I'm going from Med/Surg to Nursing Home

CarVsTree · Oct 4, 2007

Hi

My best advice to you is to try to figure out what is holding you back. By 4 months, yes you should be able to handle and time manage 6 patients. But, what is preventing you. Do you have difficulty making decisions? Are you unsure of how to prioritize? Are you spending too much time assessing rather than a focused assessment?

I don't see how a nursing home is less hectic. I also think its sad that they are forcing you to resign. Are there other hospitals you can apply at? Sorry I don't have more advice for you.

EricJRN, MSN, RN · Oct 4, 2007

Tonypeggy,

I moved your thread from General Nursing Student Discussion to the First Year in Nursing Forum so that you get more relevant responses. I wish you luck! Keep us posted.

HealthyRN · Oct 4, 2007

Was this the first time that the supervisor spoke with you about her concerns? It seems unlikely that this was addressed just one time. Did they offer you any resources for improving time management and your overall performance? What steps did you take to do so?

Instead of resigning so quickly, I would go back and talk to your supervisor again. Find out exactly where your performance is lacking and what you can do to improve it. Let them know that you want to work on the issues and succeed on the unit. If there is a particular area that you are having problems with, let them know that you need some help. Perhaps you would work better with a different preceptor. Everyone has a different way of doing things.

I am confident that you can succeed. You just have to willing to give it a chance and make changes.

tonypeggy · Oct 4, 2007

Thank you for your advice. Yes, at the beginning I had trouble prioritizing, managing my time, etc., Everything was so new and overwhelming. I felt I was progressing, but not as fast as the other new hires, that's true. But I had no prior nursing experience, they all did. I think that made a big difference.

Sometimes I'd get rattled when things were coming at me from all directions, but I was getting over it and doing quite well in the last few weeks, I felt. But by that time my preceptor had obviously given up on me 'cause she wrote that I was always late giving my meds. That wasn't true at all. I'd been getting them in on time. I told my supervisor that. She just replied that "my preceptor is the best we have and no, you can't have a different one. I really can't see any way you will be able to catch up to the other new hires." She all but pushed me out the door.

All in all, I think I just astounded them on how slow I would catch on to things in the beginning. By the time things started to "click" for me, they'd given up on me. They even had the charge nurses watching me and reporting back to them. Sheesh. That just added to my stress.

But really where I am at now is "Will a nursing home be a good place for me to develop into a more competent nurse? That's what they're telling me and I'm just wanting to hear that its true! Is a nursing home less stressful than med/surg?

tonypeggy · Oct 4, 2007

Thank you, Healthy RN, for your input. Yes, they talked to me twice before this last time. I was open ears and assured them that I am always looking for ways to do things better, and their suggestions were good ones and I left the meetings excited to have suggestions to help me.

I'm a stubborn die-hard and would ponder the day's activities when I'd get home at night and figure out ways to make things work better. I felt all my hard work was working! But, as I stated in another reply, it was just too late. At the last meeting when I defended myself and told my supervisor I was shocked at the report that was relayed from my preceptor, that I'd felt I was doing much better, and would like another preceptor she said the one I have is "the best we've got". It is obvious beyond a shadow of a doubt (I don't have time to give details) that I've been labeled a "dud" out of all the new hires. But as I stated in my other reply, I was the only new hire that didn't have prior nursing experience, so I felt I should have been given more time to prove myself.

But I just really want to forget about all this and go on and get excited again about nursing. I'll work in a nursing home, I'm just hoping to get some encouraging responses about the benefits of working LTC...uhmmm...just so I feel better about everything....

tonypeggy · Oct 4, 2007

Thanks, Eric, for moving my message into a more appropriate place. I'm still learning how to navigate here...!

patwil73 · Oct 6, 2007

Thank you for your advice. Yes, at the beginning I had trouble prioritizing, managing my time, etc., Everything was so new and overwhelming. I felt I was progressing, but not as fast as the other new hires, that's true. But I had no prior nursing experience, they all did. I think that made a big difference.
Sometimes I'd get rattled when things were coming at me from all directions, but I was getting over it and doing quite well in the last few weeks, I felt. But by that time my preceptor had obviously given up on me 'cause she wrote that I was always late giving my meds. That wasn't true at all. I'd been getting them in on time. I told my supervisor that. She just replied that "my preceptor is the best we have and no, you can't have a different one. I really can't see any way you will be able to catch up to the other new hires." She all but pushed me out the door.
All in all, I think I just astounded them on how slow I would catch on to things in the beginning. By the time things started to "click" for me, they'd given up on me. They even had the charge nurses watching me and reporting back to them. Sheesh. That just added to my stress.
But really where I am at now is "Will a nursing home be a good place for me to develop into a more competent nurse? That's what they're telling me and I'm just wanting to hear that its true! Is a nursing home less stressful than med/surg?

From what you describe it might be difficult to get the supervisor to give you another chance, but if the only choice is between hospital or nursing home - I would definitely try. (This is nothing against nursing homes - but if you have difficulty prioritizing now, try 30 patients each with 20-25 meds, assessment, wound care, etc.)

A nursing home can make you much better at prioritizing and focusing, but not if you are having trouble with it already. I would go back to your supervisor, or maybe your manager if you think your supervisor has written you off, and ask if you could work out a plan on what needs to be learned and where you need to be. Go over everything you feel you have improved on (write it down if necessary) and calmly ask to continue your orientation.

If they still refuse ask if you can try another unit - Med/Surg is one of the most hectic and stressful units to work on. Surgery might be a better fit for you.

Hope this helps,

Pat

tonypeggy · Oct 6, 2007

Thank you so much for taking the time to write. When I talked to my supervisor last she stated there was no time left for me to get caught up to where they thought I should be. It was very clear they didn't want me there. I suggested another unit,or working nights (I did fine on med/surg nights), but she said if I couldn't do med/surg days then forget it 'cause they want nurses who can. (This is a hospital mainly med/surg).

CarVsTree · Oct 7, 2007

OMGoodness. Please, please, please don't listen to those idiots! Are there other hospitals in your area? Where are your fellow nursing students working? Don't work in a NH unless you want to work with that population. You sound like a typical new grad. They are idiots for comparing you to experienced RN's.

I know it stinks and its hard to pick yourself back up. They have wrongfully damaged your self-esteem. Well guess what, they are WRONG about you! You listened to their criticism, you improved, you were doing better.

We have had nurses that take longer than average to get up to speed and guess what? We give them the time that they need. You however, may not even be taking longer than average. You sound like you're catching on and improving. It is very normal even for an experienced nurse to get overwhelmed at times.

Find another hospital and start over. You will do fine.

jb2u, ASN, RN · Oct 7, 2007

First, I am sorry to hear about your difficulties.

As far as LTC being slower paced, I'd say that depends. I've never worked LTC as a nurse, but I have as a CNA, and I've heard every nurse there complain about being behind. Most residents have many meds and take forever to take them. You also must do wound care, assessments, charting, planning, labs, talking to family/MDs, etc. So as you can see, it makes for a busy day. Also, the nurse to pt ratio is higher and you have to do a lot more managing of the CNAs. I think it is really just a different kind of nursing and not a slower pace nursing. I also think you need great assessment skills in LTC because you will have to pick up on a resident that may need to be sent out to the hospital.

The choice is yours, but I'd think you would be better off evaluating exactly what you need help on. I'd say that four months is a lengthy orientation, but that is not to say that you will never get it. Understand that the hospital does not really benefit off of a nurse on orientation. They are actually paying two nursing salaries plus a preceptor bonus pay for the same pt assignment. I know many of my fellow new grads that received a 6-8 week orientation. I received ten weeks in an ICU. The fact that they invested 4 months on a new grad is impressive to me. My opinion is to tell them that you understand their position on this matter, thank them for their time that they spent training you, and ask them if before you leave they could tell you exactly which areas you need to work on so that you can become the great nurse that you know that you can be. Now, I'd say get a job lined up before doing this, but be sincere with them about wanting to improve. Take every criticism as a chance to improve. Some criticism may be unvalid, as you said that you have improved on your time management, so seriously evaluate wheather you could improve upon it more. If so, then move on to the next criticism on the list. By the end of the list, you will know exactly what you need to do in order to achieve your goal. I wish you all the best. Let us know how everything works out for you. One day you will be a nurse with twelve years experience and this will all be just four months out of a rewarding twelve year career!!!

Sincerely,

Jay

RN1989 · Oct 7, 2007

I'm not your preceptor so I can't tailor this super specific. But to me, it sounds like you are a victim of the system. My guess is that when you graduated, you and your fellow students, were not taking a full patient load at clinicals. This is getting so common in nursing schools. Then you get a job at a place that likely has a high turn-over (which place doesn't these days?). So they need you out of orientation ASAP because you are costing them a ton of money. Not only that, but with September usually being the end of the fiscal year for many hospitals, the managers just got their butts chewed for going over budget and were instructed to get the newbies into the staffing numbers ASAP. You haven't necessarily done anything wrong except you want to do things the right way and not the fast easy way that is expected. At least you have not shortcut your patients and signed your name to treatments and meds that you never gave like some seasoned nurses do when the going gets tough.

Would I recommend you go to LTC. NO! Hospital nurses frequently think that LTC is slow paced and good for people with time management problems. This couldn't be further from the truth. Granted, you can frequently get away with sitting on your butt more than a nurse at a hospital, but that is the only reason people think it is slow at the NH. When you are a nurse at the NH, you can have 30+ patients to care for. These people rarely have ID on, so that will put you way far behind until you figure out which people go with which treatment sheet. And then you have to find them. They don't stay in their rooms. They wander off. You leave them one minute and have to go to the other end of the facility to find them when you get back from the supply cart. This eats up precious time. Most LTC facilities are for-profit. Which means that they can get even worse about cost-savings. In fact, you have to document in a certain format just to get paid - unlike the hospital where you chart what happened. If you are an RN in LTC, you can get even more responsibility thrust on you. Because then you may have to pick up a wing of patients while still covering for all the other patients in the facility. Many LTC facilities do not have staff available when someone calls in sick. If other staff won't work extra shifts, then you end up even shorter. Frequently agency or PRN nurses are not an option. So -in short - I don't believe that LTC is the way to go simply because you have been told you have a problem with time management.

I would recommend finding another hospital. And make sure of what the orientation process is. You should be receiving frequent updates from your preceptor on your strengths and weaknesses. Your preceptor should then be assisting you to identify the cause of your weaknesses and a plan to correct them. It sounds like this hospital is just trying to spit the newbies out on the floor without giving them the support they need. And if the preceptor that you had was their best - it doesn't sound like they have very good preceptors - hence their need to get you out of orientation quickly before the get more staff turnover. Don't be bullied into a job simply because it is a job. You may have to take a job you don't like as far as specialty wise, shift wise, etc. but if it is a job where you can receive the support you need to get experience as a nurse in a safe environment, then the job is a good one. Once you get the experience you can always move on.