Med/Surg fail x 2. Now what?

HeatherGurl84 · Sep 1, 2013

Have you thought of clinic nursing such as physician's offices, health departments?

all4neuro · Sep 1, 2013

Do you find yourself being stuck on one pt's assessment b/c your afraid you'll miss something?

If you have great assessment skills, and found that it is a ratio issue maybe a unit with 1:1 or 1:2 ratio would be your niche.

There are different types of "busy" that suit each nurse. ICU, PACU, L&D for example all are still hectic, but they fit for certain personalities.

Our p/p is that ICU nurses do not take more than 4 patients as a float to med/surg. They're not acclimated to med/surg type of "busy".

Same as a med/surg RN floating to ICU, we assist the ICU RN with treatments, and work with the techs, but DO NOT take a pt. as primary care. We're are not trained for the level of care pt's need in ICU.

It doesn't make a RN better or worse.

Just a suggestion. This was an example, intended to assist you with finding your strengths.

Give us a bit more of the feedback you received.

Anna Flaxis, BSN, RN · Sep 1, 2013

Have you considered Home Health or Hospice? You'll have 3-4 patients to see in one day, but they will be one on one at the time. There is absolutely nothing inferior in either of these specialties, and seeing each patient on their own turf can be really refreshing!

babyjRN · Sep 1, 2013

I ditto home health and hospice. I love the freedom and autonomy I have in hospice. I also love that I can spend as much time as needed with a patient and not feel rushed.

That being said, you need to feel very confident in your nursing skills as there is no one else there but you (in home hospice). You always have peers a phone call away, but you will be the only eyes on that patient in that moment in time. You must be organized and have outstanding time management skills. You must be able to prioritize. At most companies you will be responsible for your own schedule....that means at the end of the week you had better been able to see all your patients the set number of visits, documentation is turned in, and you have no overtime. Management won't tolerate "I couldn't get it all done".....that translates in to "Medicare isn't going to pay".

I wish you the best of luck!

amzyRN · Sep 2, 2013

I wouldn't recommend LTAC because I've heard it's like the ICU but you get worse ratios and the patients are sicker. The only difference between that and a hospital is the patients stay for a longer time, usually more than one month. I've heard LTC can be crazy, but they aren't acute patients, so you don't have to worry as much about a patient coding and such. Maybe you just needed a longer orientation or less unstable patients. On my unit, the charge nurse making the assignment does so based on experience, so most of the newbies get patients that are safe for them to handle. If they are giving you the sickest patients on the unit, that's a mistake on their part.

sunmaidliz · Sep 11, 2013

I worked LTC after going from med/surg and at the end of it, I felt that the 6 pts of med/surg would be a breeze. This is also time for some soul searching, something I've had to do after 2 new grad jobs. What is my problem? (Yeah, that sounds harsh but it needs to be asked and the gentlest person to ask is yourself). Is it a confidence issue? Is it a time management issue? Maybe you need to spend some time off shift doing some studying and research. And trust me, after LTC, med/surg will seem like a breeze. Maybe an LTC to fill in that 1 year gap you have before you reach your 12 months.

DrivenToDream · Sep 11, 2013

Thanks for all of the ideas. Community Health is a possibility but I have not found any opening so far. I love the idea of hospice but, as mentioned by others, I think one needs to have some significant skills and confidence to go it alone. Same for home health. In addition, in these parts, there are large home health care organizations but all the feedback I get is that there is a ton of charting done after hours, at home, unpaid. Yuck. I am still looking into it, though.

I have looked at my weaknesses and I know that time management is one of them (but isn't that the case for most new nurses?). I felt like I was making progress but when the plug was pulled, that was it. The other feedback I got was that I seem to do fine until the unexpected happens. My ability to quickly reprioritize has been brought into question. I am a very organized person, so both of these problems baffle me. I gather what I need so I'm not making needless trips back and forth. I think through the things each patient might need given their condition and status. But throw a new patient into the mix and I fall behind and find it hard to catch up.

The good news is that I have an interview coming up. The bad news is I am terrified. It is a hospital position, however, this hospital, especially on the floor I am looking at, is not likely to assign more than three or four patients per shift. These are sick folks who need increased assessment and monitoring.

It has crossed my mind that I might be better suited to a unit such as this. I like complex care, but I can't see handling too many complex patients per shift. Problem is, if I couldn't handle a big patient load of medium-complex patients, how can I convince anyone that I could do well handling sicker, more critical patients?

Keep the thought and advice coming. It s very helpful. Any ideas on how to discuss my two prior experiences?

Thanks!

nurseprnRN, BSN, RN · Sep 17, 2013

I used to say that I loved knowing as much as possible about my patients and hated wasting time running up and down halls, and with the smaller nurse/patient ratio of critical care or what sounds like an observation unit that is just the ticket. You'll still be plenty busy, though.

sunmaidliz · Sep 25, 2013

Why do you think you had trouble handling your full load? Was it simply time management? Was it organization? Was it just feeling stressed and overwhelmed? I think those are questions you need you answer for yourself. Otherwise, you might come across this problem again.

I worked LTC after doing med/surg. 6 patients would seem like a breeze. In LTC nursing, you don't really monitor your patients like you do in acute care. There maybe some days (most days) where the only time you interact with the residents is when you hand them their morning vitamins. LTC nursing though really requires you to organize yourself, since you have so much to do and so little time to do it. It made 6 patients seem like a breeze.

As discussing your two last experiences, just say it wasn't a good fit. Which is true. Tell them what you learned from them. Be positive. You don't have to explain yourself. If they press the issue... not quite sure what to say if they press the issue. Maybe... "I feel that I will benefit and grow more professionally if I am able to have more resources to utilize." Which is true. If the unit hired more nurses, than the ratio wouldn't be 7:1. It would be the extremely manageable 4:1 and it would lead to a decrease in burn out and decrease the likelihood of nursing errors. Which is all true. Never EVER intimate that the reason why you left the jobs is because you weren't good enough. That's not true. You are good enough to do any kind of specialty you put your mind to. YOU decide what is good for you, not what other people say you are good at or not. You are the master of your own boundaries.

You probably need a confidence shot in the arm. You also need to do a lot of soul searching. If you get the job you are interviewing for, really think about what you need to get yourself able care for 7 patients. Remember, nursing greatness comes from experience and experience is all you need. Unfortunately, in this economic climate they would rather get rid of you than nurture you. Maybe it really isn't your fault you couldn't care for the ratio. They obviously didn't teach you well enough. Those last two hospitals failed YOU. YOu didn't fail them.

BSNtraumaqueenRN · Sep 26, 2013

Don't get discouraged! It doesn't sound like Ltc would be a good fit. Try looking for jobs such as a school nurse, physicians office, clinics, etc. start there