New Nurse 1 year in...should I change floors?

[freespyryt]

I am a 23 year old nurse who has been working on a surgical oncology floor for my first year of nursing. It's a well-known hospital and we have patients from all over the world come for treatment. My floor, from what many others (float pool nurses, nurses floating from other floors) say, our floor is the hardest in the hospital due to the severe illnesses of our patients and the vast amount of technical knowledge we are expected to know (5 surgical teams, 2 medical teams all on our 30 bed unit).

When I started working, I knew oncology was where I wanted to be. I wanted the continuous personal relationships with my patients, to build bonds, to feel like I'm helping them, and to have some continuity I knew I wouldn't get in a regular medical-surgical unit. I LOVE my patients, but our floor is so, SO surgically oriented I'm severely lacking that interpersonal connection. While we do have many patients that we see as repeats, it's usually due to surgical complications, and we're so busy we have no time to sit and chit chat. Those rare nights I get the chance to really talk to a patient and their family are the best nights for me. I feel fulfilled. There is also a lack of support from doctors (mostly residents...) and many ethical issues I feel I face at work that I'm not entirely comfortable with.

I have the option to move to an entirely medical oncology floor (well, apply at least). While the prospect sounds AMAZING, I'm a little frightened. I've floated up there and know that it's definitely more laid back and the nurses get that 1:1 care I desire, I'm kind of stuck about leaving. Firstly, I'm scared the team won't be as good. Our crew on this floor helps each other, we're cohesive, and I've got my skill set far above my peers that have graduated and worked at other hospitals. I've worked with many more lines and drains than I thought I would, and I'm also a little nervous to lose those skills.

Additionally, I don't know what to say to my manager. While I'm happy at my job, I ultimately want to move into palliative care/hospice, because I feel like that's my calling, but I'm not ready to leave the hospital just yet and I feel like this transition makes sense, but we've had so many nurses leave our floor in the last year that I'm scared she might block me or feel the need to chat with me prior to letting me go.

I have no contract holding me here, 6/8 of the nurses I was hired with have left to go other places.

I'm just so torn.

TL;DR: I love my team, but want more time with my patients. Should I move to a calmer floor, or stick it out here a couple more years and move to hospice?

Any input would be helpful...I need some less biased input. I've heard so many varying opinions.

[Ruby Vee, BSN]

In general, a new nurse ought to stay at least two years at her first job. You're only just becoming competent after one year, and your manager deserves to get some good out of the new nurse she hired! It takes two years to really learn your unit.

Since you're torn between wanting to leave, and wanting to stay, I'd advise you stay another year. You like the place, the teamwork and the team. Stay. The medical oncology unit will still be there in another year, only by then you'll be in a position to take your skills with you. Good luck! I loved oncology when I did it.

[turnforthenurse, MSN, NP]

Do you have the option to float to the other floor you are considering? If you're able to float and work a few shifts there, it may give you an idea on how the unit runs, how the nurses are and if you will like it, etc.

[MattNurse, MSN, RN]

I would move on to the next unit. Sounds like you have already talked yourself into moving.

[engjacques]

The first year you are only learning the basics, and it is a lot. If your positives outway the negatives of maybe giving it another year I think you shouls stay, Maybe think about moving after a couple of years. Volunteer to float to Med Onc when they needspmebody rather than just take your turn.

If pallitive care will remain your goal, then working med onc a couple of years prior would be good - your goals may change as mine have several times in my 14 year nursing.

Best of luck in your choices

[KountryPrincess]

I would move to med onc. That is the type of floor I started on as a student for a year and then as an RN for the next five years. I loved it, and you will probably find a great group of nurses up there. On my floor we were very supportive of each other emotionally, because med Onc can break your heart when you do get those close relationships with your pts. You will continue your education and get proficent in chemo administration and teaching. I would go for it, sounds like that is where you wanted to be in the first place.

[freespyryt]

Sorry, it's been a while since I posted. I wanted to elaborate more on this since some more problems have arisen.

Over the last year I've been in a very tumultuous state. I started out loving my floor. It was challenging, but the population was good. Then, within the first month, my boss started calling me into her office constantly to talk about things (issues I was having apparently?) Obviously some of them were relevant but I learned quickly to ask for help and to learn from my mistakes. However, she'd call me in without looking at my charting to investigate issues (patient complained about pain control and I had charted the pain level, interventions and patient response and had checked on him frequently and he indicated the control was adequate), but instead of looking at my charting, she called me in and made a huge deal of it. Since then it seemed like there were constant things she needed to talk to me about, even though all my coworkers (from day AND night shift) said I was a fantastic nurse and that I was far above the level of a normal new grad, and the charge nurses indicated that they trusted me with the hardest patients on the floor.

I talked to some of the other nurses and apparently this is a common issue on the floor. She targets people, especially people who don't do well standing up for themselves (which admittedly I have a problem doing, I'm a bit of a people-pleaser) and then she undermines their confidence and calls them in for issues that aren't necessarily the most important things. She won't order us sitters because they're expensive, so instead she wants us to try restraints and medications first, which partially I feel is okay to try medications to calm patients down first, but restraints over a sitter seems morally bankrupt and ehtically I have a very hard time dealing with that, and on our floor a lot of patients have head and neck surgeries and have a trach and often are delirious, so if we restrain them and lose their airway, they couldn't call at all! I've brought that up but she says sitters don't reduce the chance of falls.

I recently had a fall of an ENT patient. It was his second fall in the hospital (not on my watch) but when I called and asked for a sitter (since we have to call her to get approval, doctor orders don't matter) she said "Day shift could handle him, why couldn't you?!" I was about in tears! I had just had a fall, and ended up having to spend the rest of the shift sitting in the patient room, luckily my other two patients were comfort care so I only needed someone else to sit in the room once an hour to check on them, but it seems so unsafe, and this has been going on since she became manager with other nurses. I talked to her one morning and thought that was the end of it, but then I get an e-mail calling me into her office the next week and to fill out this learning debrief etc. and have it ready to talk about in the meeting. We are union and technically no-fault falls are the standard. I was so shaken up I couldn't eat or sleep because every time I talk with her I leave feeling inadequate and like I'm a terrible nurse, and like I can do nothing right. I know this is a huge rant, but multiple complaints have been made about my manager and nothing has happened and I feel like I'm so stuck and have nowhere else to go. Who can I talk to? She said she couldn't recommend me for the job on the other floor given my fall and she felt I needed to stay put and work on these issues. I feel so helpless. I'm depressed, I don't have energy to do anything, and I'm about ready to just leave nursing and start a bakery or something. My boyfriend says he doesn't even remember the last time he heard me laugh. I just want to enjoy my job and feel like I'm a good nurse, and my coworkers all tell me I am, and they tell me repeatedly that I should just brush it off...but I feel like I can't. I've seen a therapist (at the beginning of my job) to deal with these issues and they were better for a time, but my therapist moved and the issues are coming back. Her undermining me makes me more nervous to do my job and I feel like I'm checking myself a dozen times just because I'm scared of having to deal with her again.

I feel sick going to work, I can't sleep and I'm super jittery when I see her. I've even changed my shift to working Fri-Sun nights so I only have to see her Monday mornings because the thought of saying hi to her every morning makes me feel terrified.

Sorry, again, for the rant. I'm just so lost and discouraged. Any advice would be great.

[Yourfriend2]

I'm so sorry to hear you are going through tough times. I'll pray for you.

[Daisy_08, BSN, RN]

Being blamed for a fall is rediculous unless you've done somthing truly unsafe. I think you do need to try and bush it off. Leave work at work. Easier said then done. I'd try for the other job for sure. Do you really need this managers blessing? Can a senior nurse give you a reference? Also if you have a union can they really stop you from getting the job?