New nurse with LTC experience terminated from med surg floor

[LTCnurse11]

Hello to all nurses of any title and/or experience level. I am in need of advice and guidance.

I am a Registered Nurse of 18 months with a background Hello to all nurses of any title and/or experience level. I am in need of advice and guidance.

I am a Registered Nurse of 18 months with a background primarily in long term care. Prior to becoming a RN I earned my LPN diploma in May of 2009. I did amazing in school, excellent grades and even earned recognition as an "Outstanding Program Student" from the college. I received many words of praise and admiration from my instructors and colleagues. During my transition toward my RN degree, I worked at a long term care facility which I had been employed as a CNA for 5 years prior.

When I got closer to graduation from the RN program, I chose to apply at a hospital about 30 miles from the city I live in. The job was a casual RN position on a skilled nursing floor within the hospital and was hired as a new grad. I passed my NCLEX and started my job there, working there for about 9 months. 3 months into my new position as a RN I chose to enroll in an RN to EMT bridge course offered by a local technical college which was approximately 12 weeks, being able to earn my EMT license. I have been working for a local rescue squad since obtaining this license. After my 9 months of employment plus the EMT training, I was feeling the interest/need to transfer to an acute care setting so as to learn more about acute care nursing and work my way into an ER/ICU/OB setting. The hospital at which I am employed had posted a full time opening on the medical surgical floor on the day shift which peaked my interest.

Therefore, I applied to the position and was hired for the job. My training included starting out for 6 weeks on the night shift and the remaining 6 weeks on day shift. Basically what happened was my orientation on the day shift was a huge flop and my preceptors were not very understanding of how uncomfortable I was with my patient load. I had up to 4 patients with admissions and discharges. It's a general med-surg floor in a critical access hospital so med surg gets a little of everything. I started to feel like each day my clinical coaches were getting more and more irritated with the speed that I was working. I was either way too slow, or they thought I wasn't "getting it".... By the end of my last week of orientation, I had been through 2 preceptors and felt as though I was uncomfortable to be out on my own. The unit manager was on my case every day I was at work. So I utilized clinical education, but really did not get any education tools. Prior to orientation on the floor, I had to take a PBDS assessment that I was told was to "guide"my orientation. I was told it was not a pass/fail assessment nor would it determine whether or not I would remain employed. It's just to get an idea of how much you know. If you don't do very well, you do a reassessment to see where you stand with critical thinking, etc.

Not quite sure what part of the orientation process went awry, but it just felt as though I was getting no guidance. I never made a significant error or put a patient in jeapordy; I had my preceptors with me and consulted with them with each question or doubt I had. Maybe that was part of the problem...I didn't trust myself enough and asked them about almost EVERYTHING. Maybe it was they thought I didn't have enough confidence? Although, part of me feels this is a two way street. If something is a struggle for me (or anyone for that matter), I feel that is when guidance is needed the most and it is clinical education's job to help me out. Mind you, clinical education is supposed to meet with me each week to track my progress, however, the clinical educator did not make an appearance until week 7.

Instead I felt like they would just tell me "You really need to move faster." Or "You really need to get this." Or "This is the nature of the floor, you need to fit in." Hearing that everyday for the last 3 weeks increased my anxiety level significantly to the point where I felt like no matter what I did, I would screw it up anyway, so I kind of started to give up. Finally, the last week of my orientation I took my other PBDS assessment. I went and talked to that day after my assessment --just to ask her for guidance and suggestions. I told her I was struggling. She was very helpful and straight forward and basically told me to ask my preceptors for as much guidance as possible. So I did that. I asked questions every day and I made sure I collaborated with her with each concern.

Then on my "last day" of orientation, I received another "unacceptable" reveiw of my PBDS.....at this point I didn't even know my first one was "unacceptable" but apparently it was. At this point, I asked what was going on and they said "We need to terminate your employment if you don't quit. It's due to not meeting job expectations." I had a feeling this was about to happen. I was very, very upset but at peace, too. I felt that there was so much wrong that at this time, the job didn't belong with me and I didn't belong with the job. I'm also feeling that their orientation was really poor but at that point, there was nothing much else I could do. So I talked to my old unit manager and was re-hired onto the floor as a casual call employee in skilled nursing.

It's really made me sit and reflect on where I want to go in nursing. I feel that often times critical thinking needs to develop and by doing that over time and experience, it can get better. So that's where I stand. I'm not full time, but I have SNF gave me a warm "re-welcome" if you will.

SO--having said all of that--what information can I get from any of you re: applying for jobs in the acute care setting? I have been working in long term care basically since I graduated with the exception of 3 months of med surg. What do I say in an interview and how do I address this issue with future employers? I am still very personally distraught about failing at my attempt at med surg but I feel that maybe the floor was a poor fit. Is there still hope . Prior to becoming a RN I earned my LPN diploma in May of 2009. I did amazing in school, excellent grades and even earned recognition as an "Outstanding Program Student" from the college. I received many words of praise and admiration from my instructors and colleagues. During my transition toward my RN degree, I worked at a long term care facility which I had been employed as a CNA for 5 years prior.

When I got closer to graduation from the RN program, I chose to apply at a hospital about 30 miles from the city I live in. The job was a casual RN position on a skilled nursing floor within the hospital and was hired as a new grad. I passed my NCLEX and started my job there, working there for about 9 months. 3 months into my new position as a RN I chose to enroll in an RN to EMT bridge course offered by a local technical college which was approximately 12 weeks, being able to earn my EMT license. I have been working for a local rescue squad since obtaining this license. After my 9 months of employment plus the EMT training, I was feeling the interest/need to transfer to an acute care setting so as to learn more about acute care nursing and work my way into an ER/ICU/OB setting. The hospital at which I am employed had posted a full time opening on the medical surgical floor on the day shift which peaked my interest.

Therefore, I applied to the position and was hired for the job. My training included starting out for 6 weeks on the night shift and the remaining 6 weeks on day shift. Basically what happened was my orientation on the day shift was a huge flop and my preceptors were not very understanding of how uncomfortable I was with my patient load. I had up to 4 patients with admissions and discharges. It's a general med-surg floor in a critical access hospital so med surg gets a little of everything. I started to feel like each day my clinical coaches were getting more and more irritated with the speed that I was working. I was either way too slow, or they thought I wasn't "getting it".... By the end of my last week of orientation, I had been through 2 preceptors and felt as though I was uncomfortable to be out on my own. The unit manager was on my case every day I was at work. So I utilized clinical education, but really did not get any education tools. Prior to orientation on the floor, I had to take a PBDS assessment that I was told was to "guide"my orientation. I was told it was not a pass/fail assessment nor would it determine whether or not I would remain employed. It's just to get an idea of how much you know. If you don't do very well, you do a reassessment to see where you stand with critical thinking, etc.

Not quite sure what part of the orientation process went awry, but it just felt as though I was getting no guidance. I never made a significant error or put a patient in jeapordy; I had my preceptors with me and consulted with them with each question or doubt I had. Maybe that was part of the problem...I didn't trust myself enough and asked them about almost EVERYTHING. Maybe it was they thought I didn't have enough confidence? Although, part of me feels this is a two way street. If something is a struggle for me (or anyone for that matter), I feel that is when guidance is needed the most and it is clinical education's job to help me out. Mind you, clinical education is supposed to meet with me each week to track my progress, however, the clinical educator did not make an appearance until week 7.

Instead I felt like they would just tell me "You really need to move faster." Or "You really need to get this." Or "This is the nature of the floor, you need to fit in." Hearing that everyday for the last 3 weeks increased my anxiety level significantly to the point where I felt like no matter what I did, I would screw it up anyway, so I kind of started to give up. Finally, the last week of my orientation I took my other PBDS assessment. I went and talked to that day after my assessment --just to ask her for guidance and suggestions. I told her I was struggling. She was very helpful and straight forward and basically told me to ask my preceptors for as much guidance as possible. So I did that. I asked questions every day and I made sure I collaborated with her with each concern.

Then on my "last day" of orientation, I received another "unacceptable" reveiw of my PBDS.....at this point I didn't even know my first one was "unacceptable" but apparently it was. At this point, I asked what was going on and they said "We need to terminate your employment if you don't quit. It's due to not meeting job expectations." I had a feeling this was about to happen. I was very, very upset but at peace, too. I felt that there was so much wrong that at this time, the job didn't belong with me and I didn't belong with the job. I'm also feeling that their orientation was really poor but at that point, there was nothing much else I could do. So I talked to my old unit manager and was re-hired onto the floor as a casual call employee in skilled nursing.

It's really made me sit and reflect on where I want to go in nursing. I feel that often times critical thinking needs to develop and by doing that over time and experience, it can get better. So that's where I stand. I'm not full time, but I have SNF gave me a warm "re-welcome" if you will.

SO--having said all of that--what information can I get from any of you re: applying for jobs in the acute care setting? I have been working in long term care basically since I graduated with the exception of 3 months of med surg. What do I say in an interview and how do I address this issue with future employers? I am still very personally distraught about failing at my attempt at med surg but I feel that maybe the floor was a poor fit. Is there still hope

[MichelleRN34, ADN, RN]

Honesty is the best policy...Tell them the unit was not a good fit or something along those lines.

[military spouse]

Are you sure you want to work in an acute setting? It is 100% okay to not do it. I know, so often we are told to get that med/surg experience, and I do encourage it, but maybe you found out early that it isn't for you. I've worked in a few hospitals and I'm grateful for the experience and confidence it gave me, but I don't miss it and have no desire to go back. I'm not a hospital nurse and THAT IS OKAY!!!! I like corrections....I like hospice.....I like school nursing.....and so on!!

Just make sure you are really doing it because you WANT to and not because you think you should. There are GREAT nurses that are successful and happy outside of hospitals :)

[LTCnurse11]

The whole deal is that I know I'm interested in acute care and like the learning, but I'm not 100% the right time for me. I only was there 3 months and was burned out from nursing school and the EMT program right after. I really want to be sure I don't force myself into another mistake. I am feeling very upset about having been terminated and I think part of me wonders whether or not I'm cut out for it. I know I can do it. I just need more training or something. I also would like to have the option to further education by obtaining that benefit.

[DSkelton711]

LTCnurse11 said:

The whole deal is that I know I'm interested in acute care and like the learning, but I'm not 100% the right time for me. I only was there 3 months and was burned out from nursing school and the EMT program right after. I really want to be sure I don't force myself into another mistake. I am feeling very upset about having been terminated and I think part of me wonders whether or not I'm cut out for it. I know I can do it. I just need more training or something. I also would like to have the option to further education by obtaining that benefit.

My first job was ICU. Never did do med/surg. Although I feel that is the meat and potatoes of nursing I'm not sure I would have made it through it. With your EMT education and interest, maybe you should focus on ICU rather than floor nursing. Before you do anything though, really look deep into yourself and find out how you can improve. If you were constantly asking questions, more than "normal", then yes that could be a sign of lack of confidence and/or knowledge. It also drives people crazy. So while I think you should definitely ask questions, remember you made it through school and you should take an initiative to look up something and educate yourself. Think hard about what you really want to do. Good Luck.

[CapeCodMermaid, RN]

There is no rule that says you have to like med-surg. I've been a nurse for 30 years and never liked med-surg. I got a job in the hospital because it was expected that all nurses wanted to work in a hospital or they weren't 'real' nurses.I live in a place that has a high percentage of the population over the age of 80. The hospital there had no clue how to treat elders. I left the hospital after 4 months and went to work in a skilled facility. I love what I do. You'll find your niche.

[Esme12, ASN, BSN, RN]

LTCnurse11 said:

The whole deal is that I know I'm interested in acute care and like the learning, but I'm not 100% the right time for me. I only was there 3 months and was burned out from nursing school and the EMT program right after. I really want to be sure I don't force myself into another mistake. I am feeling very upset about having been terminated and I think part of me wonders whether or not I'm cut out for it. I know I can do it. I just need more training or something. I also would like to have the option to further education by obtaining that benefit.

I am curious.....what made you get your EMT right after school? What career path are you looking at?

You said you had up to 4 patients......unfortunately that isn't a lot of patients for a med-surg floor. I think you need to gain control of the basics before the next step. What was your struggle? My new grads have trouble with organization.....brain sheets.......here are a few.

5 Pt. Shift.doc

1 patient Float.doc

MTPMedSurg (2).doc

Report Sheet.doc

FinalGraduateShiftReport.doc

DAY SHEET 2 doc.doc

[LTCnurse11]

Esme 12: Thank you for your genuine response and your helpful sheets!!!!

I think my biggest struggle was the lack of confidence, the fear of harming a patient due to my lack of knowledge and experience level. My organization was not quite up to par. I felt as though I got distracted many times and found that once I got off track, I had difficulty pulling myself back to the list of high priority tasks. I am really trying to understand if this was something I could have avoided and corrected, or if this is part of my nature and I am unable to manage that type of environment successfully.

So you mentioned getting a handle on the basics. Do you mean things like prioritization, organization, confidence? Or nursing skills? If you have any suggestions for strengthening my knowledge base or skills. I'm all ears.

[LTCnurse11]

In response to why I chose EMT training, I wanted to maintain the "thinking on your feet" aspect of patient care. I do like my job as an EMT alot. There have been so many experiences I have had that have allowed me to use my critical thinking and assessment skills. Also I am able to work with a varied population with different health problems. It also has been helping me assemble the "whole picture" if you will since I have seen the ER side of care, the med surg side of care and also the skilled nursing part of care for the older population.

[jram88]

Hey just wondering if you tried to reapply to any med surg positions again and if so what did you tell the interviewer when they asked what happened or did u find that u like working at the snf

[LTCnurse11]

I did apply to another job and I was hired into an RN position in a cardiac stress lab--I really like it. The convenience of the day hours is great and I learn tons about cardiology. The problem is it's very routine and the critical thinking aspect is different than floor nursing. IM happy, don't get me wrong. There's just still a painful part of me that feels doesn't have closure about the whole med surg debacle. I've since resigned from the hospital I was employed at previously. And I wanted to clarify that I never got fired from the hospital however reassigned to my old unit. I've been there for a year now and they seem to like me a lot. Just earned an advanced EMT license--Really I'm in a good place. Still can't shake that med surg!!

[LadyFree28, BSN, LPN, RN]

\ said:

The whole deal is that I know I'm interested in acute care and like the learning but I'm not 100% the right time for me. I only was there 3 months and was burned out from nursing school and the EMT program right after. I really want to be sure I don't force myself into another mistake. I am feeling very upset about having been terminated and I think part of me wonders whether or not I'm cut out for it. I know I can do it. I just need more training or something. I also would like to have the option to further education by obtaining that benefit.

This post says it all; it may have not been the right time for you.

The thing about transitioning from LPN to RN is you have to go BACK to being a novice nurse ALL over AGAIN-the role expansion and the information from the new role and in a new setting can be a HUGE shock as well as a learning curve, at least it was for me; then add a new grad program that is transitioning, well, it was a miss for me, and I had a few (understatement here) components missing-I was simply NOT ready.

I think I wanted someone who was in my position to mentor me desperately, but I forgot the key issue that helped me shape my previous nursing years-me. I was nervous, felt like a fish out of water and had very song attributes that if I had my heckles down and a strong base before jumping into where I was (PICU), I would still be there...although That doesn't mean I can't succeed there, just at a different time and where I can see myself being there; it anywhere else in acute care; it is still possible and VERY early in my practice.

I currently work in LTC as a nursing supervisor-this job helped me hone the skills that I think I was lacking a year ago; I hope to be moving back to sub-acute/post-acute/step-down as a base FIRST, keep myself educated, and try again.

I suggest you try again; learn this year FIRST; it's rough! Get to know the "newness" of being an RN; it's even (slightly) different; the approach to pts; it's an evolved approach that comes with the territory.

Keep looking for other positions, as well as higher acuity patients at faculties; even if it's a LTACH perhaps.

Trust me, it gets better; just that your path to you goal has become more interesting.

Sending positive vibes on your success-you WILL get there!