NEED Some INSIGHT!!!

[winter99camp]

Hello

I just had to resign form my first nursing job at a large well known cardiac specialty care hospital. It was my next to last precept ed shift. I was to work days, med/surg tele. The pace was too fast, and half my patients would go for procedures in the am, and new pts would be admitted to replace them. I was very overwhelming and harder than I imagined. I couldn't develop a routine and didn't have the time to stop and think about what I was doing or look up my meds. I felt unsafe. Management met with me, and pretty much voiced the same concerns, that I was not safe to be on my own. There were no night shifts available. I totally agreed. so I need some feedback on what I should look for on my Next "first" job.

Here is my background: Nursing is a second career for me, I worked full time 6 years at my local county health department in environmental heath a job i got with my 1st bachelors, I then pursued a BSN in nursing. That job paid well and provided my benefits, so I had to stay. I couldn't work at a hospital to get experiences like other students while I went to school.I have no hospital experience beyond my clinical. Ive never even put in a foley.

I think I jumped at this first job oppotunity at this prestigious hospital with out being able to evaluate if it would be a good fit. This hospital was very selective and I think I was just in awe that chosen. There they precept ed new grads for 9 to 12 shifts, after 2 1/2 weeks of classroom orientation, is this average? There is a large nursing job fair tomorrow and need some advice on what to look for. I'm on a mission to find the right place for myself as a new grad.

thanks

[crb613, BSN, RN]

I too am am a new grad, & work med surg. I did my orientation on days w/1 wk classroom & 3 months w/preceptor. I had zero previous experience. It seems if I am understanding you correctly you had ~ 1 month w/preceptor. I don't think its you....more like you did not get enough orientation. I was paired w/the same nurse for my entire orientation. It amazes me that you worked med surg & never put in a foley.........I just don't think you got a fair shake. Good luck & don't be too hard on yourself 12 shifts is not enough.

[Daytonite, BSN, RN]

i am sorry to hear what has happened. my recommendations for new grads is to work on units that have stable, regular routines. most any of the surgical and medical units fit this bill. you might find surgical units a little happier as most of the people get to have their surgeries and go home although not all the time. some people find medical units to be depressing because of the chronic conditions they see and they can also be a bit fast-paced at times. the thing that you want to look for, however, is that you have the same doctors admitting to the unit and the same types of patients day after day so you do develop a routine that you can settle into. this is how you will be able to better hone skills of prioritizing and organizing.

i worked on a very busy icu stepdown unit for almost 6 years. i had a good many years of experience as a hospital nurse when i went to work on this unit and it was still a culture shock for me. our unit manager at the time, who was an experienced icu nurse, refused to put any new grads on the unit and there was good reason for it. stepdowns are not really a place for new grads. as you found, it was fast-paced, overwhelming, and you often felt unsafe. often, the regular staff is so busy with their own patients and their problems that they barely have enough time to help a new grad who needs a lot of support. i would not blame yourself for this. the people who hired you into the position have more experience and wisdom and should have used better judgment in placing new grads on this unit. this particular forum, i'm sad to say, is just filled with stories, very similar to yours, of people who attempted stepdown units as their first job out of nursing school and it just didn't work out. again, i have to say that more than half the blame belongs to the people in charge who hired them because they do know better than the new grads. they are just taking advantage of them and merely putting bodies into the place of open holes on their staffing schedules. that is sad. don't let this put you off to stepdowns, however. after a few years of experience you might want to give stepdowns another go, if only to prove to yourself that you can do the work.

[jjjoy, LPN]

i am sorry to hear what has happened. my recommendations for new grads is to work on units that have stable, regular routines. most any of the surgical and medical units fit this bill. ...the thing that you want to look for, however, is that you have the same doctors admitting to the unit and the same types of patients day after day so you do develop a routine that you can settle into. this is how you will be able to better hone skills of prioritizing and organizing.

most med-surg units have stable, regular routines? where is that? my experience is that most of them are always hectic with a fairly wide assortment of patients and conditions and never enough staff to be able to step back and get a sense for more than just drug-pushing and patient juggling.

in regard to your advice about a place with the same docs and same types of patients day after day, i agree that that's ideal. i just don't know how much opportunity there is with such an environment. maybe i haven't looked in the right places.

[hhnursewyo]

If you could get some good skills in a slower paced hospital somewhere, like your catheters, assessment skills and basic nowledge of different disease processes, IV's, drawing lab work, trachs, patient-nurse realtionships and teaching, end of life care, etc., home health is a slower paced but very rewarding field. The documentation takes a little learning, as it's different in some respects than hospital or nursing home charting, but it's a unique way of making a difference for the ill.

[Havin' A Party!, ASN, RN]

Lots of wisdom in your post, Day.