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?

[carolinapooh, BSN, RN]

Shoot, people call me "kiddo" (or something like it) all the time and I am far from a kid. I don't get all bent out of shape, and take it in stride. Always have. Never let it bother me. Most mean it affectionately and if they don't, they are not your "kind" of people and you should not care one whit what they think anyway.

Life is too short for me to be butthurt over ill-conceived, albeit, well-meaning remarks. You get this insight with age, I guess.

I don't get butthurt. I find it unprofessional.

That said, I have family in the Northeast and they seem to use the term the way Southerners say "sweetie". In that regard, I'm unbothered.

The response wasn't in that regard. It was a jab at the OP.

[carolinapooh, BSN, RN]

Sorry, I'm still chuckling over how a very casual kiddo that I didn't even think about is being dissected on multiple levels. LOL!!!

My bad--I should not have assumed the OP is a young nurse, although, you must forgive me, since the entire tone of her post does not exactly scream 'mature.'

It seemed less than casual in interpretation. :) I do agree she sounds young (albeit with four kids - no judgment!)....

[cardiacfreak, ADN]

Sorry, I'm still chuckling over how a very casual kiddo that I didn't even think about is being dissected on multiple levels. LOL

.'

I'll be your kiddo. (In my best Val Kilmer/Doc Holiday voice.)

[Janetnzrn]

ouch OP! I'm a NICU nurse, have been for quite a while and I do a lot of charge nurse shifts. I have a lot of sympathy for your plight as I know feeders and growers aren't the most thrilling of patients. However, if you use these assignments to hone your skills as a lactation assistant, and work on your family communication skills the time won't be wasted. I have to agree with a previous poster that over confidence can be a scary thing as staff that exhibit this tendency tend to not ask for help when they should. On my unit we work very hard to keep people's skills up to date and rotate our level 3 nurses down to Levels 1&2 as taking care of feeders and growers are skills as well. Your personal experiences as a parent are very much separate to your skills as a nurse, sometimes nurses who have had premmies can transpose their experiences onto their patients. Can you try discussing this with your unit educator? Or coming onto shift early and talking to the charge nurse doing the allocation? If you contribute during rounds regarding your patients in a knowledgable way that will get noticed. Nine months isn't very long, on my unit you would only be doing CPAP! We don't orient to vents until you've been there a year!

[carolinapooh, BSN, RN]

My thought was also ask if she could shadow someone with a higher acuity patient between doing her own patient care. I used to do that when I was a newbie and I learned a lot.

[TheCommuter, BSN, RN]

Moved to the First year After Nursing Licensure forum.

[BeenThere2012, ASN, RN]

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.

OP....I remember what it was like when I was a "new grad" and anxious/excited about learning more and progressing. I know you have taken a lot of "re-direction" from a lot of the responses here, and I agree with some of the points but want to give you some constructive support.

First...Keep in mind that although you feel ready, there really may not have been the "right" or "best" opportunities for you yet depending on skill mix and timing for patient safety reasons. I know you are not feeling challenged, but it is very important to keep your cool and patience at this point. Meaning...since so many have felt you are a bit too "confident" and maybe pushy, you should listen for now without feeling offended. We have all been there in one way or another and know that sometimes new grads come off as overly confident when they truly are simply excited to progress, want to keep going in their learning momentum, etc., but this can put people off when your approach sounds like complaining. It gives the impression that you think you know better than they do and that you feel entitled etc..This can be offensive to them. Please do not take offense to this. It is meant to have you consider how they may be feeling at this point, in a way that you possibly haven't realized or intended and hopefully may help you settle down and think about changing your approach.

Please consider the following...As others have said, try talking to your manager, senior nurses, or charge nurses with whom you feel you have a good relationshp. Apologize. Such as, "Ive been thinking about this and realize I may have been coming off too pushy, impatient, and want to apologize. I'm just so excited to learn more and progress. When time permits, please consider pulling me into learning experiences and let me know if I can be of help when someone with a critical patient could use some assistance." Something to this effect....

You can turn this around. One day, you will recognize the same in another new grad aproaching you!!

In the mean time, there is always something to learn with the patients you now care for. Give them your best. I'm sure you are likely doing a very good job with them, but you do have so much more to learn.

Start studying about pressors, doses, indications. Ventilator settings and modes. Practice how to interpret blood gases, the difference in ABG's, Cap and venous gases. Make sure you are familiar with policies and procedures for central line dressings, blood draws. TPN/lipids, ramping etc...Study some of the more nitty gritty and you will definitely impress the ones who will be mentoring you. I'm not saying you have to know all this before progressing, but you will eventually and you may as well start now to be more prepared. Do not be like a know it all, but when you are helping or caring for a critical patient and can demonstrate you have done your homework, it makes a big difference in the confidence they will have in you.

Just some thoughts. I hope they are helpful.

[BeenThere2012, ASN, RN]

I work in the ER and it is quite the opposite. While in orientation if there is an EMS code coming in bet your ass you're going to be right there on the front line. Stoke that needs TPA and the neurologist on call is a pain in the ass, that's your patient. Hypotensive sepsis with a lactic acid that you have never seen before or a dialysis patient that needs bipap with a potassium of 9--- again you will be pulled in there. New nurses are trained there so that they can handle the ICUs.

I think you're right, it's about exposure. What happens when that veteran nurse of 19 years needs to take a month off for surgery. Would they rather have new nurses that are trained to handle critical patients, and how to find the info they need or would they rather have nurses that are going to crash and burn because they don't know what to do? I am a new nurse, I've worked for less than a year and if a critical patient comes in my crew knows I can handle it and I know how to get others involved if I need help. So why should they not trust their ICU nurse?

I would let my manger know, and frequently why I think that I should have more critical patients. If they object I might think about what other ICUs in the area need some help :)

I appreciate your point of view and am very happy you do have the support you need when the critical patients come in. NICU is quite a different ball game when it comes to having an assignment where you are responsible for all numbers of things..each of which is very sensitive and complex. In the ER, you guys are for sure under the gun. So please do not take offense, but it is entirely different to start setting up things when a patient presents, than it is to manage all aspects of care when all the balls are now in the air. The orders changes and interventions come in fast and furious and you have to consider each and manage each simultaneously. It is a bit different. As new nurses in these scenarios, it is best to learn gradually, when possible, as opposed to jumping into the most critical at once. OP does need "exposure" in order to start being prepared. But that has to come in time. She may not realize there is a lot more to learn in the mean time even with her current patients.

[BeenThere2012, ASN, RN]

Hi OP,

You sound like you are really hoping to take care of some sicker babies.

I can tell you from experience that firstly getting along well with your nursing team will make you a shinier candidate to begin to work with sicker kids. After your stable babies are well cared for you could ask some of the nurses with sick kids if they need help. Pick up extra shifts and cover sick calls. Ask your unit director if there are any evidence based research topics you could look into for the unit. Focus on safety and safe medication administration. Happy, safe, helpful nurses get promoted. Even young ones, trust me. I know.

Very good, useful advice. I know many were hard on the OP for good reason, but, unless we present advice in a helpful manner, she won't hear it.

[BeenThere2012, ASN, RN]

Didn't want to say it but I'm glad you did. I would get the hint after the 2nd and definitely would think twice after the 1st. What a terrible way to welcome your newest addition into the world time after time after time....after time. If one of hers was a "golden hour" preemie, that is implying (I guess, since it's not really a widely established standard of care) very low birth weight. I'm also very jaded when it comes to NICU. When I had my clinical rotation at the county hospital I was assigned to, it was the first day I cried after clinical. My precepting nurse said something along the lines of, "Usually if a baby ends up here, it's because mom didn't have too much of a clue." And, considering the population that was being served by that facility, this is true. Women going into labor at 22 weeks (7th child or so) because they were high on meth and wondering aloud to the nurses "if CPS would let me keep this one." Women who were absent from their education sessions for their third or fourth preemie because the other two or three kids were disabled and it was a hardship just to get back to the hospital.

Not that this has anything to do with the OPs situation but, when one chooses to start a family, the onus is on them to try make sure that conditions are optimal for the kid who, frankly, did not ask to be born. All I'm saying is that 4 kids in the NICU does not a good NICU nurse make. This unnecessarily highlights their personal situation and calls into question their judgment in their personal lives (which, again, does not have any bearing on their situation at work but...if the OP has made mention of that as a way of supporting their request to have harder assignments, I can see a big eye roll coming down from management).

I don't think it is appropriate for you to judge her decision on having her children. That is a side note of your opinion and low blow into her personal life. She mentioned it, and I do agree using it for reasoning that was somewhat flawed, but none of our business and nothing to do with this post. You don't know everything about her or her family.

[BeenThereDoneThat74, MSN, RN]

I don't think it's "ummm...interesting." She could be someone who has an incompetent cervix and delivered all her babies early after PTL. She could be someone who gets pre-eclampsia (which, if you get it once, you're at greater risk of getting it again) and had to be induced with all of her children at 34 weeks.

I don't agree with her assertion that it makes her better at the clinical skills of a NICU nurse, but I think it was pretty ****** to imply that there is something...I don't know...nefarious about the fact that she had 4 kids in the NICU.

thank you for your response. This is what I was thinking (I have a good friend, happens to be a nurse- a good one at that, who takes very good care of herself, and had 2 out of 3 NICU babies). I understand the connection between good prenatal care and high risk newborns/preemies (not fully, admittedly, since I'm not a NICU nurse), I just didn't think we were automatically going 'there'.

As far as the decision to keep having children despite ones previous struggle, that's not for me (or any of us) to judge. That's a personal choice. I have one physically healthy child, went through a very uneventful pregnancy, delivery and post-partum course. So I don't know what it's like to want to try again to get it right. I have worked in areas where I've seen it (long term peds- kids with chronic/special needs). It's really not my place to judge these people.

Now, being a crack-head is a whole other situation :0