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New Grad in LTC - Should I Stay or Should I Go Now?


Hello All. Seeking advice regarding my job. I have been working over 5 months as a new grad in LTC/sub-acute facility. I work on a cart that has a mix of sub-acute patients, LTC patients, and hospice patients. Most days I love my job. I have about 20 patients but it's usually manageable. The patients love me and I have an amazing rapport with the aides. They come and tell me everything. Up until today I have received great feedback from my DON. He has asked me multiple times if I am planning to leave for a hospital. I have also had other supervisors ask me the same because they say they do not want to lose me.

Today my DON informed me he was upset because nothing was done the day prior regarding a critical lab. A fellow nurse took the lab via phone and handed it to me via sticky note. The supervisor takes care of the labs once they are faxed in so I didn't think much of it. The DON was under the impression nothing was done regarding the lab because the supervisor did not write a nurses note and neither did I. The supervisor wrote on the lab itself that the MD was aware and just wanted us to monitor the patient. I told the DON this after the fact and he said this was unacceptable. He told me he was going to be watching me from now on. I said, "ok." At the end of the shift, the DON made me give him report and told me once again I was going to be watched. I did not know what to say so I said that it was ok with me to be watched because that means there is someone to check to make sure I'm doing everything right. The DON said that I would regret saying that and that it is not a good thing that I am being watched.

I have a few things running through my head but as I am a new nurse I have a few questions because I am not sure what the nursing world is like. Is it normal for a DON to tell a nurse that he will be watching from now? It almost seems like a scare tactic to me. My facility has trouble retaining nurses and they seemed to want me to stay but this experience is very off putting to me. I have also heard that one of the nighttime supervisors is constantly asking people about me to check up on me so I am upset about this as well. Is this normal behavior? I am considering applying to jobs in the hospital because maybe this experience means I cannot handle 20 patients. If I apply to a hospital, should I ask them not to contact my current employer? Does this look bad to the hospital? I do not want my current job to know that I am leaving as I told them I was planning on staying. Overall I would rather not leave my job but I do not like the idea of being watched and spied on. I put my heart and soul into my work and I do as much as humanly possible in 8 hours. I just feel that my hard work is going unappreciated.

You and your supervisor contacted the MD, what else did the DON want you to do? I would possibly ask that if he mentions the watching you comment again. Get more clarification and don't sign anything until you have that clarification

Noone can tell you what to do. If you generally like your job then I'd stay. The grass is not always greener

Thanks. He said that even though the MD was notified, there needed to be a nurse's note stating that the MD was notified. That is the reason as to why I am being watched apparently.

I realize the grass is not always greener but I am torn because I have an aunt who has worked both LTC and the hospital and she has been telling me to go to the hospital. As a matter of fact, I trained an RN last week who has been a nurse 12 years and she told me I should go to the hospital too! That is why I am so torn. I have so many people telling me to go to the hospital that I don't know what to do.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

If you're doing well where you're working now, like the people and (mostly) enjoy the work, stay. At five months, you're still too new to have learned everything you can at your job, or even most of what you can learn. It takes about two years.

It is normal for new grads to be "watched," although most supervisors wouldn't put it to them quite in the way that yours did. We watch you to make sure you're learning everything you need to learn, that you're progressing appropriately and to make sure you're not making major errors or overlooking major signs and symptoms. They're our patients, too. Going to the hospital won't change the "watching" one bit -- in fact, with more acute patients you'll be watched more intensely and with more RNs on staff, you'll be watched by more people. It's not "spying." It's watching. Be grateful.

As far as your hard work being appreciated -- it sounds as if it is being appreciated. They've indicated that they want you to stay. When you have a real job, your manager isn't going to seek you out to praise you unless you've done something truly, stupendously wonderful. As a new grad, you're doing well to be marginally competent. Truly, stupendously wonderful is still out of your grasp.

iPink, BSN, RN

Specializes in Critical Care, Postpartum. Has 8 years experience.

I agree, your manager could have chosen his words better, but being watched normal. You're new and your response to him was appropriate and it seemed to throw him off guard. When I started off, I welcomed the offer from my assistant nurse manager to shadow me one day on my unit. She provided great feedback along the way and gave me great advice to help me improve my time management skills.

As you stated, they are happy with your performance and every mistake is an opportunity to learn. Don't doubt yourself. In the beginning you said you were handling the 20 patient load and then in the last paragraph you were doubting your ability to take care of that patient load. Don't allow that doubt to creep in or it'll fester and take on a life of its own. Keep at it and welcome any constructive criticism.

If you ever decide to leave, it'll be there loss.

Ruby, I think this is great input. Walking away from my conversation with my supervisor I felt as if I were being spied on but I agree that it must be normal for new grads to be watched and now that I realize this I feel better about the situation. Honestly, I have nothing to hide. Anything I can't get to I endorse to the next shift. It is true that I share my patients with my supervisor and it is both of our responsibilities to watch over them together. If we do not all work together to protect our patients then it can put everyone's license at risk. I think ultimately my supervisor is just looking out for me and wants me to be more careful.

iPink, I agree that my supervisor could have chosen his words better. I think that the way he approached me is what upset me most. I had a nurse of 14 years shadow me a week ago because I was supposed to orient them to my cart. The nurse said I did a great job for a new grad and that she was going to tell my supervisor she was very impressed. I think that my supervisor's comment shook my confidence and that is also what upset me greatly. I was starting to feel in control of my cart and I did not go home anxious every day. Receiving my supervisor's feedback shook my confidence and made me slightly anxious again. That being said, we all make mistakes. Even experienced nurses. I am going to look at this as a learning opportunity and I will try to go in to work just as confident as before. I now know for next time what is expected of me and I will do a better job next time.

I think the strangest part of this is not that you are being watched, but that your supervisor said you would regret your statement and that it is not a good thing to be watched. This makes it sound to me like if you make the slightest mistake, you are going to be fired. His statement seems to have bad intentions. It sounds like you are doing a great job and get along with the staff so I don't know why such a small mistake would be a big deal. Perhaps you could talk to this supervisor about it and clarify--maybe it was simply a misunderstanding. Assert yourself and be confident. Good luck.

Violetsmom, I agree with you. In the beginning, I felt that the comment had bad intentions. I thought about it a great deal, though, and figured that if the supervisor really wanted to get me in trouble then he would write me up. I have not been written up yet since being hired. I have a feeling that my supervisor just wants to be taken seriously, although I could be very wrong. My supervisor was also born in another country so it is possible that the way that he presents things could easily be misunderstood. I hope I am right. Overall I enjoy my job and do not like the idea of someone trying to have me fired.