Low acuity nursing job???

[wilsonra]

I am a new grad, I've been doing PCU for the past few months. I've been making some mistakes in orientation (not major ones) but enough that my manager feels that Intensive care isn't my forte.

Any time I consult with my preceptor about what I should do in certain situations, my preceptor counts it as a near miss and tells the manager. For example, I pulled a B-blocker for a patient that was tachy and I paged my instructor b/c the orders said "for sustained HR above 120" but the HR wasn't sustained there (it went up and down) and his BP was normal. She told me to look at the vasoactive manual, but it didn't answer my question - it just gave basic info and different amounts of the drug given. I told her that I wanted her professional opinion and she said to give it. She told our manager that I was looking like I was going to give the drug without consulting my resources.... and this wasn't the first time she has said things like this about me. I do feel like I owned up to my other mistakes and I showed up to work an hour early daily when I felt I began to struggle. But I also felt like my work environment was slightly toxic and that I wasn't getting the support I needed. (My preceptor tended to just drop me in situations or put me on the spot)

I'm planning on quitting today because I feel like I need a chance at a new start. I just wanted to know: What kind of jobs are out there that are lower acuity and that I could work in?? I don't like intensive care. I don't want to say "easier" but in essence I want something thats lower stress so I can get work experience under my belt.

[HouTx, BSN, MSN, EdD]

Don't Quit.

You need to have this conversation with your preceptor. Clear the air and make sure you are both in synch with the expectations. For instance, you may want to tell her that you are asking for her validation with any thing that is a 'judgement call'... and this is very appropriate for an inexperienced staff who has not yet developed the frame of reference needed for making that clinical judgement. In this instance, you needed clarification on the criteria that should be used to determine whether a heart rate was "sustained".

Utilizing available resources - including advice from more expert staff - is NOT a "near miss". At least not in my organization. If you can't repair the relationship, can you work with a different preceptor? Don't let this one person determine your future.

[Lev, MSN, RN, NP]

What happened OP? I think you need new preceptor. Also, keep in mind that utilizing resources also means speaking with experienced nurses other than your preceptor as well as your educator.

[turtlesRcool]

Do not quit over this!!!!! You have worked too hard to get where you are to leave before you have exhausted your options to salvage the situation.

Some preceptors are...not very good at being preceptors. They may be awesome nurses, but that doesn't mean they know anything about how to teach/coach/mentor a newbie. It's too soon to assume this is a YOU problem, and not a HER problem. Or it might just be a you+her problem because you two don't mesh. Think back to when you were in school and there were instructors that some students loved and others hated; it wasn't necessarily a reflection on the quality of the student or the teacher, but on the relationship between them.

At this point, I would go directly to the nurse manager, and discuss some of your concerns about the preceptor. Do not be unprofessional. Do not throw her under the bus or look like you are making excuses. But do clarify what you should expect from a preceptor, and discuss some of your concerns that you and your preceptor don't seem to be in synch. The scenario you described above sounds to me like a valid way to use your preceptor as a resource, which is her job. Perhaps use that as an example, and ask the manager if there was a better way to handle it. She'll either realize the preceptor is off in her approach or give you guidance you can use for the next interaction.

When I was in my last semester of clinicals, one of the floor nurses gave me this advice: don't ever be afraid to ask for a new preceptor. As a new grad, you are extremely vulnerable. How you do in the beginning can set the tone for your continued employment and future career. You need to have someone you work well with. She said don't worry about being "nice" or hurting your preceptor's feelings; worry about getting the support you need to be a safe and effective new nurse. I mean, OP, you are ready to quit your job right now. What more do you have to lose by asking the nurse manager for advice and/or requesting a new preceptor?

Quitting won't solve the problem. No matter what unit you are on, there is a steep learning curve in the transition from student nurse to practicing RN, so going to med-surg, for example, isn't going to be any easier than where you are. Lower acuity means more patients, so you're not going to find less work or less stress.

[calivianya, BSN, RN]

I would be interested in knowing if you quit!

I also agree on asking for a new preceptor. She is clearly not the right fit for you.

[wilsonra]

I did end up quitting. I really wasn't doing well in my opinion (being late on meds, not always able to answer docs questions on the spot, getting nervous when preceptor was watching and I would fumble, not giving A+report with good flow) but its the nature of the beast in PCU because RNs are expected to be fast + accurate+ efficient. I'm still learning how to plan my day right and multitask to get maximum efficiency. I eventually became scared to ask questions because I was afraid I would get reported to my manager about a lack in knowledge. And looking things up (like drug interactions, protocols, or things to help me understand Drs notes) took valuable time that made me late. Thats why I showed up an hour early daily. My manager pretty much said either I go on a learning plan (basically probation) or I quit. I was honest with her about each situation and I always took ownership of any mistakes. I truly thought I was doing better near the end, too. Now I'm thinking that I should do something where I have more time to learn and ask questions during the day. Something slower paced until I gain enough confidence and experience.

[wilsonra]

Much like a "good death", quitting my job was a "good quit" :). I told my manager that I really did learn a lot and I will be taking that knowledge to my next job. She seemed to really like me as an employee and appeared sorry that I left. But I do feel like I need a slower paced job. I have anxiety, and I do my best to overcome it (and I never tell anyone I work with! They'd think I was incompetent).

Maybe psych nursing or procedural nursing (like IR) would be good? I worked on the ICU as a tech. The death never creeped me out or made me extremely emotional, I felt that it was natural. I did enjoy hearing the patient's stories and talking to families. I had social issues when I was younger, so frankly just being able to talk to people without getting nervous makes me happy! My manager told me that I seemed to have a talent for developing a rapport with pts and families and to play on that when I apply for other jobs.

[LadyFree28, BSN, LPN, RN]

OP, no matter what nursing you get I to, if you have anxiety, get that under control; there really isn't that many "less stressful" positions on nursing-each have their own set of stressors that you can't avoid.

I didn't last in one of my positions due to my own anxiety and depression related to PTSD; I traded the high acuity of Critical Care for Emergency Nursing, which is just as stressful and needing adjustment to rapidly changing conditions; I am thriving because I self corrected what I needed, which included taking care of my PTSD, to the point of taking medication, seeing a counselor and a psychiatrist; but it was just what I needed to help me be successful-I completed orientation and am very comfortable in my environment-but I did the work that I need to be able to be successful.

Best wishes.

[RNgirly07]

I agree with the above. You must get your anxiety under control before you can ever be happy in nursing. The first three years of my career I moved from inpatient job to inpatient job looking for a "lower stress" area. I eventually had to face the fact that I had to get my own mental health under control before I would ever be happy in a position. I would check and recheck everything I did and every med I gave. I would stay after work and recheck all my charting and documentation and when I was at home I couldn't stop thinking about every little thing I could have done wrong or all the ways I could have hurt someone. My anxiety worsened all the time until I finally couldn't take it anymore. I finally did leave the hospital environment and have found a job I love as an aesthetics nurse while I am undergoing treatment for OCD. I hope you don't give up on a career in nursing, and I hope that you can find some help for your anxiety issues. Don't wait any longer- I wish I had gotten help waaaaaaaay sooner than I did. Once you start to feel like you are in control of your anxiety, you can start looking for a new position. I know everyone says it, but there really are so many options in this field and I know you will find your niche.

[wilsonra]

I talked to an experienced RN that I trusted and she recommended that I get a job in med-surge or psych nursing. The patients are typically lower acuity. She said that my focus in those jobs would be taking care of daily needs and that most patients would be at a lower risk of safety issues. I understand that all Nursing Jobs have their difficulties. Med surge is more bulk, psych is dealing with chronic mental problems that may never be fixed. I just want a job where I can actually learn as a new grad. ER, ICU, PCU- these are jobs that are best left to more experienced and/or confident nurses. I have learned that I need to be in charge of my education and be more assertive. Not all my preceptors are going to be great teachers. I really wish that nursing students could learn this in their first year.

[LadyFree28, BSN, LPN, RN]

I talked to an experienced RN that I trusted and she recommended that I get a job in med-surge or psych nursing. The patients are typically lower acuity. She said that my focus in those jobs would be taking care of daily needs and that most patients would be at a lower risk of safety issues. I understand that all nursing jobs have their difficulties. Med surge is more bulk, psych is dealing with chronic mental problems that may never be fixed. I just want a job where I can actually learn as a new grad. ER, ICU, PCU- these are jobs that are best left to more experienced and/or confident nurses. I have learned that I need to be in charge of my education and be more assertive. Not all my preceptors are going to be great teachers. I really wish that nursing students could learn this in their first year.

OP, those specialities that you speak of are high acuity as well; pts are sicker and have complex issues as well; I suggest you go over to those threads to have a more realistic picture.

There is no "low acuity" job out there-I have worked in a tone of out of the box specialities in my 10 years of nursing and my nursing practice has learned to transcend; each death with complex acuity and complex needs.

The best thing for you to do is handle your anxiety, even by seeing a licensed therapist to help address your needs.

Next, understand your leaning style; you are still in the learning stage of your career; once you understand your learning style, it will help express your need when you are precepted.

Also, once you find a new position, SELF-STUDY. Again, you are still in the learning stage and anything and everything you come across in your nursing care, studying is key to build a base.

Best Wishes.