Lack of acute care experience

[mzilos, BSN, RN]

Hi everyone!

I’ve been an RN for a little over a year now and my nursing career didn’t start off the way I had hoped. I was hired onto a tele unit and struggled all through orientation. In fact, I didn’t even make it through orientation. My educator just assumed I wasn’t trying hard enough and my preceptor had no faith in me whatsoever. I didn’t feel like I had the support I needed and despite all the effort I put in, they had me transfer to outpatient neuro where I have been now for almost a year. 
 

I’ve gained some experience and made it through my first year as a nurse, but now that I look back, I don’t feel like I know much. I’ve been applying to new jobs now, but it seems like no one wants to consider me and it feels like it’s because I lack the acute care experience. I would like to try again, but I’m terrified of failing again. I know I don’t do well in high pressure situations and I’m a bit slow with processing things in the beginning. It takes me a long time to get the hang of things, but I’m confident that once I get there, I can do a good job. 
 

All that being said, I don’t know what I’m qualified to do at this point. I have so many interests (infusion, wound care, psych, etc) but no matter how many places I apply to, I get rejected left and right. It feels like I’m the only one in this situation, among all of my nursing friends. Why did I struggle so much at the bedside? I feel so embarrassed. 
 

Any feedback would be great, thanks ?

[JKL33]

Hello ~

It's hard to offer feedback; a lot of figuring out how to succeed will involve just carefully reviewing the feedback you received during your first stint in acute care. And of course sometimes the stars just weren't aligned. I've certainly read some posts where it sounded like the person just wasn't really given a chance.

1 hour ago, mzilos said:

I know I don’t do well in high pressure situations and I’m a bit slow with processing things in the beginning.

This ^ is probably a good focus for your self-critique. It sounds like it was a painful (disappointing) experience so maybe now that some time has passed it will be easier to honestly review your performance. As with a lot of things, the specifics matter, though you don't need to share them here unless you want to. What does not doing well in high-pressure look like for you? Are there steps you can take to remain effective when you feel under pressure? Same with slow processing: Most of us understand that with a first role in acute care it will take time for things to come together. But not being able to make sense of the basics or not being able to use resources to figure out some of the more basic things is a little more concerning.

Again I want to emphasize that there are situations where there was a mismatch between employer expectations and reality right from the get-go (E.g. they hired a new grad and almost immediately started getting pissed that the person wasn't picking things up fast enough or working practically independently). If you honestly think that is the situation you were in, then just let it go and keep moving forward.

Are you getting interviews?

Are you applying to different health systems?

 

[mzilos, BSN, RN]

No, I have not gotten a single interview yet. I’ve been at this for about 2 months now. I have applied to home care, infusion, outpatient clinics (planned parenthood, MAT facilities, family care, etc), wound care, pretty much everything except bedside. I’m open to psych too, but haven’t seen any openings yet. 

Looking back now, I didn’t have an interest in cardiology to begin with and it was difficult for me to understand why you’d see XYZ with certain acute or chronic illnesses, why did the doctor order x drug, why  is this test being ordered. My preceptor was tough, but at times I’d ask questions and she would tell me that she discussed it with me and would not address them anymore. She had very little confidence in me. My nurse educator also kept telling me I was asking too many questions, I didn’t understand why it was an issue. I know I’m supposed to. 

It didn’t help that my unit at the time was mostly COVID, and I felt pressured to be on my own sooner that I felt I was ready to go. I asked for an extension on my orientation and was told I couldn’t get one. 
 

Out of all the orientees, I noticed I was the slowest one. I was really excited to be on the floor, but as the weeks progressed, I felt myself fall behind and I’m sure I would’ve been a good floor nurse if I had more time. I know it wasn’t possible, but I’m a slow learner. I was like that in nursing school too. Even when I failed, I’d try again.

[Lemon Bars]

Hello, mzilos. I had a similar experience with my first hospital nursing job after graduation. I do think that my trainers during my orientation did a poor job and overall their expectations were unreasonable for a new grad. High stress, multi-tasking, and cutting corners with patient care are not my style either. I failed my hospital orientation and ended up getting a job at a primary care clinic, where I have been successful as an RN for almost three years. There are many nursing skills that I never got to practice, and I regret that, but I am sane and making money. I intend to try other jobs such as home health or urgent care for the future, but I will never work in a hospital as a bedside nurse again. Hospital nursing is not for everyone, especially the way modern hospitals are run short-staffed with few nurse aides, no relief nurses, patients on the regular floors who should be in an ICU, no breaks, etc. There are many nursing jobs outside of hospitals if you want to make money and keep your sanity. 

[JBMmom, MSN, NP]

Unfortunately, just because nurses have experience nursing that doesn't mean they have the skillset to effectively teach newer nurses, and not everyone has the patience or desire to precept. Some of the people with poor skillsets in those areas are still given responsibility for teaching and encouraging new nurses and the results can be less than anyone would hope for, especially as a newer grad.

Clearly you have a good bit of self awareness which will serve you well in job situations throughout your career. And you've been able to identify some clear areas that are weaknesses so you can work on that.

And there's nothing wrong with NOT being an acute care nurse. Every nurse is vital to the patient population they serve, no matter where you end up, don't let anyone make you feel like less of a nurse because of you who choose to serve in your career. There's nothing to be embarrassed about in the situation that you described. 

Keep trying, something is going to come through. Sorry you're having a tough time, but things will work out in the end. Good luck!!

[LibraNurse27, BSN, RN]

Do you want to try acute care again because you enjoyed it, or because you feel like you should? If it's the former, keep trying! Covid is still an issue, so some hospitals may not have the capacity to train new grads now, but maybe when things get better, and hopefully you can find a teaching hospital or one with a good new grad training program. If you don't think you enjoy acute care and it makes you too stressed, there is no shame in not working in acute care. All areas of nursing are important. 

[guest1171208]

AT least you had the chance to try acute care!

I have been a nurse for 18 years. I always applied to hospitals  from day 1 and never got hired. I tried as an Lpn,as an  ADN RN,and even now as a BSN. Mind you,I was trying to get hired for a med surg position. 

The only  places that call me back are non acute care positions like long term care,homecare,and esp pysch.  I stayed in private duty nursing for 15 years. You would think hospitals would jump at the chance to hire a nurse with 18 years experience but no,they won't. I guess working on ventilators,with trach,and wound vacs isn't enough experience for them.  I should also add that non acute care does not pay well. Private duty definately does not pay well. I think working agency homecare one on one  killed my nursing career honestly. Most people do not see it as real nursing. 

Yes,my self esteem has taken a hit. There are nurses that have two years experience that make more money then I do and are now supervisors. I met three such nurses yesterday at a rehab center.