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.
