In serious need of advice

[WillingDisciple RN]

Hello all,

After all this lurking, I wanted to add something to the discussion

I'm sure you all heard the same story about nurses being tired of the floor, and I have read a lot of great responses and guidance but I have a unique case and I am in desperate need of your sage (and up-to-date) advice. I will give you all a background of my experience, just so you have a better overall picture of my situation.

The story began when I started in nursing 3 years ago. I worked in a mostly ortho and GI surgical floor with general med/surg thrown in. I had struggles with charting and clinical skills but I was fresh faced and ready to take everything on. I did the best I could (we had paper charting to boot) but I was there on average until about 10-11AM (I worked 7PM-7:30AM night shifts. Let me just say, I am one of those unique individuals who prefer working nights and turned down an opportunity by my boss to work days shortly after I was hired) I was there for about eight months when management transferred myself and most of the nursing staff to another hospital in the system.

At the next job, it was a similar unit, but mostly ortho (with computerized charting!) I felt like I was getting used to the pace of the place and I was actually leaving on average between 8-8:30AM (once again working a 7PM-7:30AM night shift), which was really good for me. About a year and a half working there, my boss gave me a heads up that I should move on before they made cuts (When they did the transfer of our old staff, they overestimated the need for so many nurses at the new place and they were constantly floating us around or giving us time off, we had more nurses than patients half the time) At that point, I was becoming weary of the floor and my bosses happily offered to be my reference. They said I needed to work someplace more challenging (the floor I was on currently was more or less a slower-paced floor, though at the time I didn't really know how exhausting med/surg could be)

I looked for work and found a position that was completely med/surg which is where I am at currently. Where I work is exhausting, they don't have appropriate CNA staffing which makes our jobs as nurses difficult. Most of the doctors treat us like crap and we have to tip toe around them and be sure not to call if it isn't important (like I wanted to call them in the first place!) and the patients are not always stable and I feel that they are keeping/admitting unstable patients to our floor at times, which I know isn't anything new. On top of that we are constantly being threatened to keep our patient satisfaction scores high (of course)

Constantly indundated with admissions, phone calls, patient complaints and the heavy responsibility of knowing that everyone's job (lab tech, CNA, MD's, housekeeping- I know that happens on every floor) is on my shoulders. And the sinking feeling that I must have everything patched up but "don't tell me to do my job!" is wearing down my last nerve. And finally, there are skills that I am not comfortable with at this point in my career that I am frustrated with (IV and foley insertions are the big culprits) and it seems that all it takes is for a patient to look at me and their IV goes bad Admittedly, I didn't have much experience doing those skills at my former jobs, but I feel as I am no longer a first level RN, it is not something that people would appreciate nor expect from my clinical experience.

I know these are problems that are common in med/surg and I wasn't the first nor will be the last to complain, but I think a huge part of my wanting to leave the floor is my lack of confidence in my clinical skills for the reasons I already mentioned. Even my co-workers with less experience than me treat me like a new grad (I ask a lot of questions) but for the most part, most of my co-workers are supportive (when they have time to help me). I just feel like a burden sometimes and I am back to working 15-18 hour shifts just trying to catch up. My boss doesn't like it but since they can't retain their nurses, she doesn't have much of a choice. I hate staying late but I get so overwhelmed by the hustle and bustle that I don't get a chance to chart until after the shift is over. Unfortunately, leaving late is something I'm used to at this point, it doesn't even bother me anymore. I leave exhausted and dread going back.

I knew I never wanted to do ER, critical care or home care. I don't want to do a job where clinical skills have to be strong or too much clinical autonomy is needed. I was thinking of going into education (in the school setting) and I love teaching other people things (things that I am comfortable teaching) but since my clinical skills are not strong (and the fact I work nights) I don't get the opportunity to teach and I wonder if that will hurt my chances and if I should even go in that direction. I am also considering utilization review but I'm not sure if someone with my experience is qualified, but I am applying to those jobs and looking for openings for entry level positions. I am willing to be trained in a new area if it meant doing something I can tolerate, maybe even love. I'm realistic; I don't mind a pay cut to do it either. I see how many nurses here find their niche and I hope that I can find mine as well.

After 3 years of experience (finally!) the only opportunities I'm finding seems to be med/surg and that was through a staffing agency, the main jobs aren't calling back. I thought my initial struggle to find work as a nurse was over once I started working in the field and gained experience, but it seems just as hard to change specialties. Everyone says that nursing gives you room to grow and change but it seems that change only works if you are changing buildings only

I am open to suggestions for different areas. I don't mind a job that is routine, where I can really learn by doing the same things everyday, where clinical skills don't have to be as strong, where there are hardly any emergencies, basically a job that would bore you to tears, because I never get bored. If it's a specific type of floor, fine, if not, that's fine too. I was also considering school nursing... the autonomy of that (being the only health professional in the school) makes it a little unnerving.

Thank you so much for reading and sorry for going on for so long!

[quazar]

Why not a doctor's office or a day surgery center or outpatient endoscopy clinic or something? No nights, no weekends, no holidays....depending on the office/location it can be pretty nice. I know several nurses who work in outpatient settings who are blissfully happy with their jobs.

[jadelpn, LPN, EMT-B]

Outpatient or dialysis, urgent care. School nursing.

If you stay where you are, you need to think about changing your system. Chart as you go!! You should not be staying hours to chart after the fact. It backs everything up, the MD's can't find info when they look for it, lots of things. Not to mention supervisors get a little prickly about staying on for OT to chart for up to 4 hours. And don't EVER chart and not be on the clock!

Use a paper brain if you need to figure out how to do your thing, organize yourself and your day, Iv's and foleys just take a lot of practice, but if the goal is to not stay on MS then do what you can when you can.

Best of luck going forward!

[Marisette, BSN, RN]

I don't think there are any boring nursing jobs. If you find one, please let me know. Be careful, because a pay cut may not mean that the job is more mundane. I've tried this and one thing does not lead to the other. I think a job becomes boring after you have performed it a million plus times and there are no challenges in doing the job. When you work with people there are always variables.

I worked dialysis for years. It was very stressful. I had a friend who went into school nursing. She said she would have 30-40 sick children wanting to go home in a day and a principle telling her not to send the kids home. Yes, stressful. The long hours of work, even if you don't appear to mind, may lead to nursing burn out in the long run. You may have to learn to delegate, prioritize and think of your own needs to chart so you can go home on time.

[jdub6]

Have you considered leaving acute care? A hospice inpatient facility has less stress with worrying about your pt crashing. Depending on the facility you will do a lot of foleys and a fair number of iv starts (but then some do almost none. ) it certainly is stressful but most of the stress is emotional dealing with dying people and their families. There are some symptoms that are common in dying people and you will learn how to treat them fairly quickly.

You may also want to look into long term care. Probably not rehab as that might be too much. Look for jobs where you could work on the long term care floor or unit of the facility; whet the residents live there. While you will always have a few just out of the hospital and some developing new conditions to treat or send out you will get a chance to know your population. Your main job will be passing many many meds (think 5 to 15 a person times 20to30 people. ) and doing dressing changes when needed. You will need to assess anyone with a change in condition and call their doctor. They do iv starts,Foley changes, wound care and trach care. Again there is stress, usually due to the sheer number of meds to pass and people to assess.

If you don't want to do pt care you mentioned utilization review-another option would be mds coordinator in long term care. This is basically handling the many charting requirements for Medicare to pay for ltc services-it is a desk job. Most want some ltc experience but you may be able to take an mds class to make yourself more marketable if it's something you want to do.

If long term skilled care sounds too overwhelming see if there is an intermediate care facility (sometimes called a rest home) around you. Those places only take pts who are stable, can be out of bed at least to a wheel chair, don't have trachs or iv needs. Sometimes if one of these pts is hospitalized will go to another facility for rehab before returning to the rest home as these do not provide rehab. Again you will have many meds to pass but you can usually get into a routine as acute changes in condition are less likely (but still happen but usually the md will just say to send them out since basically the only things you can do in house are start new po meds and give neb treatments. ) you will get to how your residents and once you do you will have a good sense of how to do med pass most efficiently and it will be easier to spot any change in their condition. You will not gain many technical skills here but you may have chances to advance to management or mds coordinator positions.

[jdub6]

Óh another thing would be drug treatment or methadone clinic nursing. In drug rehab you basically handle detox assessments and meds. The pts are less likely to be violent than the average psych pt although they can be very emotional and disruptive. Medical emergencies are rare. Few technical skills there.

In a methadone clinic you will quickly and briefly assess to ensure the person is not intoxicated, pass methadone, and in some clinics also handle labs-hiv, hepatitis, liver function. From what I have heard it is very low stress, easy to learn, not much charting. You won't gain many skills here that aren't specific to the job though. And few opportunities for advancement unless you want to move into a psych or addiction role. But again- minimal stress- occasionally the clients may be disruptive but most just want their meds and to get on with their day.