job to job like that don't move up or forward in their career, they just get frustrated as they face the same problems repeatedly in a variet of different places. Take the time to explore and then choose a career direction before you "quit your day job" if possible. Explore possibilities first by trying a few things out (as you seem to be doing with this post) -- and then make a well-informed choice about the next phase of your career.

[whitecat5000]

Thanks for the responses!

I have my ECG, ACLS, BLS, and PALS. I can't take my med/surg cert or gerontology cert until August 2013.

I've just become part of the SuperUser team, Skin/Wound team, and Shared Leadership team, and I'm taking steps to become a preceptor.

I'm also going back to school to probably get a Bachelors of Science in Psychology.

I volunteer to float a lot to other units. That way I can learn new things, and try and remember old things.

I work nights, and I don't want to transfer to days. Even though I might see more and learn new things, I work best without constant supervision. I'm the type of person where if you give me direction and orders, I'll make sure it's all done, and done well.

I guess I was worried that something was wrong with me because I've never had a job where I felt this bored. And I guess I feel a little disappointed, because I was hoping that I would never be bored in nursing. That there would be new thigns to learn and new things to do always.

Ah well, I shouldn't complain so much. I have a job and I'm content. I guess that's better than most people.