Newer nurse hating cardiac stepdown. Where to go from here?

AxelNewRN86 · Jun 20, 2019

As a nurse that had to switch jobs after 5 months, I highly recommend you stick it out for a year. I had to leave a med surg floor due to low hours and needing better income so I could afford childcare. I switched to a med sur/ psych floor. I love my coworkers but honestly I feel so behind on my nursing skills. After I get in my year at my current employer I plan on transferring internally other to labor and delivery (where I feel passionate about) or to a more acute med surg floor to gain experience and skills in areas I feel I am lacking and need to gain confidence in. So from my personal experience, you should stick it out a year to help yourself in the long haul. It looks better on the resume and you are getting great experience. You are already half way done with a year. See if you can switch to nights since you said you like nights. And then at a year mark apply elsewhere internally.

hardworkpaysoff, MSN, RN · Jun 21, 2019

On 6/17/2019 at 9:21 AM, michigan94 said:
I’m veryoverwhelmed with how unstable these stepdown patients can be, the patients are very complex and have a lot going on besides just cardiac issues.

Please stick it out. Give it some time. It’s only been a few months. ^Doesn’t sound like ICU is a good fit at this time either.

Look at potential openings throughout the hospital to transfer to in about 6 months-year. That’ll give you something to look forward to but keep in mind that the grass isn’t always greener. It might take time to find a good fit. Nursing possibilities are endless.

You deserve to be happy in whatever you do but part of your burden is adjusting to a new role. It will take time. Best of luck!

allnurses Guide · Jun 24, 2019

On ‎6‎/‎17‎/‎2019 at 8:21 AM, michigan94 said:
Hello! I’m a fairly new nurse (graduated in December) and I’ve been working on a BUSY cardiac stepdown unit since January. I’ve been hating my job since I got off orientation and feeling like I don’t belong in nursing because of it so I really need some advice. I’m very overwhelmed with how unstable these stepdown patients can be, the patients are very complex and have a lot going on besides just cardiac issues. I work days and I hate the constant flow of people, the families, docs, social work etc. all wanting something from me every minute. Constant new admits as soon as I discharge. Never having time to take a break or use the restroom. I did my leadership in cardiac so I felt like I had a good understanding of the heart but I’ve realized I’m not interested in it and it’s not for me. Before graduating I was a CNA for 4 years on a neuro-surgical floor and I loved it, the main reason was my amazing coworkers but also enjoyed working with the CVA and surgical patients. Unfortunately when I graduated the hospital I was at was under a hiring freeze so I had to go elsewhere. I’m just really confused on where to go from here. I know staying a full year on this floor would be best but I am so miserable. I came really close to taking a job in psych but an experienced nurse gave me the advice to stay on the medical side being so new. I know that one thing that may make me happier is night shift. I’m also somewhat interested in ICU, I like the idea of focusing in on a lower number of patients and knowing everything that’s going on. L&D also interests me however I know that’s hard to get into. My question is does anyone have any other suggestions of specialities I may be happier in? I know the first year is rough for all new nurses, but I don’t think my dislike for my job only comes from being new. I know i’m getting great experience but I don’t want to ruin my attitude toward nursing. Wherever I go next I just want to be happy. Any suggestions would be greatly appreciated, thank you.

I do not mean this unkindly, but nobody thinks their dislike of their job is because they are new - and in truth, it isn't because you are "new", it is because it is humbling. Its busy. Its frantic at times and exhausting and anxiety provoking. It causes you to second-guess yourself, to be worried etc. It is so normal that people write books about it and your situation is textbook from what you have written here. Not until you get some experience with complex medical issues and recognize your own growth will you feel better. Changing specialties will make it worse most of the time.

Its impossible to know how far you have come until the next new batch of new grads start and suddenly you can see where you were versus where you are.

Work is just work. Remind yourself of that. One of the hardest things about nursing is how many people go into it seeking personal fulfillment. There will be moments of that, but there simply is not a job in existence that is going to give you happiness. Happiness is primarily an inside job - meaning its something you give to yourself. Seek out happiness outside of work. You will be more likely to find it in your work if you don't need it there, ironically enough.

I strongly recommend you stick this out for at least one year. The grass is not greener. ICU definitely is not easier.

Forest2 · Jun 24, 2019

I know the norm would be to stay for one year. On the other hand, there is work and there is unsafe work. Do you think it is just you or do you think it is the unit? Is the staffing unsafe for the level of acuity? Those are the things I would be asking. Not always do skilled and experienced nurses stay in a job and can handle it, sometimes it is the unit. AND appearances often don't tell the truth.

10yearsundermybelt · Jun 29, 2019

I’ve been there, thinking I was incompetent. I’ve been in nursing for 10 years. What I’ve learned is this: if you are feeling chronically overwhelmed and on the verge of quitting the profession for good, switch specialties. Cardiac step down is HARD, especially for a new nurse. In my opinion I think all nurses should start on med/surg. It will give you the knowledge and skills about almost everything nursing. From there you can fine tune your skills and choose a specialty that’s right for you. The complexity of cardiac, ICU, CVICU, etc, can be very overwhelming UNLESS you have a fabulous preceptor that’s willing to continue helping you. Right now I work in chemo infusion and love it. If I started out there, with all the chemos and biologics and side effects and ports I probably would’ve left, too. If you aren’t on a contract to stay there, try applying other places. Don’t give up on nursing. We need good nurses that care about their pts and feeling overwhelmed shows me you care about your pts and want to do everything right by them, you just lack the experience which will come in time. Hang in there!!

mommy_love8626 · Jun 30, 2019

Hey! I'm a new grad, actually just graduated in May about to start work next month. I'll be working nights on the unit I did my capstone at which is our Med-Surg/ICU step down unit. I know I haven't been working yet, but in my opinion if you could switch to nights and stay to get that "golden year" of experience would probably be in your best interest. I didn't want to start out on nights as I have two small children but I have been told that doing nights initially can be a great way to begin your practice as it typically isn't as overwhelming and you may have more time to grow and learn the best way to help your patients. ? the best of luck on your nursing career!!

GoWiththeFlowRN · Jul 1, 2019

"The patients are very complex and have a lot going on besides just cardiac issues. I work days and I hate the constant flow of people, the families, docs, social work etc. all wanting something from me every minute. Constant new admits as soon as I discharge. Never having time to take a break or use the restroom"

I doubt L&D would be a good fit then. It's critical care, you never know what's going to arrive on the unit. Woman have comorbidities too, requiring magnesium or insulin drips, or emergency c/sections NOW. You will most always get an admission if you have discharged one. The docs are all surgeons and can be real PIA dictators. Documentation is required usually every 15 mins once in active labor. At the minimum its hourly. The babies arent considered pts so you can possibly be responsible for all their charting and care post birth. You cannot quickly just go pee... you'll have to go get someone to agree to watch your patient while you pee. I wouldnt do anything else, but I like the intensity and do well under pressure.

I think taking shadowing shifts on various units would be beneficial to you to find a better fit. Now that you have been a nurse, you'll know the stuff to ask the nurse you shadow that matters to you (pace and complexity of unit seems to be your problems)

Good luck finding your niche, nursing is huge! You can even do case management or something not at the bedside, clinics etc.

llg, PhD, RN · Jul 1, 2019

You wrote that you thought a switch to the night shift might help you. Why not try that as a first step? Talk with your manager and tell her that you would prefer to work more night shifts -- that it would fit your personal schedule preferences better -- no need to give her a big explanation.

Give nights a try. That might help make your next few months more pleasant and "buy you" a few more months.

SarahRN2013 · Jul 2, 2019

Days on that type of unit can brutal constantly transferring or discharging to make room for admits from the cath lab means it never ends! Have you considered finishing out your year on nights? WAY easier. At most, one late cath lab patient who needs a radial band off or a line pulled. Rarely a discharge. Rarely more than one admission. Less family and interdisciplinary interactions. I love nights on cardiac stepdown. You couldn't pay me enough to work days on that unit!