New RN struggling with Critical Care needs to move on

[SpecialK38, ASN, RN]

Hello all-I just graduated in December of 2011 and got a job in a Long Term Acute Care Hospital (LTAC). I had my clinicals at a LTAC so figured I new what to expect and was excited to get hired in March of 2011. To my dismay, I have been completely overwhelmed and dropping balls left and right. I was on days so we had admits, discharges, doctor rounds with orders, PT, OT, procedures, etc. Our ratio is 4 patients- many of them vented. We have paper charting, tons of meds and a very high acuity level. I was just told today that I was not turning out to be a good fit for them. I had made a couple of med errors. (forgot to split a 5 mg lisinopril and didn't hold a coreg) plus giving meds before doing VS and a few bad judgement calls. No patients were harmed and my DON feels I could still do a good job in a less acute environment.The hospital system is going to help me transfer into another position in the next 30 days. I'm trying to not feel like a total and complete failure (almost straight A's in school and passed my NCLEX 1 week after graduating) and "getting back on the horse" So to speak. There is a position I have applied for- Ambulatory Surgery RN- PT days. Can anyone give me advice if this might be a good fit for me acuity wise? I have also applied to L&D- was a PCT in post-partum care and enjoyed that as well.

[HouTx, BSN, MSN, EdD]

I think it's great that your DON is working with you to find an area in which you can thrive. High acuity areas are very challenging, particularly for a new grad. I would advise you not to move into L&D until you are more experienced and confident in your own abilities. L&D is much different from post-partum, it can be very stressful due to the degree of urgency & extreme focus on defensive medicine that characterizes OB these days. They are not very 'forgiving' environments for new nurses.

The Ambulatory Surgery position would most likely be very good for you, however I would caution you about taking a PT position while you are still in 'learning' mode. It will not provide you with the same amount of opportunity that a FT position would, so it may take a lot longer to become confident.