Is my short career over?

[Golden_Dawn]

ladies and gentlemen, i am having great difficulty deciding if my nascent career is, or should be, over. please be kind enough to tell me what you think. i am an rn with an as who recently graduated nursing school with distinction and a gpa of 3.9. i passed my nclex on the first try, in 1.5 hours, with 75 questions. i am acls certified. but, in school, they told me "nurses eat their young", and i have come to believe it's true. i'm not young; i was 58 years old at graduation, but young in the profession.

within a month of passing my boards, i found employment with a dialysis clinic, as a dialysis nurse and team leader. after a training period, they promised i would soon be charge for my shift, assess patients, pass meds, and supervise four techs.

unfortunately, they had my subordinates train me. i was thrown into the lion's den. my subordinates were techs with only 6 weeks of informal training from the company, but had many years of valuable experience. they seemed anxious to let me know that while i would be their team leader, they had no respect for me because of my lack of experience, and that they really ran the show. it was more like hazing than training. i would see them give a patient 250 ml of ns, go for a lunch break, and fail to chart it. when i suggested they needed to chart it before they left, they'd say, "you aren't the nurse yet, and you probably won't last long enough to ever be the nurse." i refrained from reminding them that while i might not have been "the" nurse, i was indeed a nurse, and tried to get along with them, thinking i could address this when i became charge.

they kept me busy with scut work, emptying the infectious waste trash and cleaning up blood off the floor, while they treated the patients. after a month of this, i complained to the clinic manager that i wasn't going to become proficient in treating dialysis patients by emptying everybody's trash cans. i needed to actually perform dialysis on patients. then the clinic manager put a stop to the cinderella treatment, and insisted they give me some hands on experience.

each day i had a different tech preceptor. everyone had their own way of doing things. each day my preceptor would complain that the way yesterday's preceptor told me to do things was wrong, and insist i must do it their way instead. i learned the principals of dialysis, the appropriate responses to dialysis related emergencies, how to access a "button hole", how to access a fistula, and became proficient at catheter care.

it was a crazy way to set it up, but they also had these tech preceptors evaluating my performance. even though i tried to be pleasant, they really didn't like me and i think they just resented having a newbie come in as their supervisor. their evaluations were less than flattering, insofar as they complained i was "slow in the performance of tasks". as my 3 month anniversary came near, the clinic manager told me that i was "too slow."

i explained that i had still not had much experience and that i would get faster with time. i also asked, "do you want me to be fast, or do you want me to be careful?" she said what she wanted both, immediately, and otherwise maybe i should resign. so, i resigned, but very gracefully, saying i was sorry it didn't seem to be working out, and that i had great admiration for the job she did, and the way she did it. i live in a small town, so burning bridges isn't a good idea. besides i did admire her, she was capable and had been kind to me. i did frankly tell her she should not be dismayed if my coworkers spoke badly of me, because they also spoke badly of her. the rest of the staff smiled in her face while making cruel remarks about her behind her back. she said she knew this. i also mentioned that it was probably an ill-conceived company policy to be trained by subordinates. she agreed, wished me well, and we parted on good terms.

within a week i was working again, this time at a community clinic with a low level of acuity. i was treating a broad spectrum of patients, pediatrics, geriatrics, diabetes clinic, surgical clinic, as well as women's health and pre-natal patients. in my first month there i learned how to perform many poc lab tests such as rapid strep, flu tests, rsv tests, urinalysis, pregnancy tests, a1c and accu checks. i learned how to assist in minor surgeries and pelvic exams and do prenatal non stress tests, ecgs and learned the pediatric immunization schedule.

everything seemed to be going along fine until, in my second month, i made my first ever med error. i had a baby who had turned 6 months old the day before he came to the clinic. his mother brought him in because she wanted him to have an influenza immunization. our "standing order" protocol dictated that if he were less than 6 months old he should get a divided dose, 2.5 ml now, and another 2.5 ml in a month. if he were more than 6 months old, he should, instead, have gotten one single 5 ml dose. as it happened i was distracted by people bustling around me, my preceptor talking to me, reaching around me to get into the med press, the unit clerk coming and taking over my computer while i was trying to look at the computer's calculation of his age, etc. i was also dehydrated, tired and rushed. i miscalculated the baby's age, thinking him one day younger than 6 months instead of one day older than 6 months. i gave him the 2.5 ml dose that would have been appropriate if he had come in two days earlier. the child was under dosed. i had only been there two months, and i still had a preceptor watching me, but she didn't notice anything out of the way, either, until it was too late.

well, anyone who has ever made a med error knows the whirlwind of reports that follow. i made out all the reports. i called the baby's mother at home and explained to her that i had made a mistake, but that it should not harm the child, except insofar as he would need to come back for the second dose. she was very kind. my preceptor dressed me down and wasn't satisfied until she reduced me to tears.

the don was livid and demanded to know why this happened. i explained that i had not been given a break, was fatigued, dehydrated, and the clinic was busy with people bustling about, and that a computer was not available to me to look up the child's exact age. she asked what could be done to prevent recurrences of this in the future. i suggested that the nurses should be given a 10 minute break in the morning and another in the afternoon so that we could refresh our minds, use the bathroom, and have something to drink, since drinks were not allowed on the floor. i also suggested that nurses drawing meds should be given a "quiet zone" around their computer for the few minutes they were drawing them. she said, "well, you're not going to get that! so forget it!" "and", the don added, "you are still on probation, you don't get to make mistakes! i'd better not hear of anything else going wrong, or you're out!"

the don also dressed down my preceptor, saying that she should have caught this error before it occurred. my preceptor thereafter became very hypercritical and no longer seemed willing to train me, actually ridiculing me whenever i asked for information. i apologized to all profusely and hoped i would be forgiven, but i felt i was never forgiven. very shortly after, i was so miserable, i resigned again.

i then decided that i needed a hysterectomy, before i got another job, because i had a prolapse and had been waiting for a hysterectomy since before nursing school, never having enough time off to do it. so i took that opportunity. my recovery was complicated by cellulitis of the cuff, and my doctor didn't clear me to go back to work for 4 months. but i didn't look for another job just yet, because my daughter's wedding, scheduled to take place on the other side of the continent, would be happening soon. i thought a new employer would never give me time off to go to her wedding, so i waited 3 more months. very soon after that, my brother in law, (of 43 years), was diagnosed with stage 4 pancreatic cancer with mets, and i flew across the country to help my sister care for him until died, which occurred just last week.

now i find that i have been out of nursing school for 21 months, and have only worked a total of 6 months, at two different jobs! i spent 3 months waiting for nclex, 3 months working dialysis, 3 months working the clinic, and 11 months being unemployed, reticent, and trying to fathom my future. i'm very discouraged and actually afraid to go back to nursing. i also don't know how i can be smooth in an interview when i have failed so miserably at both jobs. i was slow at one and incompetent at the other.

einstein said, "anybody who has never made a mistake has never tried to do anything new." that's true, but maybe i'm not fit for nursing, even though i enjoyed scholastic achievement. nursing school teaches you how to be a good student, but only experience teaches you how to be a good nurse.

just last week a headhunter called and asked me if i would consider going back to the same dialysis clinic, this time as the clinic manager, since my former clinic manager had resigned. i thought about it for only 30 seconds and said, "no." i remember how the nurses and techs who worked for that clinic manager spoke evil of her behind her back. when she was not in earshot they called her a fat, ugly, old *****. i ventured to ask them how that was relevant to her job. they said, "well, she doesn't do her job very well either." actually i thought she did pretty well, i did admire her. i can imagine how those techs and nurses would treat me, who they viewed as slow, inexperienced and incompetent. they would tear me apart. and they'd be impossible to manage. it would be mutiny.

if i did go back to nursing, i wouldn't know how to smooth all this into a productive interview. and i don't know what to say in interview about the long hiatus. maybe my patients are better off having a different nurse. i have no self-confidence about it. is there anything else i can do with my degree and license? would an insurance company take me as a case manager? or do they want a lot of experience?

on the other hand, i have enough money and there is a free clinic that operates solely with volunteer staff in my town. maybe they would more patiently precept me, since my labor would be free, and maybe i could get a year's experience there, and become a more astute nurse.

any suggestions on how i might salvage my career? i do have very nice letters of reference from my clinical instructers in nursing school, as well as some of the mds and rns that i worked with at the community clinic. i'm sorry this was so long. thank you very much for your time reading this, and for your consideration of this problem.

[Golden_Dawn]

*CORRECTION*

Baby was 36 months old. Sorry for typos!

[caliotter3]

I would approach a third nursing job with a different attitude. Look at two different nursing areas for possible jobs, long term care and home health care. Long term care would give you a baptism of fire in learning how to prioritize, implement time management skills, become proficient and efficient in nursing skills, and manage your nursing assistants. Extended care home health cases would offer a lower stress, slower environment where you could devote yourself to total patient care in the home environment. For an entire shift you would be responsible for one stable patient, doing routine nursing care. You can't get lower stress than that, but at least it is still nursing. At this stage of your life you might find yourself better suited to caring for one patient. I would not give up on nursing until you have given it another try in a different environment. Think it over and good luck.

[netglow, ASN, RN]

You got crappy jobs because almost all that is out there is crap. Choice is not available. The dialysis was a no go from the start. I have said this before, you need medsurg or ICU experience as prerequisite for training for dialysis. I don't care who says NGs can get hired, NGs can get hired for anything if they are foolish enough to do it. I have never heard good come of it. The promises for orientation/training are a hoax at these places.

Anyhooo. Just interview. Tell it honestly. The economy is bad. I wanted to work. I took this job. I now know that everybody and their dog can start and run hospice, home health, dialysis, etc. without any legitimate people at the helm and are in it purely for cash. I am now avoiding places like these and earnestly looking for a great group to work with where I can become part of the team and plan on building a long career with.

[llg, PhD, RN]

Your first job was a totally inappropriate job for a new grad. No new grad would have succeeded. If you want to be a nurse, you need to look for a job that matches your current skill -- and that's going to be an entry-level job, not one that involves supervising and/or leading others.

It might mean working nights, weekends, holidays, etc. and/or it might mean working with a patient population that is not your favorite. But that's what entry-level jobs often require. It also might mean getting more education as your options may be limited by your minimal level of education. An AS degree can get you a license, but it is the minimal RN entry-level degree and a lot of employers are looking for more than that.

Assess your local job market. Can you get an appropriate entry-level job with your AS in your town? Do you want to? Those are the key questions to ask.

[mazy]

I don't see how this is a case of "nurses eating their young" and hate that phrase, so commonly used by new nurses.

You also used the term "subordinate" many, many times, which reflects an attitude toward you co-workers that could be at the root of many your conflicts with them.

At the same time you remark on your training and good grades, contrasting that with their "6 weeks of informal training."

The techs are experienced and good at their jobs, and are in a position to show you the ropes; you are just starting out, and so you are not expected to be good at your job. But you are expected to be respectful of your job and of your colleagues.

You have the training without the experience, they have the experience with a different type of training. Ninety percent of what you learn as a nurse, you learn on the job, so until you get the hang of the job, your grades mean nothing more than that you know your material and one day will be able to put it to good use.

That will happen WHEN you learn how to do the job.

While you are training, you are not expected to be supervising, you are expected to be learning, and those "subordinates" who are training you are not your "subordinates."

They are the people who know what you should be doing so that you can assimilate into the team, and work together with your colleagues as EQUALS -- albeit with different scopes of practice and different responsibilities -- to provide good patient care.

I don't think you need to focus on salvaging your career. You are just starting out, you are going to make mistakes, it is a normal part of your professional growth. You do need to come at this with a different attitude.

I imagine that as someone who did well in school it must be difficult to find yourself out in the world struggling. Real world nursing is a very humbling experience, especially when you are starting out.

But it happens to everyone. The trick is to learn from your mistakes, find an environment where you feel comfortable, take your hits, accept responsibility for your learning process and most of all, have patience with yourself. You will be fine.

[Golden_Dawn]

Thank you all for taking the time to give me some advice. I will take it to heart!

[MJB2010]

You do not start out in charge,ever. When you are new, you have to suck it up and learn the job before you can have any "subordinates". You need to learn and get along with your coworkers and learn your part of the TEAM. I get the impression that you went in with a bit of an attitude thinking you were superiror or better than the techs. They picked right up on that. We work as a team. You should never been hired as a team leader with zero experience. I started out in dialysis and I was trained by the techs as well. I had excellent training and it takes experience on the job before you can be charge. You cannot be the leader if you have no idea about how to do the job. It really should be a good year before you are in charge. You cannot go in there thinking your the boss because you will rely on the techs and their valuable experience to help you out. These are the people that will save your behind when you are new. They can make or break you. You want your coworkers on your side, not beneath you.

[Golden_Dawn]

You do not start out in charge,ever. When you are new, you have to suck it up and learn the job before you can have any "subordinates". You need to learn and get along with your coworkers and learn your part of the TEAM. I get the impression that you went in with a bit of an attitude thinking you were superiror or better than the techs. They picked right up on that. We work as a team. You should never been hired as a team leader with zero experience. I started out in dialysis and I was trained by the techs as well. I had excellent training and it takes experience on the job before you can be charge. You cannot be the leader if you have no idea about how to do the job. It really should be a good year before you are in charge. You cannot go in there thinking your the boss because you will rely on the techs and their valuable experience to help you out. These are the people that will save your behind when you are new. They can make or break you. You want your coworkers on your side, not beneath you.

Yes, MJB, true, but to be fair, I did, unprompted in my original post, give them credit for their "valuable experience", and also spontaneously stated that "experiece is what teaches you to be a good nurse". So I'm not totally asleep to the points you made, and the concept of needing experience to be able to do the job. I'll grant you, as an NG, I shouldn't have been hired for a charge position, but that is the job they offered me. However taking out the trash for a month isn't learning much of anything; and the fact that they had no concensus of opinion on how to do anything didn't help either. At least consistency would have helped. As far as picking up on my attitude, I must add, they weren't nice to each other, either. They bad mouthed and back stabbed whoever was missing from the room, every time. There was a lot of animosity within that group independent of me. I didn't so much think I was the boss, as think it would be my license getting yanked if anything went wrong, so I wanted them to chart what they had given. True though, that I have never managed a team, and didn't know how, which is why I said no when they offered me the clinic manager's position later. I wouldn't have known where to begin. TY for your insight.

[Not_A_Hat_Person, RN]

If the free clinic will take you, why not get some experience there? Have you considered a refresher course? Have you considered camp nursing, or private duty (most agencies require a year of experience, but a family may not).

You do not start out in charge,ever. When you are new, you have to suck it up and learn the job before you can have any "subordinates". You need to learn and get along with your coworkers and learn your part of the TEAM. I get the impression that you went in with a bit of an attitude thinking you were superiror or better than the techs. They picked right up on that. We work as a team. You should never been hired as a team leader with zero experience.

My first nursing job was as a med and charge nurse. I knew that working charge as a new grad wasn't a good idea, but I'd been job hunting for over a year, and that was the first job offer I had (unless you count a position 2 months earlier, which was cancelled 45 minutes into my first shift). I was trained by a bunch of techs and the other charge nurse, who started a week before I did, and who was fired about 6 months later. I lasted about a year. After 2 short tours through Nursing Home Hell, I finally landed in Home Health.

As another poster said, she had crappy jobs because crap was the only thing available. I'm glad I found my niche, but I haven't forgotten what I went through to get here.

[Ruby Vee, BSN]

whenever someone starts out a post with "nurses eat their young" and then explains that they've left multiple jobs within a year after becoming an rn and justifies it with long explanations about how it's not really their fault because someone was mean to them, gave them inadequate training or whatever . . . . it makes me wonder whether that someone has taken the time for an adequate self-assessment.

nurses don't "eat their young." some people are unpleasant to new colleagues, and some new colleagues have difficulty getting along in the work place. it sounds as if you started your first job with the idea that you were going to be managing the techs. that may have been the expectation you were given when you were hired, but you knew you didn't know how to do the job the techs were doing . . . you don't start out on top in nursing. techs have different training than nurses, to be sure, but they're a valuable resource and can save your behind over and over again -- if they want to. since the techs were training you to do the job they were, in effect, your superiors. like some of the previous posters, i'm wondering if you went in with the attitude that they were your subordinates and treated them accordingly. if that is the case, no wonder they didn't like you!

i'm also struck by the idea that when you were having difficulties getting along in the dialysis clinic, you took it upon yourself to tell your boss how she should be doing her job. you may have decades of life experience and previous work experience telling you that your boss is doing things all wrong . . . but probably not a good idea to point it out to her even if she asks. at least not while you're still a probationary employee. and especially not when she's just given you a less than glowing evaluation.

you made a med error in the second job. i see all kinds of justifications about why you made it . . . it was noisy, busy, you were under pressure, etc. etc. but the point is, you made a med error. we all make mistakes, many of them far more serious than the one you made. but when you make a med error and then set about justifying yourself and blaming other people and factors for the fact that you made an error, people wonder whether you "get it" and assume that you don't. when you make an error in nursing, you can kill someone. bosses look for evidence that you understand that, take full responsibility and set about immediately to admit it, notify the appropriate personnel and mitigate the damage. i didn't see that evidence in your post, so i'm thinking that your boss probably didn't see it in your demeanor, either.

as a brand new nurse, you're brand new. you have so much to learn and even though you may, because of your previous experiences in life, have much to teach, bosses and colleagues are far less interested in what you can teach them than in how fast and how well you learn. this is hard on the ego for someone in their late 50s (as i know from experience), but at 60 you have as much to learn about nursing as any 20 year old who just got her license.

go into your next job -- whatever it is -- with the idea that you're going to learn. you can learn from everyone -- techs, physicians, patients, secretaries. concentrate on learning the most you can from everyone you meet. and forget the expression "nurses eat their young." it just gives people a convenient excuse not to take responsibility for their own failures.

[Golden_Dawn]

Nobody thought it was a good idea to volunteer at the Free Health Clinic to get experience for year? Why?