New grad asks "Am I Crazy?"

[Nurse Beth, MSN]

Dear Nurse Beth,

I'm a new nurse and after over 6 months of searching, I've recently found a hospital job in another state and I have to say I'm semi-miserable. The things that have made me feel this way have only started to surface.

It really doesn't help much when a few of my coworkers increasingly complain about how miserable they are but for some odd reason continue to risk their sanity here. People have asked me "you came here? why?" I've been here for almost 2.5 months and I'm on a 2-year contract however my manager has stated that after 3 months of being on our unit I could decide to do an internal transfer at any of their campuses.

I'm seriously considering this because I'm not enjoying how I feel each day I must work. It doesn't help much being in a completely different state, as I see constant reminders that I'm not home. Our unit is treated like a CCU (hint: we're not a CCU at all) nor are we equipped like one and yet we continue to receive ridiculously high acuity patients all while being understaffed.

I'd like to know when will this feeling go away? Am I being crazy or is this a legitimate concern? I'd like to think that if I'm using my time here to learn and grasp significant clinical skills, I should be able to do that in an environment that is safe and facilitates this, not one that throws everything on the wall just to see what sticks. I'm always having constant feelings about opportunities on how to get out, not sure if I should listen to my gut or suck it up...

Dear Semi-Miserable,

I'm sorry you are having such an unhappy start to your career.

You are a new grad away from home, 2.5 months into your career. You are at the stage where Reality Shock sets in. Every new grad asks "When will this feeling go away?" and "When will I feel comfortable?" The answer is at around 1 year.

Honeymoon Phase

Know that you are going through extreme transitions right now. The Honeymoon phase is when you start a new job and are filled with hope and excitement. It's experienced by everyone who starts a new job (not just new grads). During this time you don't see all the realities of the workplace. You view your co-workers, facility, and patients through rose-colored glasses. It's a wonderful time but it's time-limited.

Reality Shock Phase

In the Reality Shock phase, you notice that night shift (or day shift) leaves tasks undone unnecessarily, or that the B/P machines always seem to need charging, or you can never find the bladder scanner. You may witness work-arounds that contradict what you were taught in school, and even experience moral distress.

For you, Reality Shock is the surprisingly high acuity and possibly the disconnect between nursing school and nursing practice. In nursing school you are never "understaffed" and you have one or two patients.

Reality Testing

I'd love to know more about your actual nurse-patient ratios and what you mean by "treated like a CCU" and "ridiculously high acuity" because then I could give you better feedback on whether your unit is typical or not. I'm sorry, I really can't without some specifics.

Resolution Phase

After the Honeymoon Stage and Reality Shock comes Resolution. For some people, Resolution means leaving the setting or even the profession. For most people, this is where they reconcile the two seemingly opposing values and cultures of nursing school and nursing practice without compromising their values. (There's actually a name for this, it's called "bi-culturalism").

Reconciling your values means doing a patient assessment in 3 minutes and not in 30 minutes, as you were taught in nursing school. It means batching your tasks so when you go in a room to start an IV, you bring 2 catheters and a pitcher of water with you because you noticed earlier your patient's water was low.

Give Yourself Time

You frame this as listening to your gut or not, but be careful. There is a difference between emotions and instinct. Your emotions are in charge right now.

This is all to say that it is too soon to make a move. Change your focus from what's wrong to learning everything you can. Stay where you are and think to yourself "I can do this for 6 months". At the end of 6 months, re-evaluate. I guarantee you will have a bit more perspective. Remember, it took you 6 months to land this job. It takes a minimum of 12 months to be considered a marketable nurse. In a relatively short time, you will be there.

Keep in mind that you can be in more than one stage at a time. Expect ambivalence. And finally, try to make friends in your new town. Friends are priceless and can help you through this time.

Best wishes,

Nurse Beth

P.S. My new book, First-Year Nurse, speaks to your situation and much more. It's coming out in May and available for pre-order now on Amazon.

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