Mojojojo05

A (not so) little background: I graduated back in May 2016 and started working at a Level 1 trauma center. I spent 2 years on a Stepdown PCCU/tele unit, then proceeded to transfer to the endoscopy department where I spent another 2 years. Around my 4 year anniversary of being a nurse I started considering travel nursing for endoscopy, but then Covid-19 really started ramping up in my area. I found out that anyone with heart center/tele experience in our facility was eventually going to be “temporarily” reallocated to help boost the number of bedside nurses. While my endoscopy nurse manager told me they were arguing to keep me from being reallocated, elective cases had taken such a nose dive that we really didn’t have the workload compared to pre covid. It was around this time I noticed that the CVICU had an opening, and since I figured I would be pulled back to the heart center eventually anyways, I applied thinking I might as well get some critical care experience out of it. And boy did I ever get experience. I was put on night shift where it was mostly comprised of new graduate nurses. 4 months after starting was the first time I walked in one night to find that everyone else working that night had 6 months of experience or less, an occurrence that became increasingly common as time went on. Despite the fact that I was new to critical care as well, the fact that I wasn’t a new grad meant that I was often charge and/or given harder assignments because they “didn’t feel comfortable with a new nurse” having certain patients. In the end, I stuck it out for a year, getting experience with fresh post op hearts, vascular surgeries, EKOS, ECMO (covid and non-covid), ext. When Covid peaked with delta and everything went to hell, we stopped being just a CV-ICU and started taking care of just about every ICU type patient, since we were over crowded and they were just putting critical care patients wherever they could find a bed. Towards the end of August, I made the decision to move back to my hometown to help deal with some family issues that had arisen during the past year. I left my level 1 trauma center and transferred to a much smaller level 3 facility. After spending a year on nights in the ICU with a gaggle of new grads, I’m not gonna lie, I was stressed and looking for a little bit of a break. So I turned down a bigger sign on bonus to work at the new place’s CVICU and instead accepted a position in the PACU for days. I accepted the position as 9am-7pm four days a week, one overnight call/week and 1-2 weekend calls per 6 weeks. Almost immediately after starting, changes started being made. It was gradual at first. It started with backing my hours up to 8a-6p. Then it was moving away from doing 4 10hr shifts and alternating weeks of doing 4 10hrs and the next doing 3 12hrs. Which wouldn’t be so bad, except the hospital, like everywhere else in the nation, is absolutely over capacity. So being on call has often turned into holding patients for hours on end or even overnight on account of there being no beds/bedside nurses to staff them. So, my 40hr/week job that I originally thought I was getting has routinely turned 50-60hrs/week. Another issue is about a month after starting, they started making me be PACU charge. In the beginning, it was only in the afternoon after the regular charge went home at 2-4pm. The charge nurse/supervisor (the former supervisor who hired me quit a few weeks before I started) sat me down one day and asked if I was comfortable being charge more frequently. I was honest with her and told her that since I had literally just started the month prior, I wasn’t ready to be a regular charge. She told me she understood and that I would only be a backup charge when either she or two other more experienced PACU nurses weren’t working or had to leave early. That has also not panned out. One of the other “regular” charge nurses works primarily weekends, with 1-2 weekday shifts depending on the weeks. And the other one has now decided she will be quitting to do travel nursing in the near future. So most days, it’s either me or the main charge, which means I often have to come in early at 6-7am to fill staffing needs. The main charge nurse will be going out on maternity leave soon, and will be out for 3 months. So this past week it was announced that when she goes out, I will be the only charge nurse 4 days a week. Which means I will have to come in at 6am most days, since when the main charge and the one that wants to travel are gone we won’t have any early nurses. The problem with that is just because I come in early doesn’t mean I get to leave early, and I often wind up working 1-2 hours over due to late cases/ not enough PACU nurses. To meet staffing needs on the weekends, our department management wants us to start taking back up call on additional weekends for when the first call team calls out sick or they get overwhelmed with cases/holding patients. So that’s an additional 1-2 weekends out of every 6 weeks I would at least have to be on standby for the hospital. I want to be very clear, I don’t necessarily blame the unit itself. I know hospitals all over the country are struggling with staffing crisis and nothing is guaranteed. I also know that no matter where I go, it’s going to be stressful and being adaptable is a must. The main charge and department supervisor have been very nice and are also available if I’m in charge and have questions or concerns. Having said that, I took a significant pay cut to come to this hospital and their PACU, not including the lower sign on bonus I accepted because the hours and less stress were worth it to me at the time. Plus, I was originally OK working in a smaller town and hospital hoping I would have a better work life balance. Now my hours are all over the place and my stress level is often through the roof dealing with being in charge, short staffing, hospital overcrowding, ICU/floor holds, etc. I don’t think it will be better anywhere else in health care, but if I’m going to be stressed out, I might as well get to travel and make significantly more money and have the ability to take time off between contracts. I’m also aware that I don’t have enough experience to travel as a PACU nurse, and I’m OK with doing contracts for bedside. My family and friends are pressuring me to go ahead and put in my notice, but I’m struggling because I know this unit has already made plans for me to be in charge when the current one goes out on maternity leave. On the other hand, I’m really not looking forward to doing another 5 months or more, especially since I never wanted to be in a supervisor roll to begin with. How bad will it be if I put in my notice and finish out the schedule that just came out, which ends mid February? How do I explain to my higher ups in way that doesn’t completely burn bridges that I’m leaving? Is there even a way to do that? If you’ve made it to the end of this extremely too long post/rant, thanks in advance for any advice or reality checks.

Traveling has always been something I've wanted to do, and with my four year anniversary of graduating nursing school coming up it feels like the right time to try something new. In the past four years, I spent the first 2 on a cardiac stepdown/PCU floor. The last 2 have in endoscopy (I have a longer post detailing everything we do and what I've learned there) In my first 6 months in Endo we had 2 different travel nurses come through, though we haven't had any since then. So while they might not be as common as other specialties, I know they exist.? What are some good introduction material for travel nursing? Any advice for a newbie? I realize that the process will likely take time, so where do I even start? Thanks in advance!

Oh boy, sorry to be so late replying to your post! So I did get the position! This June will make 2 years in Endoscopy, and if I could go back in time I would tell myself I had no idea what I was getting myself into, both in a good and a bad way. First of all, it confirmed something that I had suspected for a long time: that I personally prefer working in an intraoperative area compared to a bedside setting. While bedside nursing in incredibly rewarding in its own right, it is also incredibly exhausting both mentally and physically. The result was that after two years I had come dangerously close to burning out and desperately needed a change. Compared to 12 hour shifts with the same patients and family members, my day is now filled with short periods with numerous patients. Our time together is limited by the specific goal of the procedure we're doing, be it a screening colonoscopy or an EGD with control of bleeding. On one hand, you don't get to develop the same relationship with patients that you would on the floor. On the other hand, if a patient or their family is, shall we say difficult, then your interactions are kept restricted to their procedures. The procedures are the best thing about Endo. I'm a very hands on person and I've learned so much in the past two years working directly with the GI docs, pulmonologists, and general surgeons. A common misconception about Endo is that it's only "Butts and guts". Since we're a level 1 trauma center, I've gotten exposed to a variety of procedures and cases. In addition to standard colonoscopies, EGDs, and bronchoscopies, we also do numerous different specialty procedures. The most common specialty procedures we do are ERCPs, which we use to treat obstructions of the common bile and (to a lesser extent) pancreatic ducts. At our facility, these are done under general anesthesia in a special cysto room in the OR. The type of patients undergoing ERCPs can range from relatively healthy young adults needing a simple stone extraction to a severely ill person who's gone septic from cholangitis. Other specialty procedures include EUS, EBUS, and Navigational Bronchs. Of those three, different nurses in our department are trained to do them and become a sort of "team" for those procedures. I've been trained to do EBUS and Nav. Bronchs (both of which have to be done in the main OR) and have had some training with EUS (which is either done in the cysto room or the endo unit), which I hope to finish learning soon. We do both outpatient and inpatient procedures. With outpatients, these tend to do routine screenings or interventions like esophageal dilatations and therapeutic bronchs. Inpatients are obviously sicker and include acute GI bleeds, cholangitis, respiratory exacerbations, and other issues. This is where I feel like we really get to flex our nursing muscles, considering their current illnesses and what we're going to do to fix it. Sometimes we place endoclips, sometimes we cauterize, and other time we do multiple treatments. Sometimes it works and we get to feel really good about helping someone, and other times I've had some scary situations with really sick people. The way we do call is different from how it was done on the floor. My old unit did call for an entire 12 hour shift meaning I would be called in for call outs and short staffing (and occasionally for high patient volume to staff overflow areas in other areas of he Heart Center, such as during the height of cold and flu season). For my call days in endo, I show up for my scheduled shift as normal and stay until all cases are done. Sometimes we finish early/on time, other times we get stuck pretty late. The latest I've ever had to stay was 2100 (usually I leave at 1600). After we leave, we're on call until 0700 the next day. If an emergency case comes in during the night, like a bleed or a foreign body, we have to come in and work the case. Then when report for our shift the next day and a different person takes over call. We also take weekend call from Friday to Monday morning, coming in if the Baylor team needs help or calls out. In addition to this, we have late stay days, where one of the room nurses stays on the unit with the call nurse until all cases are done, and then gets to go home. Unlike the call nurse, the late stay nurse does not have to come back overnight for emergent cases. The good part of call: it's not based on staffing. I get called in when a patient urgently needs me. Also, once we finish our case, my tech and I get to leave and go back home. The average time I spend at the hospital when I get called in is about 2 hours. The bad part of call: it SUCKS having to work a long shift all day, having to come in overnight, and then get up and come to work as normal. Also, while there is the potential for overtime, they are so serious about maintaining "productivity" that they usually send you home early on your regular days to avoid having to pay you for your extra work. Instead of working 12 hrs shifts, my official schedule is 0730-1600 M-F. Most of us work 5 days a week, excluding 2 10hrs nurses and Baylor nurse and tech. The pros to this are getting my weekends back, since I was a Baylor on the floor. While a more regular schedule has been so nice, I REALLY miss having extra days off during the week. I've burned through so much more PTO in the past two years. Also, while at first my schedule looks more consistent, between call, late stay days, getting sent home early when I have overtime, and having to stay late for various reason on non-call days, the reality is that my schedule is all over the place. Also, because they aggressively send people home or call them off for OT, there are plenty of days the rest of us wind up being there late because the volume of patients requires more people. While I love getting to directly work with the docs to help patients, especially the inpatients with acute issues, its hard to simply see them go after we're done. I do occasionally miss the follow up with them, and there are times that I find it difficult to only focus on the issue we're dealing with at the moment (ie the bleed or the cholangitis). Sometimes I miss getting to be apart of their overall care and thinking about the patient as a whole instead of a single body system at a time. There are no perfect jobs in any professions, and there will pros and cons to any position taken as a nurse. On the floor, it was the every increasingly sick patient population and amount of time consuming charting. In a peri-operative areas, there's the all important schedule and pressure to stay on time despite schedulers cramming as many cases in as they can even when the times are literally impossible. I've had them schedule cases in endo and downstairs in the main OR 15 minutes apart (or even at the same time) with the same doc. So while my tech, doctor, and I are working as hard and as fast as safely possible, we're often hounded by our charge nurse and the OR to hurry and rush. This creates a lot of friction and conflict from those of us working in the rooms and those that manage the flow of the units. Because while we understand the importance of staying on time, the reality is the case takes as long as it takes and it's our duty to make sure the patient and their safety comes first, not the schedule. Overall, I've been happy with my decision to move to endo. Whenever I get frustrated with call or having to rotate through preop or recovery (something all the room nurses have to do), I remind myself how much more unhappy and stressed I was on the floor. Since we do both moderate sedation and cases with anesthesia, I've gotten the chance to spend a lot of time with the CRNAs. If I were to ever go back to school, that's what I definitely want to do. It would mean going to the ICU for a few years, which would also satisfy my wanting to be more involved with the overall care of the patient. WHOOO! Now I'm tired from writing all this. Hope it was helpful, because I need to get in bed and get ready for my call day tomorrow.

Hi all, this is my first post to Allnurses! I've just finished two years on my current floor, which is also my first job out of nursing school. We're a 32 bed PCCU/step down telemetry unit, so lots of heart caths, ablations, pacemakers, afib RVRs on drips, respiratory distress, and other, non-cardiac patients. This past Tuesday with got our first TAVR patient that came straight to us instead of going to critical care first. While I have loved working on my floor, I'm ready for a change. Yesterday I interviewed for a position in our hospital's endoscopy department, and today I came back to shadow for about four hours. I loved the flow of the unit and the procedures I got to watch and am really excited at the prospect of this job. My question is this: should I be lucky enough to get this position, what can I do to better prepare myself for the transition from the Heart Center to Endoscopy? I know there will be tons of learning during orientation, but is there anything I could start reviewing ahead of time? Also, while I expressed my thanks multiple times today for my interview yesterday and letting me shadow today, would it be overkill to send a thank you email basically saying the same thing? Like this: "I just wanted to thank you again for not only meeting with me yesterday, but also for taking the time to let me shadow today. I really enjoyed getting to observe the flow of the unit and had a great time with ***. Hope you all have a nice weekend" Thanks!