New Grad's Spirit is Broken

[Nurse Beth, MSN]

Dear Nurse Beth,

I am a new grad about 9 months into my first job...in the ICU. I have had 2 performance evals and the first was "you're doing a good job, you're still new and need to improve on this..." but the most recent one broke my spirit. I racked up overtime (more than other new grads on the floor)...not too ridiculous, I think...like 2-3 hrs per pay period (which is like an avg of 30 min per shift) mainly to scramble on charting.

Some items mentioned I can completely understand needing to work on- time management, better communication with doctors/charge RN, more proactive with asking for orders/knowing what med to request...but it felt so soul-crushing to hear them say things like they were concerned for a patient's safety under my watch. Also, some negative items on my eval were when I ask experienced RNs for advice on an issue and followed their advice!

I was so heartbroken, disappointed in myself, and also annoyed with certain things that I felt were not my fault. (A nurse complained about my colostomy bag leaking...I watched her replace my bag and she put the new bag on the exact same way I did!)

The hospital is very far from my house...and I recently got an interview for a hospital (also ICU) 5 minutes away from home. (I know I have no offer YET...but I'm just thinking it over...) I'm torn. I don't want to be a sore loser/quitter in leaving my current hospital after a bad eval especially since this hospital is much bigger, probably has more high acuity pts/ better learning experience, (better benefits), and newer technology/equipment, and the team is very knowledgeable and nice (some of them). 5 min drive vs 1.5-2hr drive is tempting though.

Any advice? I've even considered that I'm not cut out for ICU or should go lower acuity to get more experience then switch later if I want?

---

Dear New Grad,

I'm sorry for your experience so far. This has got to be very tough.

If you are offered and take the new job in ICU, you will soon know if you are cut out for ICU or not. Meaning if after a time you receive a poor performance evaluation, you will know it's you, not the organization. On the other hand, you may settle in and hit your stride.

Staying regularly 20-30 minutes after shift is taken seriously by management because of the bottom line. It may help to transfer to a lower-acuity unit, although consider that time management problems can be exacerbated with 5-6 MedSurg patients.

It's usually recommended to to stick with your position at least for one year, but there are exceptions. if your job is at risk, it's better to quit than to be fired. If a workplace is toxic or unsafe, same goes.

So there are a lot of options- and the best choice will be one that is a solution to your problem. What do I recommend? Consider transferring to MedSurg. Why do I say that?

1. You will not be terminated from the ICU

2. It will give you extra time to build your nursing practice and develop

3. It is a benefit to remain with the same organization for a year or two- you can change jobs closer to home later

4. From personal experience, I have seen nurses thrive once they transfer to a different unit.

If you decide to stick it out in your current setting because of some of the advantages you've mentioned, you need specific and measurable goals from your manager in order to succeed.

When You Receive a Warning at Work is a must-read for you.

Best wishes on your decision,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[RunnerNurse09, BSN, RN]

I am so sorry you are having this difficulty. I do not think it is fair for your employer to put such pressure on you for staying later. When I was a new grad on a med-surg floor, we typically has 8 patients. I have always been great with time management and usually didnt stay late, but it was EXTREMELY common for newer nurses to end up staying 1-2 hrs after their shift EVERY shift to chart. From what I know, they were not disciplined for having to stay. I understand every facility is different, but that really sounds ridiculous. Also, colostomy bags leak, even when put in place by certified ostomy nurses. It happens. If you dont feel like you are being given the support you need, then I would take the other job. Dont feel disappointed in yourself. It really takes time to settle in as a new nurse. Best of luck to you!

[amoLucia]

To OP - it's a tough situation when something like this happens so early in your career. But it'll most likely continue to occur even when you start accumulating years of experience.

You say this was an evaluation - did they give you a 'plan of correction' or make other recommendations to you? If so, you'll need to follow them as that will insure your continued employment. Failure to do so will set you up as a target since they will have started that proverbial 'paper trail'.

'To stay' or 'to leave' is your dilemma now. Either has its pros and/or cons. And Nurse Beth offers good breakdown. But I will caution you that similar situations will occur again as you move on in you career.

[DextersDisciple, BSN, RN]

For starters, it really is true that most RNs usually need at least 1 year of experience on their unit/floor to feel competent. Most of the Eval sounds like things you will learn with experience I.e. knowing when to call the dr and for what. However I can see why the comment about pt safety would make you feel lousy. I would ask for concrete examples and set goals with your educator/manager to show you are motivated to be a safe and competent nurse.

The fact that your commute is at least 1.5 hrs away and the other position is only 5 mins would make it difficult to not want to leave your current job (if you received an offer

Of course). At least this would be the case for me if I were in your shoes.

That being said- the 1 year mark is really a good milestone to obtain. You'll feel more competent and it will look much better on a resume than 9 months.

One more thing- a lower acuity ICU could really benefit you if you still feel overwhelmed in your current high acuity ICU after your 1 yr Mark. I'd take the interview and go from there. Best of luck to you OP!

[mani96]

Racking up overtime to finish charting is very common; I see this even with experienced nurses on my floor (acute rehab). Not every shift, but it does happen. Management always mentions OT in performance evals because nurses cost the hospital money, they don't make the hospital money. You'll get better with time when it comes to getting everything done during your scheduled shift, including charting.

I've been on my unit for 2 1/2 years and I am still learning how to be more efficient, how to do better, faster, more accurate assessments, what each individual MD prefers in terms of patient info, getting charting done on time, etc. There's a lot to learn in nursing, especially because you're dealing with humans who are all different -- from the patient all the way up to management. Learning how to take care of patients safety while at the same time making your colleagues and managers happy is a juggling act and takes time. (Some people will say that making colleagues happy isn't your job, but your life will be so much better at work if your co-workers, charge nurses, and managers like you and think you're helpful and easy to get along with.)

Go easy on yourself, nursing is hard. And if you do get an offer from the ICU closer to home, I'd take it in a heartbeat, because long commutes can be a huge stressor, especially if you're doing 12 hour shifts.