New grad, do not feel challenged at all. Help?

[RNinCali15]

Hello all,

I have been a nurse for almost nine months now and work in the NICU. This was my absolute dream job, and I worked so hard to land it. While I was on orientation I felt challenged as I was learning SO many new things. I have been off orientation for a while now and have have been stuck with feeder grower patients for over a month. My unit favors nurses with many many years experience and assigns them the sicker kids, daily. They are never given an intermediate assignment.

I am talking more about the nurses who have less than 2 years experience getting mostly the stable ICU cases and some intermediate patients. We are supposed to be mixed around the unit, with at least 30% ICU exposure. I have also (politely) asked my charge nurse to assign me anything ICU because I need the exposure. Usually I am given an excuse, and the next day I am back with the feeder growers. Managment likes me, and there has never been an issue with the care I have provided my patients. I don't understand. I am just about at my wits end with this matter. I did not go to school to be a daycare provider who rarely uses her brain. I understand that an intermediate case can shift quickly, but I need consistant exposure to vents, bcpap, umbilical lines etc to remain competent. Ugh!

Advice?

[ThePrincessBride, MSN, RN, NP]

I am going through something similar. I would like to become an NNP and feel that working with mostly feeder/growers isn't going to help me with grad school. I have been off orientation for three months and have only cared for feeder/growers and bubble cpap kids. I would like experience with higher acuity but realize that I am new and many NICUs start inexperienced nurses off with lower acuity patients.

But I don't want to rock the boat either.

[SmilingBluEyes]

One more thing: SINCE you have had all 4 of your kids in the NICU, I would presume you would have wanted the most qualified and capable nurses caring for YOUR 4 kids?

Or is that an unfair assumption?

Why should these kids' parents not want that for THEIR kids? Your turn will come, if you improve your attitude and realize you surely have a lot to learn yet.

[NICU Guy, BSN, RN]

I had something similar. I was off orientation for a year and felt that every week I was getting the feeder/growers. I vented to one of our PICC nurses. A week later, I started getting vents, arterial lines, High Freq. vents. Evidently, the PICC nurse had been talking to a charge nurse and brought up that I need to be given the more higher acuity babies. The old saying was ringing true "Be careful what you ask for, it might come true". There were some days that I was busy non-stop the entire shift. I am far happier that I am finally getting the higher acuity patients, but afraid that it will end and I will be back to feeder/grower world.

You may need a seasoned nurse to vouch for you to the charge nurse that you are capable of starting to get the higher acuity patients. Like PP have said, it may be a factor that the charge nurses feel you need a little more time under your belt before stepping you up to the higher acuity patients.

[Wuzzie]

Sour,

Not sure how you think insulting my capability as nurse is constructive.

I provide excellent patient care, and know exactly what a healthy patient looks like. I have over ten years experience in healthcare, and have four children. I also have a deeper understanding/appreciation on the NICU, something in which few nurses can say they have. Each of my kids were in the NICU, and one of them was a golden hour. So please, save that anti-new grad bulling attitude for a prepubescent new nurse.

Take your bad attitude and anti-progressive nature someplace else Ms. Grump.

I read your OP and your second post. Stepped away from the computer for about an hour to think about this response because I don't want to appear as if I'm piling on but some things are becoming clear to me.

First: anybody who describes their experience as "x number of years in healthcare" is often conflating that experience to try to make it something that it isn't which is usually actual patient care experience. So what exactly was the experience you speak of because it really does change things? Being evasive does not win points here.

Second: Being a NICU mom is stressful but it isn't the same as being a NICU nurse. The only advantage you have is that you can actually be sympathetic (rather than empathetic)and you have a greater understanding of what your patient's parents are going through. This is a wonderful thing but is not even remotely related to the clinical aspect of patient care.

Third: You had an issue with a preceptor back in April. You challenged her. As a new grad this is not a good thing to do for a whole lot of reasons. There were way better ways for you to handle the situation. Yes, I'm aware that your facility's policy backed you up but if you read the responses across the board virtually every one agreed with your preceptor, after all even PO feeders get NEC and, as I'm sure you're aware, increased residual is often the first sign. Basically, you stepped in it...royally. But after all, you were right so you won...right? I'm suspicious that this may be one of the reasons you are only taking care of feeder/growers. You ticked them off. I'm guessing none of the nurses who take the ICU babies are going out of their way to show you interesting things that they think you might like to see/learn. That's a huge red flag. Any of the more experienced nurses taking an interest in fostering your growth? No? Then you posted this and it pretty much made everything clear. You stepped in it here too...royally. I know you wanted us to agree with you and tell you that the mean old charge nurse were wrong but if ALL of the charge nurses keep assigning you the sub-acute babies then there is something else going on. I believe this post tells us what it is. You've shot yourself in the foot here and probably at work but you CAN fix it. A little introspection would be a good start. Then find an experienced nurse that you think might have a soft spot for new grads and throw yourself at her mercy. By that I mean, tell her that you are really interested in learning all you can about the sicker babies. Tell her you'd like to progress a LITTLE bit farther and you could really use her help. Ask her if there is anything that she is aware of holding you back and then LISTEN to her. If you win even one ally the chances of you being successful are very much increased. As for here, although I'm afraid you don't really care, an apology for the attitude and name calling would probably be a good thing. A little humility would be a great thing. All of us experienced nurses really do want to help the newer generation but sometimes the best thing we can tell you guys is the last thing you want to hear. But in hearing it you grow as a nurse. Now, I fully expect a vitriolic, angry response from you or some other poster for what I've said but before I get flamed I would like you to understand the spirit in which this post was written. I've been where you are and only after many years of doing this did I gain insight into what I did that might have caused me some (not all) of the grief I've been through in my career. I truly do hope you can figure all this out so you have a long and happy NICU career. Now donning asbestos undies.

[roser13, ASN, RN]

I read your OP and your second post. Stepped away from the computer for about an hour to think about this response because I don't want to appear as if I'm piling on but some things are becoming clear to me.

First: anybody who describes their experience as "x number of years in healthcare" is often conflating that experience to try to make it something that it isn't which is usually actual patient care experience. So what exactly was the experience you speak of because it really does change things? Being evasive does not win points here.

Second: Being a NICU mom is stressful but it isn't the same as being a NICU nurse. The only advantage you have is that you can actually be sympathetic (rather than empathetic)and you have a greater understanding of what your patient's parents are going through. This is a wonderful thing but is not even remotely related to the clinical aspect of patient care.

Third: You had an issue with a preceptor back in April. You challenged her. As a new grad this is not a good thing to do for a whole lot of reasons. There were way better ways for you to handle the situation. Yes, I'm aware that your facility's policy backed you up but if you read the responses across the board virtually every one agreed with your preceptor, after all even PO feeders get NEC and, as I'm sure you're aware, increased residual is often the first sign. Basically, you stepped in it...royally. But after all, you were right so you won...right? I'm suspicious that this may be one of the reasons you are only taking care of feeder/growers. You ticked them off. I'm guessing none of the nurses who take the ICU babies are going out of their way to show you interesting things that they think you might like to see/learn. That's a huge red flag. Any of the more experienced nurses taking an interest in fostering your growth? No? Then you posted this and it pretty much made everything clear. You stepped in it here too...royally. I know you wanted us to agree with you and tell you that the mean old charge nurse were wrong but if ALL of the charge nurses keep assigning you the sub-acute babies then there is something else going on. I believe this post tells us what it is. You've shot yourself in the foot here and probably at work but you CAN fix it. A little introspection would be a good start. Then find an experienced nurse that you think might have a soft spot for new grads and throw yourself at her mercy. By that I mean, tell her that you are really interested in learning all you can about the sicker babies. Tell her you'd like to progress a LITTLE bit farther and you could really use her help. Ask her if there is anything that she is aware of holding you back and then LISTEN to her. If you win even one ally the chances of you being successful are very much increased. As for here, although I'm afraid you don't really care, an apology for the attitude and name calling would probably be a good thing. A little humility would be a great thing. All of us experienced nurses really do want to help the newer generation but sometimes the best thing we can tell you guys is the last thing you want to hear. But in hearing it you grow as a nurse. Now, I fully expect a vitriolic, angry response from you or some other poster for what I've said but before I get flamed I would like you to understand the spirit in which this post was written. I've been where you are and only after many years of doing this did I gain insight into what I did that might have caused me some (not all) of the grief I've been through in my career. I truly do hope you can figure all this out so you have a long and happy NICU career. Now donning asbestos undies.

Standing ovation:cheeky:

A much needed bit of advice and very eloquently put.

[BSN16]

I have a friend who is a new grad in the NICU as well. She only gets feeders/growers as well. Same as anyone else who is new to the NICU, despite their previous experience. I think this is kind of a common thing

[BuckyBadgerRN, ASN, RN]

Re-read this. I think you may find the reasoning behind your being "held back" in your unit. A little too much attitude...

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Sour,

Not sure how you think insulting my capability as nurse is constructive.

I provide excellent patient care, and know exactly what a healthy patient looks like. I have over ten years experience in healthcare, and have four children. I also have a deeper understanding/appreciation on the NICU, something in which few nurses can say they have. Each of my kids were in the NICU, and one of them was a golden hour. So please, save that anti-new grad bulling attitude for a prepubescent new nurse.

Furthermore, it is a new rule that each nurse needs at least 30% exposure to ICU assignments for a couple reasons. The first being that a stable intermediate case has the potential to shift to an ICU case quickly. Secondly, the unit has had days when those "experienced, always in ICU nurses" were not working. Nurses who were only placed in intermediate assignments felt out of sorts in their ICU assignments and complained. How is that what is best for the unit?

Take your bad attitude and anti-progressive nature someplace else Ms. Grump.

[chacha82, ADN, BSN]

OP, you will receive the more challenging patients in time when the UNIT (charge nurse, management) deems fit. Other areas of nursing are like this because it is what is SAFE for the patients. You will be trained bit by bit, step by step and if someone is out and you need to take a challenging patient another nurse will walk you through it. This is where your unit has dropped its dime and that's how it will be. In the meantime do a good job with your patient and you can always help others when asked. But your attitude of "I'm 9 months in, I know it all" is too confident for any job.

[Kooky Korky, BSN, RN]

Does 4 kids in the NICU give anyone else pause?

What are you implying?

[djh123]

I fail to see how 'Sour's comment that she doubted you know it ALL is 'an insult to your capabilities'. NONE of us 'know it all', no matter what kind of nursing we're doing. I also agree with some who said you've got to be a little more patient. Few people get to do exactly what they want when they want it... but if you keep doing a good job and wait a bit, you'll probably get more of what you want.

[nutella, MSN, RN]

I worked years in critical care and that is how the cookie crumbles. Not only in NICU but generally speaking unless your facility and charge nurse feel that you are ready. It is not enough that you feel ready. They have to be confident that you do a good thorough job with easier patients first. As somebody else explains - first you get the not so sick/routine patients and after that slowly build up.

I do not think that 9 months is an awful lot of experience since you were a new nurse I assume. So the first 6 months are usually basics and orientation and getting used to everything. I understand that you feel you are experienced, but we are talking strictly professional RN experience, not experience as a mother or in a different role. And - you might have to get "in line" - there could be other nurses who started before you and are still being trained for sicker kids. You mention 2 years as the thresh hold, which is very common for any critical care area that has very sick patients. It took me some while to go from basic ICU non vents to vents to CVVHD, IABP, transplants, artificial hearts, and and and - it is a process.

Even though some paper may state that you need 30% exposure - what does that really mean? If they assign you a sicker child, they also have to make sure that somebody is there to help and train you. Perhaps they do not have that capacity. Your options are to suck it up and wait your turn for sicker patients (this has been the traditional model - not saying it is right but that is how a lot of nursing places operate) and in the meantime enjoy your work. Or you don't want to suck it up and speak up and discuss it with the charge nurse - changes are that they will not look at your favorably and it can jeopardize your future career at that place. Or you suck it up to get at least one year of experience and after that think about applying somewhere else if you are truly not satisfied with the workplace. A lot depends on the culture of your workplace but I can not imagine any NICU being gung ho about a new nurse taking on sicker children.

If you need an outlet and want to use more of your skills but also keep that job and lay low perhaps look into a per diem job in private or 1:1 home care as they have a lot of sick children at home. Not sure if that is a viable option for you but sometimes that can help with the feeling of not using your education.

[Jedrnurse, BSN, RN]

By "bulling attitude" did you mean to write "bullying"? Might as well strike that word from the lexicon as it's been so used and abused. Bullying is now: "Somebody said something I didn't like or didn't give me what I wanted."

By the original meaning of bullying, Sour's post was no such thing. By the newer, special snowflake one, I guess it was...