Need some career advice. - long

[Nepenthe Sea]

I really have no idea what to do with myself, in regard to my nursing career. I graduated from school last May. The whole reason I even went to nursing school was to work in NICU (my kids are NICU grads). I was a student extern in the unit where I want to work, which is also where my kids were patients. I never had a chance to work there as a tech during school because at the time, they were not hiring in that unit, so I went to work in our SICU. Upon graduation, there were not any NICU jobs, and I did not get a PICU job I applied for, so I went to work in SICU, as I was offered a job there by my boss. To try to make a long story short, I did not do well in SICU. They even extended my orientation, but it was just too overwhelming for me. To give myself a little credit, we were VERY high acuity last summer (we are the regional trauma center, so we get the worst of everything) and they told me that some of the patients were not ones that they would usually give a new grad, but that they had no choice. In the end, they decided that it was not the area for me for the time being, and I agreed with them. I honestly felt relieved.

Of course, now that I was unemployed, there were still not any available NICU jobs. I even tried for newborn nursery, but didn't get in there, either. I ended up with a med surg position - not really where I wanted to be, but I decided to go there and learn as much as I could, and just get some experience. I have been there for almost six months (here in another week). At first, I really thought med surg wasn't so bad. It took me awhile to get used to patient care and getting all my charting done on time. My supervisor was getting unhappy with me because I was late most days getting out. Then one week, it all came together and I was getting out on time, but still taking care of patients. As far as patient care goes, I believe I really do a good job. Just slow getting charting done. It doesn't help that we have NO help on nights - no tech, and no unit secretary, either. Our charge nurse is usually doing the secretarial work. So, we are doing all of the turning of patients, vitals every four hours on 4-6 patients, etc. Some weeks it's okay. Some weeks, I have two or three (or more) total care patients, a bunch of patients who need help getting up to the bathroom, etc. Just a lot of stuff going on. I know this is probably the case in most hospitals, so I'm not trying to sound like I have it so rough - just trying to explain my job situation.

Recently, our hospital told us that they are losing millions of dollars each year, but instead of firing employees, they are cutting our staffing grids. So now, instead of four patients and no help being the norm, we will be getting five or six most of the time, but still without any help. As you would expect, this is hard on me because I am still not efficient at getting charting done, but all of the nurses are having a hard time with this - even the ones that have been there for years. I am now getting to the point where I hate my job. It's not the population I want to work with anyway (lots of stroke patients and dementia, which I really hate working with), and with them expecting us to do more and more, but still expecting us to clock out EXACTLY on time, I am really unhappy. There are now several NICU positions open, and I have considered applying, but at the same time, I don't know if I am just a crappy nurse, and this is why I can't get my work done, or if I have a legitimate reason. I am trying to figure out if I am better off staying in my current position and trying to improve, or if I need to go somewhere else. I know that not every nurse is suited for every nursing job, but I don't want to be running to another nursing job if I am just a bad nurse. I especially don't want to go to NICU if I am a bad nurse. I have looked at other nursing jobs, just to see if there is another environment I may like better but there are no office jobs available at this time, and I am afraid to go into home health because I don't want to be on my own (obviously, my self-confidence is not very high).

I know NICU is not an easy place to work, but I have spent time there as a parent and as an extern and student, and I have seen that it is not the same level of chaos as what I am experiencing in med surg. I am very much "at home" in NICU, and feel very comfortable with the patients there. I worry, though, because I am only out of school for a year and already on my second nursing job, and not sure I am doing all that great. I sometimes think about not even being a nurse at all, but don't want to give up after working so hard to get through school. Plus, I REALLY want to give NICU a shot before I give up entirely.

So, do I stay in a job I hate and where I worry about my license just to get more experience, or do I at least try to get in an area I really believe is where I need to be? Am I just destined to not be a good nurse because I'm not excelling in med surg?

[canesdukegirl, BSN, RN]

Where is your heart? It's clear to ME, but you are dealing with so much static right now that it may not be clear to YOU.

Apply for the NICU job. You aren't losing anything by doing so, but you are making a choice to shut that door if you DON'T apply.

Your facility is handling things badly by piling more work on the nurses without the benefit of ancillary staff, and making it worse by demanding that you clock out exactly on time. That's not fair-it's like making airlines fit 10 more people into a small plane by having passengers sit on each other's laps, not providing extra fuel for the extra weight, and demanding that the pilot make it in time...it only hurts for a little while, but after doing this same charade for 3 trips or so, the passengers and the pilots are gonna find another airline. Don't be surprised if you see a mass exodus of nurses at your facility.

It doesn't cost you a darned thing to apply for that NICU job. I encourage you to apply sooner rather than later, as competition is stiff right now.

[Nurse SMS, MSN, RN]

Apply for NICU. Let them decide if you are "good enough". You will miss 100% of the shots you don't take.

[MN-Nurse, ASN, RN]

I agree with others who say apply where you want and do your best.

As a fellow new RN who has taken heat for having trouble getting charting done on time, I want to commend you for ensuring you take care of your patients FIRST.

A couple weeks ago I took report from an RN a couple weeks off orientation. It was a complete mess - meds not given, orders not acknowledged, plans not implemented, not even protocols run with some pretty bad AM labs.

I wasn't mad at her at first because I have had bad days and handed over some real crapshows. I worked on prioritizing how I was going to dig out of the mess and ensured her it would be OK.

I was then shocked when, immediately after report at 1530, the nurse punched out and zipped out the door. This nurse had done all her charting INSTEAD of taking care of patients. Further, her charting rather sucked. In response to pressure from management about OT, she basically abandoned her patients during her shift.

I'll take heat for OT any day rather than endanger patients.

[nurseprnRN, BSN, RN]

nicu, nicu, nicu.

i think our work here is done!

let us know how it works out.:cheers:

[Nepenthe Sea]

Sorry it took me so long to reply to all of the comments. Thanks to all of you for your advice.

We had a meeting at work on Monday, where we discussed the new staffing grid. We were told that if we cannot meet production with the grid we have now, that corporate will be forced to cut our grid even further. So, we will be punished for not being able to keep up with the harder workload that we have now.

I had two days this week (out of four) where I had to stay late to finish my charting. One night, we ALL had to stay late because we all got hammered, but on Wednesday, I was the only one who had to, and I had to stay for TWO hours because I could NOT get any charting done during my shift. My patients had so much going on all night that I couldn't stay out of their rooms. My supervisor saw that I was there late, which I know made her mad. As I was charting, I thought to myself, I cannot do this anymore. I worry all the time now about getting fired because of my overtime. Everyone I worked with that night saw how busy I was, and they all helped as much as they could, but they were all really busy, too. If I am going to work someplace where I have to take on more work with less help, I at least want to work with the patient population that I am interested in. I kind of lost it, and when I finished my charting, I was going to go tell my supervisor that I will be seeking employment elsewhere. I saw her making rounds with someone, though, and I couldn't wait for her to get done. I told the daytime charge nurse that I am making plans to leave. She listened to me vent, and hugged me and asked if there was anything she could do. I just told her that I will call the director when I have a day off. So, as soon as I can get my resume updated, I am going to apply for NICU. I have no idea if they will even consider me, but I can't stay on this floor. Many people at this hospital talk about how hard it is to work on this floor, and how our grid is always worse than the other units, patients harder to deal with (we're the stroke floor, and we also get lots of confused elderly and detoxing alcoholics, which are all patients I hate dealing with), etc.

Until this week, I was still considering staying put just to get more experience, and because I was grateful to my director for giving me a job there in the first place. Now, I am considering waiting tables instead of nursing. Again, thank you for your words of advice.

[Nepenthe Sea]

I may get out late, but my patient care is done, meds passed, etc. The only thing I am ever doing when I stay late is charting. If I could do that without getting in trouble or risking our grid being cut again, then I wouldn't worry so much about the OT.

[minnymi]

med/surg is HARD. most people don't like the job and most people don't stay long....that's why there are so many new grads. my first job was on a med/surg floor and i'm one of those people who takes a job intending to stay forever. i lasted barely over a year and i don't know how i did it. throughout that year there was a lot of "maybe i should quit" and "no, i don't want you to quit."

eventually, i ended up quitting...and even though my manager was upset...it's the best decision i ever made. i've found that when you have a job already you don't try so hard to find a new one. i get the whole having kids thing and not being able to go without a job, but being someone who was in your spot.....JUST QUIT!

when you're unemployed, you will try like never before to get a new job...and you WILL get one. just get out of there! now!

even though i put in a notice and did what i should've done, and even though my manager said many times that i "reminded her of herself" and begged me to stay more than once....she put me down as no rehire. that was a huge blow. i've never had anything like that happen to me or be put on my record. STILL....it was worth it to get out of med/surg. it was THAT bad....and i sense it's that way for you too.

it'll be okay. put in your notice NOW!

[Nepenthe Sea]

Minnymi, was your new job at the same facility? Because the NICU that is hiring is in the hospital where I currently work. I am afraid to burn bridges. I am scared, though, because when I left my first job in SICU, I was unemployed for two months. That's why I took the med surg job, even though I was sure I probably wouldn't like it much. I hate to think about ending up in the same position if I didn't get this NICU job.

Also, how bad is it that I've had two nursing jobs in my first year of nursing, and am already looking for another? I know it costs a lot of money to train a new person. Of course, since I have a year of experience, and part of that included critical care experience, maybe it won't take as long to orient me.

[minnymi]

Minnymi, was your new job at the same facility? Because the NICU that is hiring is in the hospital where I currently work. I am afraid to burn bridges. I am scared, though, because when I left my first job in SICU, I was unemployed for two months. That's why I took the med surg job, even though I was sure I probably wouldn't like it much. I hate to think about ending up in the same position if I didn't get this NICU job.

Also, how bad is it that I've had two nursing jobs in my first year of nursing, and am already looking for another? I know it costs a lot of money to train a new person. Of course, since I have a year of experience, and part of that included critical care experience, maybe it won't take as long to orient me.

it actually was in the same facility. fortunately, anytime anybody asked who my former manager was and i told them they gave the "eye roll." she had a reputation.

the thing is...you're right, it does cost a lot to train a nurse. that's all the more reason for HR to want to keep you. the nurse manager on the med/surg unit is losing out on her budget, but it's good for the facility budget to keep you in their facility! they don't have to pay for you to go through all of the orientation videos and paperwork as you already know the hospital policy...they just have to stick you with a new preceptor. trust me, this is how med/surg works...it's a revolving door and you won't be the first nor the last to go through it.

[anotherone, BSN, RN]

shouldn't be too bad about being a new nurse with 2 different jobs in less than a year as they have been in different areas and nicu is completely different yet- it is what you want and it is a good excuse for the bs exit interview/reason for switch.apply now and keep your mouth shut!! if your unit's staffing is tthat bad and experienced nurses can't hack it, expect them to also apply and many will have connections after all those years to start applying to NICU, ICU, step down etc, anywhere with "less pts". yes they are more intense but it does make a difference. i work on a unit similar to yours and have seen ICU and step down nurses in tears and complete panic when pooled to our wonderful 6pt per nurse med surg floor with the dementia DTs and drug seekers on q1 dilaudid. Also this seems like the type of facility that would say, if you can handle 2 NICU pts you should be able to handle 3 and maybe a 4th who "isn't that sick!".....................................it will get alot worse before it gets better

[Nurse SMS, MSN, RN]

Do not quit your job without another lined up. And it sounds like it is too late, but never give forewarning that you are looking for work elsewhere. They will seek actively to get rid of you so that the leavetaking is on their terms not yours.