new grad RN needing some advice!

[jennsrn]

I have been an RN for about 9 months now, working in a LTC/SNF. I am burnt out! Any area or specialty of nursing is sure to bring stress, especially as a new nurse, but it's to the point where I get extreme anxiety about going into work. I don't like the hours, management is extremely unhelpful, staffing is an issue, and the nurse:patient ratio is just too much. As much as I hate my current job, looking back to September, I see progress in myself. I still have a lot to learn, but time management, especially in LTC, is something that I greatly improved on. What I'm worried about, especially in the setting I am in, is my critical thinking skills, and my basic nursing skills. I am sometimes SO overwhelmed in my patient load that I just feel as though all I'm there for is popping pills, and that important things such as a change in a resident's status is easily overlooked because I am so caught up in everything else. I can't spend any more than a few minutes with my patients, I get no help, guidance/assistance from my supervisors/managers, and it's weighing on me heavily. I do not know if I'm doing a good job, or bad job, I've been given no feedback by my employer and, and I feel as though I am just a body that fills their schedule. I feel like I am a "fake" nurse, who is just there to get the job done. I am a perfectionist, and that's also part of the problem. I know I need to leave, I have been looking elsewhere for employment, but due to COVID-19 it's been a bit difficult.

I have some friends who work in hospital settings, and all I hear are horror stories, the stress, the hours, and especially with this virus, it's only gotten worse. I have been considering the hospital setting, but I am very nervous. I know deep down I am capable (I graduated nursing school, passed NCLEX, so I think I am pretty capable), but I struggle with anxiety and fear of doing something wrong, or looking stupid when speaking with a physician, another nurse, patient's family, etc. I know that time will only boost my confidence, as I grow more comfortable in the job, but I am also hesitant about going into the hospital because I already know I will not like night shift, and that's most likely what I'll be given. Many hospitals in my area also require BSN to even be considered, which I am currently in school for. I just recently started a per diem job at another LTC facility, which I can already tell is MUCH better than my current one, and I am hoping maybe a full-time position opens there. But the whole "get the hospital experience" is weighing heavily on me. Even the nurse educator told me I should go into the hospital to get some experience. I just feel like I am being pressured, and that only "real" nurses work in the hospital, which is why I should do it. At the end of the day, I don't know if my hesitancy is caused by me just having no desire to work in a hospital, or because I'm genuinely scared. I did do a preceptorship in the hospital before I graduated nursing school, and I didn't have many feelings about it, because at the end of the day, I had someone to fall back on, and it wasn't all my responsibility.

I'm just looking for some advice! I do plan on graduating with my BSN by the end of next year. I honestly don't know what to do. I get paid great at my two current jobs (more than what the hospitals around me are paying), but there are many cons (work hours, poor management, poor guidance/assistance). I am currently looking for another job in LTC, and/or maybe sub-acute, with better hours, where I can use and develop my nursing skills without being in a hospital. Does anyone have any opinions? I am just in fear that if I don't get hospital experience now, I'll never get it, and it will be a missed opportunity.

[Nurse SMS, MSN, RN]

On 5/13/2020 at 7:59 PM, jennsrn said:

I have been an RN for about 9 months now, working in a LTC/SNF. I am burnt out! Any area or specialty of nursing is sure to bring stress, especially as a new nurse, but it's to the point where I get extreme anxiety about going into work. I don't like the hours, management is extremely unhelpful, staffing is an issue, and the nurse:patient ratio is just too much. As much as I hate my current job, looking back to September, I see progress in myself. I still have a lot to learn, but time management, especially in LTC, is something that I greatly improved on. What I'm worried about, especially in the setting I am in, is my critical thinking skills, and my basic nursing skills. I am sometimes SO overwhelmed in my patient load that I just feel as though all I'm there for is popping pills, and that important things such as a change in a resident's status is easily overlooked because I am so caught up in everything else. I can't spend any more than a few minutes with my patients, I get no help, guidance/assistance from my supervisors/managers, and it's weighing on me heavily. I do not know if I'm doing a good job, or bad job, I've been given no feedback by my employer and, and I feel as though I am just a body that fills their schedule. I feel like I am a "fake" nurse, who is just there to get the job done. I am a perfectionist, and that's also part of the problem. I know I need to leave, I have been looking elsewhere for employment, but due to COVID-19 it's been a bit difficult.

I have some friends who work in hospital settings, and all I hear are horror stories, the stress, the hours, and especially with this virus, it's only gotten worse. I have been considering the hospital setting, but I am very nervous. I know deep down I am capable (I graduated nursing school, passed NCLEX, so I think I am pretty capable), but I struggle with anxiety and fear of doing something wrong, or looking stupid when speaking with a physician, another nurse, patient's family, etc. I know that time will only boost my confidence, as I grow more comfortable in the job, but I am also hesitant about going into the hospital because I already know I will not like night shift, and that's most likely what I'll be given. Many hospitals in my area also require BSN to even be considered, which I am currently in school for. I just recently started a per diem job at another LTC facility, which I can already tell is MUCH better than my current one, and I am hoping maybe a full-time position opens there. But the whole "get the hospital experience" is weighing heavily on me. Even the nurse educator told me I should go into the hospital to get some experience. I just feel like I am being pressured, and that only "real" nurses work in the hospital, which is why I should do it. At the end of the day, I don't know if my hesitancy is caused by me just having no desire to work in a hospital, or because I'm genuinely scared. I did do a preceptorship in the hospital before I graduated nursing school, and I didn't have many feelings about it, because at the end of the day, I had someone to fall back on, and it wasn't all my responsibility.

I'm just looking for some advice! I do plan on graduating with my BSN by the end of next year. I honestly don't know what to do. I get paid great at my two current jobs (more than what the hospitals around me are paying), but there are many cons (work hours, poor management, poor guidance/assistance). I am currently looking for another job in LTC, and/or maybe sub-acute, with better hours, where I can use and develop my nursing skills without being in a hospital. Does anyone have any opinions? I am just in fear that if I don't get hospital experience now, I'll never get it, and it will be a missed opportunity.

Take a deep breath. You have a lot going through your mind and its going to make you nuts.

If your current employer is not a good fit, its fine to get a different one. You did very well getting a per diem elsewhere. That way you can test the waters and find out if it meets your needs.

Stop thinking that if you don't work in a hospital you aren't a "real" nurse. Think about what that says about all the nurses on here who work in SNF, LTACH, Home Health, Clinics, Dialysis, Public Health and all the other specialties out there that are not hospital based. Pretty insulting when you think about it, eh?

Nursing is a broad umbrella. If you don't want to work in the hospital, congratulations! You figured it out without having to put up with two to three years of misery and wrestling with the decision. There is a reason most bedside nurses work hard to get away from the bedside. If you have aspirations to a career path that will require acute care experience, then yes, you need to get a hospital job. However, if you don't, then stop this silliness.

Its hard, but you have to start focusing on how you feel about yourself and your worth in what you are actually doing. When you are taking care of someone in long-term care, they don't need a hospital nurse. They need a nurse who is going to be with them for months or years, helping them relearn how to eat, helping them manage their medications, helping them learn to maximize their function. You are the kind of nurse that patient needs in the setting in which they need it. How silly to think you aren't real. You have a specialty. Don't believe me? Find the certification information for your area and start reading the prep to study for the exam. Stop worrying about what people are thinking. They don't matter, especially strangers on the Internet or people who aren't part of your every day life. It's a hard lesson to learn when you first get out of school and making administrators and instructors happy was part of the goal on the way to your degree. Your focus now should be on keeping your patients safe, providing the care they need. You can't do that if you are denigrating what you need to do. Are they less because their needs are long term? No, they aren't. It's well known in the nursing world that the future of nursing is outside of the hospital.

There is no hierarchy in nursing. Some think there is, but they are wrong.

Find a job that makes you feel like you are satisfying your own ability to do your job well. Work on your self esteem. Take the time each day on the way home to identify one thing you did that shift that met someone's needs.

Good luck and keep your chin up. Nursing is broad, wide and huge in scope.

[katrn, BSN, RN]

I am currently in a similar situation. I'm also a new nurse with only 4 months of experience. I work in a hospital, because of the pandemic we are short-staffed, and they really don't have a structured system for new nurses so the transition is difficult, after orientation I was given 6 patients, I was so overwhelmed. I feel so incompetent and my critical thinking is not there. it's still hard for me to communicate with doctors and other health care professionals. I find it hard to apply what I learned from school to the actual setting. I had to talk to my manager if she can pair with a nurse who was more willing to teach. that really helped me a lot. But since I feel like I'm not getting the training that I need, I applied for a residency to help with the transition.  I have friends who joined the residency and said it helped and especially knowing that you're not alone in this journey and having that support system. hopefully, everything works out well for you.