non-clinical nursing?

kiddoRN · Jul 8, 2003

What about working in a different area of nursing such as a doctors office, school nurse or employee health (occupational nursing). Many of the larger manufacturing facilities have on site medical teams. School systems are in high need of nurses. The doctors office is a good place to be with no nights, weekends or holidays to work.

James Huffman · Jul 8, 2003

Joy, I wonder if you are selling yourself short. Just because you were unable to handle the load at first doesn't mean you are incapable of doing it. I wonder if you have convinced yourself that you are not able to do clinical nursing, when the problem may be elsewhere. Could it be that you have troubles with organization, goal-setting, or planning? I'm certainly not saying you should be in a clinical setting, but I would hate to see you (or anyone else) avoiding clinical work because of what may be secondary issues.

You have discovered that most positions require some minimum of successful clinical practice. I think this is because general clinical nursing allows us to bring together many of the theoretical skills we have learned. (It's one of the reasons I'm a big believer in one to two years of med-surg practice before going to other, more specialized fields). I think that many positions are going to be wary of hiring you if you have a spotty track record in clinical settings.

Have you considered speaking with a trusted nurse confidante (maybe a former teacher or someone of that nature) about your problems? Such a person might be able to point out things that you are not seeing, and give you advice that might help the situation.

Good luck, and, again, don't sell yourself short. Lots of folks have difficulty with the transition from school to practice, and especially with finding the niche they best fit in. Don't feel like you're alone -- use the resources you have, and find where your particular skills and talents can best be used -- for yourself, for consumers, and for nursing as a professional field.

Jim Huffman, RN

http://www.NetworkforNurses.com

jjjoy, LPN · Jul 8, 2003

Medical assistants are much more common in doctors offices. If they need an RN it's usually because they do outpatient procedures and, they often want a nurse with hospital experience who has dealt with codes, can start IVs in any vein and has a second sense in patient assessment. I will keep my eyes open but have seen VERY few job listings for RNs in doctors offices.

I did look into school nursing and occupational health nursing while still in school. At that time, I didn't feel like a nurse and in those jobs you are "the nurse." After a few months of working as a nurse full-time, even just on orientation, I do feel more like a nurse. While I had a hard time handling the pace and distractions, I'm much more comfortable with my skills and more confident in my knowledge than I was just after graduation. So maybe it's a good time to look into those areas again. But how much are these kinds of nurses expected to know about dealing with emergent situations? Is the occ hlth nurse expected to recognize if a worker complaining of chest pain is having a heart attack? Is the school nurse expected to recognize if a child is going into insulin shock? I have the textbook symptoms down, but I've never witnessed these events before.

For me to be successful in a clinical setting, it would have to be pretty low stress - that is possible to get everything done in the given time period. Of course, there are good days and bad days, but in many places the expectations seem next to impossible to meet even on good days. And, again, I don't want to be the only RN on shift. I'm not confident I'd recognize a pt "going bad" soon enough and quickly take necessary actions.

Brita01 · Jul 8, 2003

What kinds of clinical settings have you already worked in? Med/Surg? Med/Surg is extremely busy. If you still need acute care experience, you may want to try long term acute care. You will use your med/surg skills, but there is less running around putting out fires because these patients are a little more stable. There is usually more wound care in this setting. And you'll also get ventilator experience. Another area to consider would be a SNF unit in a hospital. You use your skills and there is less running. You will probably be responsible for more patients, a lot needing total care. And the paperwork is heavy on admits. One or two years at either of these jobs should give you enough experience to go out and try a little more independent nursing. Such as home health, occupational or school nursing. Good luck.

jjjoy, LPN · Jul 8, 2003

"Could it be that you have troubles with organization, goal-setting, or planning?"

It could very well be. But how to work on it? I need time to organize and plan, and there's just not that much time available when working. I'd come in early to try to get some extra time preparing and planning. Of course, oftentimes the assignment changes so you can't plan ahead.

It seemed like there was never time to do everything. If I checked for new orders, I didn't get the meds passed on time. If I passed the meds on time, the new orders weren't taken off in a timely manner. I wrote lists, made check off forms to try to make sure I didn't miss anything, tried to plan ahead, but there's always something new, something else that needs to be done now - a new admit, a request for pain meds, someone vomiting, a high temp, doctor on the phone, etc. Planning and organzing can only get you so far.

Goal-setting. Do you mean in terms of what to accomplish each day during orientation? Giving all meds for a certain number of pts? Try to get certain procedures on the checklist done? Do all assessments and charting? Whatever I'm working on, generally the orienting RN is busy doing everything else and must be found to ask questions to and so everything I do takes that much longer. And the orienting nurse gets annoyed at the frequent interruptions from me, but if I just plow along, "saving up" my questions (like for an hour, not a whole shift), I'd end up with several things being quite behind schedule because "going back" and doing things takes even more time. If the preceptor tells me to go it on my own for awhile and comes back to find me far behind schedule, she wonders at how I could "let" everything get so backed up.

Again, there's no time during the shift to sit down and discuss what you did when and why and how else you could've handled it. By the end of 12 hours, I'd be kind of fuzzy on the details of my day. I could sit down, review my notes, recall certain choices... but I need some quiet and calm to gather my thoughts like that. None of that til at least 30 minutes after the shift is over.

I am a thinker. An analyzer. And much of nursing is action. Of course, there's reason for that action, but there's often not the time to fully process the whole line of reasoning. You need to get from A to C quickly without spending time pondering B and it's relationship to A and C.

Thanks for your thoughtful responses! I'm still working through why I had such a hard time and what do now. Like looking at those 3-D "hidden" pictures - sometimes you just can't see something even though you're looking hard.

jjjoy, LPN · Jul 8, 2003

I worked on busy med/surg floor. And at busy LTC facility. Are there any environments in acute or sub-acute that aren't crazy busy? Where you can go home on time on a good day? It's not that I care about getting off right on time, it's just if the experienced nurses aren't getting everything done on time, I sure as heck won't!

Brita01 · Jul 8, 2003

Some of the SNF facilities I've worked at inside of hospitals were very nice and not too busy. 12 to 13 patients on the whole unit with two nurses.

ceecel.dee, MSN, RN · Jul 8, 2003

How about an assisted living residential home? We have one near here with 20 residents, very minimal skilled care, but the need for an RN overseer to take Dr.'s orders, transcribe those orders, do care plans, and basically manage the "shop". Patients are obviously there a long time so care planning is something that needs updating every 90 days and you supervise the CNA's and LPN's who do the patient care. Much slower pace, but not for dummies. Time to actually engage with the residents!

llg, PhD, RN · Jul 8, 2003

We have a unit in the children's hospital where I work that often works well for people in your situation. It's a long-term care unit for children with respiratory problems. They can't be cared for at home yet, but they are fairly stable and not much changes from day-to-day. Because they see the same patients day after day and get used to their routines, there is not as much "new information" each day for a new nurse to cope with.

Perhaps you can find a unit similar to that.

Also, it sounds as if you weren't getting a very good orientation. You mentioned that you would have to go find the "orientation nurse." A new grad need a preceptor who shares a 1-nurse assignment with the orientee -- so that the orientee and the preceptor are working together, side-by-side on an assignment that is appropriate for one nurse to handle by herself. The preceptor only leaves the orientee "unattended" when the orientee is ready for that greater independence.

In other words, it sounds if you may have been "cut loose" way too early. Are there any hospitals in your area that offer orientation programs that are specifically geared for new grads? ... or perhaps has a new grad residency program?

llg

jjjoy, LPN · Jul 9, 2003

I guess I've just gotta keep looking. The assisted living I checked out locally had one RN for about 80 residents with a couple of LVNs to pass medications. I checked out a ventilator weaning unit on the advice of another nurse who figured the patients were pretty stable, but the manager there discouraged new grads from applying. There are so many different facilities and arrangements out there. I guess I've just got to check them out one by one.

My preceptor did share just one assignment with me. It's just if I were doing something, she'd usually start doing something else. If I were passing meds, she'd disappear to help other nurses, take care of incidentals, etc. At that point, I did need to be working more independently; I just needed her to be more readily available. I got the feeling that my needing to ask so many questions was a problem in and of itself. That while I was new and questions were good, I wasn't following the usual progression of a successful new grad.

In the hospital, my biggest weakness was assessments. Until I've seen a definitive symptom first hand, I'm not sure if I will know it when I see it. So for any slightly abnormal symptom - abdomen a little distended, complaint of some nausea, headache, I'd be checking with the nurse. Is that normal in these cases? What would abnormal be? Was it noted by the previous shift? Is this something I need to point out to the next shift?

In LTC, I just couldn't get all of the medication passed out in the time period. Not even close! And of course, there were lots of other things that needed to be done as well. I couldn't figure out how anyone else did it. I tried and was terribly behind. I wanted to see how they managed to do it all. I'd ask to just watch, but they'd push me to do it myself. "You don't learn by watching. You learn by doing!" Except I couldn't seem to get it all done.

I never had such trouble just getting by in a job before. I pick up on the systems very quickly and know all that I'm SUPPOSED to do. I just can't seem to do it all fast enough and keep it all straight without sitting down and making a neat list. Very frustrating.

MelRN13 · Jul 9, 2003

I think that you are selling yourself short. Things in the "real" world are so much different than those in the "school" world. If you ask anyone here when the last time they did an assessment the way they were taught in school, the answer would be :confused: "I really can't remember." When I assess, I focus on the "presenting" problem, not the 15 page assessment I was taught to do.

I don't really think that nursing schools prepare us for the "real" world as well as they could. How often in clinicals did you have more than three patients? And you always had someone to back you up.

I think that your preceptor really did a diservice to you and was not there in the sense that she needed to be for you.

Have you thought at applying at a different hospital or in a different department? Maybe if you had the chance to have a devoted preceptor, you would think differently about this situation.

Whatever you decide, I wish the best of luck to you.