Long, sad story. I graduated from BSN program as a second-career nurse in December, 2017. Passed NCLEX in 75 questions in Feb. of 2018; secured first job in ICU at a Level I trauma unit in a residency program summer 2018. Was asked to leave program after 2.5 months on that job, with management saying that ICU is too difficult for a new grad nurse. Took psych job at small, poorly run standalone facility and worked 50+ hours/week, was assaulted, had 20+ patients at times. Was offered and accepted dream job at a highly reputable rehab hospital in the specialty I've always wanted. Did not make it through orientation here either. Manager and one of the preceptors stated that maybe I'm just not cut out for floor nursing.
I came into this job with almost no bedside experience. I arrived for 6:30 a.m. shift at 6:00 a.m. every day. I lived, ate and breathed this job, spending all non-working time reading about disease pathophysiology, watching YouTube videos on suctioning and IVs (just to name two, there are many skills with which I had no experience) designing shift report form and tightening up med pass procedure. For many of these, I actually acted out the processes just to get some muscle memory. All to no avail. One preceptor remarked that I was "passionate" and "the most hard-working person I ever met," but, something just wasn't "clicking" and I wasn't "making connections." She also said that she loved my inquisitive nature, hinting maybe I should try research.
Here's my question. Are there really some people who just can't do bedside nursing? I don't want to appear as bitter arrogant, but, come on, this isn't rocket science. This most recent dismissal happened a week ago and I'm working hard to gain some perspective and insight. I would definitely look to other areas of nursing, but it seems most want at least 1-3 years bedside experience. Where do I go if I can't manage that?
Many of the problems you describe seem pretty universal, so try not to get too discouraged. I remember thinking nursing school taught me everything I need to know about a med, except how to open the package. The first year is pretty awful, for pretty much everyone. I second the advice to start out doing med-surg--or at least, regular acute care. I've worked neuro my whole career, but I count that as med-surg, along with ortho, cardio, and other specialties, as long as they aren't ICU. (I do stepdown, now, and that's not a bad place to start, either, except it isn't great preparation if you get floated to a six-patient team in regular acuity.) I would also add, start on nightshift, if you can. The pace is different, and coworkers actually have time to help and guide you. Patients don't skip off to PT before you can give their meds. There are less doctors and family members and other assorted looky-loos in the way. But also less resources, which forces you to get creative.
I would also suggest being as up-front about your history as possible when you interview. Ask questions about how much orientation you can get, what sort of mentors you can expect. Many jobs, you wouldn't want to create an impression of being "damaged goods," but this isn't most jobs. Their are managers out there who are desperate to hire you and just aching for you to do well. Find one.
As "unglamorous" as Med/Surg nursing is, it is the backbone of nursing. I think you have to do the time if you want to climb the ladder and stay there. I did my Med/Surg time during the period that my family was moving compliments of the Air Force. Every time my husband was transferred, the only jobs I could find was back on the bottom rung. But by the time we "settled" I had amassed enough "acute care" experience to begin looking for jobs that really interested me. I also made an "outside the box" decision about my continuing education. By the time I decided I needed to add to my ASN (I waited because I already had a 4-yr degree), I researched BSN programs and curriculum. I decided that there was nothing that a BSN program could teach me at the 15 yr point that I did not already know, so I wandered into Health Care Administration. Got a BBA, then a MBA and I thoroughly enjoyed every minute. I have had some great jobs, and have never felt discriminated against because I don't have a BSN. Only thing I cannot do is teach, have no desire to go there. Bide your time, instant gratification is not always the best thing. And when you go back for your MSN, make it a dual - I recommend MBA in Healthcare Management. Employers love "big picture" nurses.
Well, this is what I call reconciling your dreams. Sometimes when you have to fight so hard for something, maybe it wasn’t what you were supposed to be doing. I’m not saying don’t be a nurse but ICU is a helluva way to start nursing with little clinical experience. You have lots of options and people here are giving you good advice. I’ve worked mostly in teaching hospitals (huge difference between private and teaching hospitals!) and Indian Health Service. Those are both good places for people (like myself) who are more bookish and don’t fit in with whatever it was that didn’t work for you. On another note, if you have large student loans, IHS is a great place to work and get your student loans paid off. Best of luck to you.
Community College may have continuing Ed classes that could help you gain skills.
BTW I am very disappointed for you about your school’s utter lack of clinical preparation. You paid for an education that should have prepared you to hit the ground running. Too bad they were only looking at the NCLEX score instead of the RN job you needed to be prepared to do.
Long, sad story. I graduated from BSN program as a second-career nurse in December, 2017. Passed NCLEX in 75 questions in Feb. of 2018; secured first job in ICU at a Level I trauma unit in a residency program summer 2018. Was asked to leave program after 2.5 months on that job, with management saying that ICU is too difficult for a new grad nurse. Took psych job at small, poorly run standalone facility and worked 50+ hours/week, was assaulted, had 20+ patients at times. Was offered and accepted dream job at a highly reputable rehab hospital in the specialty I've always wanted. Did not make it through orientation here either. Manager and one of the preceptors stated that maybe I'm just not cut out for floor nursing.
I came into this job with almost no bedside experience. I arrived for 6:30 a.m. shift at 6:00 a.m. every day. I lived, ate and breathed this job, spending all non-working time reading about disease pathophysiology, watching YouTube videos on suctioning and IVs (just to name two, there are many skills with which I had no experience) designing shift report form and tightening up med pass procedure. For many of these, I actually acted out the processes just to get some muscle memory. All to no avail. One preceptor remarked that I was "passionate" and "the most hard-working person I ever met," but, something just wasn't "clicking" and I wasn't "making connections." She also said that she loved my inquisitive nature, hinting maybe I should try research.
Here's my question. Are there really some people who just can't do bedside nursing? I don't want to appear as bitter arrogant, but, come on, this isn't rocket science. This most recent dismissal happened a week ago and I'm working hard to gain some perspective and insight. I would definitely look to other areas of nursing, but it seems most want at least 1-3 years bedside experience. Where do I go if I can't manage that?
Any guidance would be much appreciated.
You put me in mind of a fellow nurse who is bipolar. She is very intelligent. She sees things in a situation that I do not. I wish I did catch every detail the way she does, but I don't. Her bad habit is that she tries to educate everyone, whether we are in a mood to be educated or not. Are you coming across as a know it all?
I really don't know what to suggest. It sounds like you are doing all you can. But maybe you can go back to your school professors and ask for help from former instructors. They didn't really do such a good job, it seems, if you are totally lacking any clinical skills.
Your former bosses and peers should be able to give you some feedback about what you should focus on, how you should go about getting and KEEPING your next job.
Just a thought - you could work for an Agency that hires companions for people in their homes. No, you would not be functioning as an RN but you would get some pt care. Maybe you could do suctioning, catheterizing, tube feeds. For that matter, I guess you could work as an RN and do those things for a home care patient. NOt home health, where you kind of run in and run out, but where you stay for a full shift and do the bedside care + cook, feed, bathe the pt, maybe go to their doctor with them. It's a start, a chance to practice some skills, like med pass, bathing, etc.
I think you should try a different employer - maybe a skilled nursing facility, maybe a long-term care one. It would let you get real good at doing meds, some dressings, deciding when a status change warrants a call to the doc, catheter care I guess, charting. Or just try for another bedside position.
But I really think you need some feedback and help from the Professors/Instructors. They know you. Or what about the people terminating you? Surely they should have some suggestions. Ask your former peers, too.
I guess some can't do bedside care for various reasons. But Nursing encompasses so many areas that I believe you can find something if that is your desire. Best wishes to you.
Community College may have continuing Ed classes that could help you gain skills.
BTW I am very disappointed for you about your school’s utter lack of clinical preparation. You paid for an education that should have prepared you to hit the ground running. Too bad they were only looking at the NCLEX score instead of the RN job you needed to be prepared to do.
This is something else I've learned. My school (and others, from what I've heard) does not prepare students for nursing jobs. It prepares students to pass the NCLEX. That's a piece of advice that I've given people considering nursing school...beware the school that touts their NCLEX pass rate. Maslow's hierarchy of needs and Erickson's stages of development count for zero on the floor. Oh yeah, and that Peplau person...
It sounds perhaps like you are having issues with critical thinking? Are you mostly task oriented?
I really hope not. Yes, I was focusing on certain tasks that needed to be mastered, while trying to keep the big picture in mind. "Task-y" is almost the worst thing anyone could ever say about me, in my world. And to be perfectly honest, yes, I've always thought myself to be a critical thinker, but this whole experience has left me questioning my abilities in that area. Here's an example. A preceptor admonished me for not taking a patient's bp before passing meds that included beta blockers and Ca+-channel blockers. My reasoning: 1. There were no call or hold orders. 2. BP had been taken a few hours earlier and was w/in baseline for pt. 3. I had never seen any other nurse taking vitals before med pass. In my past experience, a doctor would have thrown a fit if I called w/a bp and there were no orders. This only happened once, and I took bps every time I passed meds after that. Of course, again, kind of a time suck....
Specializes in Nurse Leader specializing in Labor & Delivery.
My husband was not cut out for floor nursing. He learned that within the first year of his career, and went into hospice, where he flourished. Good luck in finding your niche.
I really hope not. Yes, I was focusing on certain tasks that needed to be mastered, while trying to keep the big picture in mind. "Task-y" is almost the worst thing anyone could ever say about me, in my world. And to be perfectly honest, yes, I've always thought myself to be a critical thinker, but this whole experience has left me questioning my abilities in that area. Here's an example. A preceptor admonished me for not taking a patient's bp before passing meds that included beta blockers and Ca+-channel blockers. My reasoning: 1. There were no call or hold orders. 2. BP had been taken a few hours earlier and was w/in baseline for pt. 3. I had never seen any other nurse taking vitals before med pass. In my past experience, a doctor would have thrown a fit if I called w/a bp and there were no orders. This only happened once, and I took bps every time I passed meds after that. Of course, again, kind of a time suck....
I would still check BP/HR only if the med would affect BP/HR even if it was already checked few hours before because it could change anytime. With that being said, I'm still not immune to the problem arising when I hold the med if I think the BP is too low. I was also a baby nurse at that time and I didnt know that I need to notify doctor if I hold the med. Management wrote me up then and tried to guilt me that pt had severe tachycardia because I held the med few days ago before he went to the icu. I was not even on my shift when he went to the icu. The sister's pt requested me to hold the med because she's very concerned with his low BP. Even after the incident with her brother went to the icu for severe tachycardia, the sister hugged me and thanked me for caring her brother. Hospital is always looking for scapegoats and nurses seem to be the easiest target.
My point is hospital is overrated. Your niche doesnt always have to be the same with majority of nurses who work in the hospital. I work in a school, and I'm still stressed out at work, but I do not regret my decision to leave hospital for good.
I really hope not. Yes, I was focusing on certain tasks that needed to be mastered, while trying to keep the big picture in mind. "Task-y" is almost the worst thing anyone could ever say about me, in my world. And to be perfectly honest, yes, I've always thought myself to be a critical thinker, but this whole experience has left me questioning my abilities in that area. Here's an example. A preceptor admonished me for not taking a patient's bp before passing meds that included beta blockers and Ca+-channel blockers. My reasoning: 1. There were no call or hold orders. 2. BP had been taken a few hours earlier and was w/in baseline for pt. 3. I had never seen any other nurse taking vitals before med pass. In my past experience, a doctor would have thrown a fit if I called w/a bp and there were no orders. This only happened once, and I took bps every time I passed meds after that. Of course, again, kind of a time suck....
Critical thinking in nursing has to be based on a foundation of nursing/medical knowledge. For new nurses that knowledge derives from their nursing program. Nursing school is where nursing students first learn about safe clinical practice. Were you taught in nursing school to check the patient's blood pressure and pulse before giving medications that affect the patient's blood pressure and heart rate such as beta blockers and calcium channel blockers? Were you taught why this is important? What could happen if you administer a beta blocker to a patient who is significantly hypotensive or who has significant bradycardia? This is an example of the type of critical thinking nurses engage in.
Man, I am about to commit to an ABSN program and hope it is not the same one as you mentioned where they provided minimum clinical hours. What state did you go to school if you don't mind me asking and how many hours is considered little for new grads?
I would still check BP/HR only if the med would affect BP/HR even if it was already checked few hours before because it could change anytime. With that being said, I'm still not immune to the problem arising when I hold the med if I think the BP is too low. I was also a baby nurse at that time and I didnt know that I need to notify doctor if I hold the med. Management wrote me up then and tried to guilt me that pt had severe tachycardia because I held the med few days ago before he went to the icu. I was not even on my shift when he went to the icu. The sister's pt requested me to hold the med because she's very concerned with his low BP. Even after the incident with her brother went to the icu for severe tachycardia, the sister hugged me and thanked me for caring her brother. Hospital is always looking for scapegoats and nurses seem to be the easiest target.
My point is hospital is overrated. Your niche doesnt always have to be the same with majority of nurses who work in the hospital. I work in a school, and I'm still stressed out at work, but I do not regret my decision to leave hospital for good.
Keep your hospital skills and med/surg knowledge up to date. You never know.
nursemike, ASN, RN
1 Article; 2,362 Posts
Many of the problems you describe seem pretty universal, so try not to get too discouraged. I remember thinking nursing school taught me everything I need to know about a med, except how to open the package. The first year is pretty awful, for pretty much everyone. I second the advice to start out doing med-surg--or at least, regular acute care. I've worked neuro my whole career, but I count that as med-surg, along with ortho, cardio, and other specialties, as long as they aren't ICU. (I do stepdown, now, and that's not a bad place to start, either, except it isn't great preparation if you get floated to a six-patient team in regular acuity.) I would also add, start on nightshift, if you can. The pace is different, and coworkers actually have time to help and guide you. Patients don't skip off to PT before you can give their meds. There are less doctors and family members and other assorted looky-loos in the way. But also less resources, which forces you to get creative.
I would also suggest being as up-front about your history as possible when you interview. Ask questions about how much orientation you can get, what sort of mentors you can expect. Many jobs, you wouldn't want to create an impression of being "damaged goods," but this isn't most jobs. Their are managers out there who are desperate to hire you and just aching for you to do well. Find one.