m0ckingbird

My thoughts...I don't know your age, but I do know that sticking around at one job for longer periods of time, even if you become unhappy there is more common with previous generations. It's much more common now for people to hop around to various jobs, I think. I also know lots of nurses that do this that are not bipolar. Maybe you would enjoy doing contracts or being a travel nurse. Some people really like change or else they get bored. I would ask yourself if you find you are making the decision to move when you are in a manic phase or maybe just because you want a change. Nursing is stressful and burnout is very common. Our work environments can be unhealthy. Change might be a form of trying to take care of yourself for some people. Talking these things through with a therapist could help. There is also a book I recommend called Trauma Stewardship that talked about people in caring positions leaving their jobs that gave me some insight. Be forgiving of yourself. I feel like our society and capitalism puts a lot of pressure on us to do right by our employer, but you should do right by yourself.

I work in a teaching hospital and every month or so our fellows and residents change. However, the fellows we have this time scare me, and I'm afraid that something is going to go wrong. I have been in the cardiac ICU for one year. I worked three years in CT stepdown before that. I have been charge on both units, and I'm a new charge in CICU. I work with advanced devices, but some of them are still new for me like impellas and balloon pumps. I can give many of our newer doctors ideas and advice to help patients such as drips, sedation and weaning ventilators. But, there are other areas I'm not trained in such as acting as a CVAD nurse. We usually have a CVAD nurse we call to the unit for line placement. We are very understaffed now, and yesterday there was no CVAD nurse in the hospital. I had a patient with possible bacteremia and they wanted to remove a femoral iHD line that had been in for 2 days and place a new iHD in his right jugular. They came to tell me that the CVAD nurse was unavailable, so I should assist them. I don't normally do that. I set up the room and got the checklist. My charge nurse handed me an iHD trialysis line and I brought it to the room. I felt rushed and I gathered equipment quickly. I reminded them to wash their hands and asked them if they scrubbed the site for 2 minutes. I had them do a time out. I felt like I was doing all the things that should be done. The patient was scared and I gave him fentanyl and ativan to relax him. He spoke Spanish and we had a translator on a phone. The doctors started to place the line and then dilated the jugular vein. Then they pulled out the iHD cath and said "this looks long, how far should I put it in?" I'm thinking- how the hell should I know you are the doctor. Then they said he seems to be having a lot of bleeding. I realized then they had never asked me to stop the heparin drip. I told them about the heparin and I stopped it with a verbal. I felt awful that I should have reminded them about the drip and not let them start a procedure yet. I was rushing to do something new and it slipped my mind. I started to get very scared that this was taking a turn. I called the CVAD nurse repeatedly and got an answer eventually from an ICU transport nurse who was busy but covering and I asked their question about insertion and catheter length and they told me it was the wrong length. This was for a femoral line. I called the more experienced CN IV for help and we started calling other units that carry a 15cm line. I started to feel panicky that the doctors didn't know the right catheters or steps. They were working very slowly and had made two attempts to find the IJ. They didn't look adept at the procedure. I called the attending and said I think he needs to come. A few physicians showed up and started watching them. We got a new line to them. Then the physicians had to tell the fellow and resident each step to do this correctly. They looked like they didn't know what they were doing completely. I pulled heparin locks, but they kept asking me what strength was needed. They had the pharmacists try to figure out the strength and they said they didn't know. I talked to several nurses on the unit and then chose the heparin strength. Still no written orders for this and doctors asking me what strength to use. This whole situation was terrifying me and I felt like it was all out of order. We finished the procedure and I tried to take a break at 3 p.m. and they were like, let's pull out the other iHD line. I told them the other doctor just had me restart the heparin and I needed to eat lunch and see my other patient. They waited for me to come back and tell them when I was ready. But I was really on edge and I felt like I didn't trust them. The more experienced physicians stayed on the unit for a few more hours while they tried to place lines in other rooms and took twice as long as it should take in patients that were decompensating. I repeatedly asked for orders to match the verbals they gave me in which they had me override medications to adequately sedate the patient ativan and fentanyl. All these steps put me in liability and risk and it's become very routine on our unit. We're always rushed and told to get things now, they will write orders later. Our heparin drip, I was told later, should be discontinued when paused per joint commission and then reordered. I just don't know what to do. I have this terrible fear that something will go wrong and the nurses are having to babysit the doctors. But, I know I don't know enough to do that in every circumstance.

So I'm a new grad nurse and I am looking for some advice on the direction I am going, because I'm feeling a little uneasy about some of the choices I have made and whether they are helpful for me in the long run. I finished my ADN and took the first job I was offered, at a small rural hospital, after I was turned down by the first three jobs I interviewed for. I live in an area that has lots of big teaching hospitals, but none of them hired me. Most of the other students I knew had NA jobs already and got jobs in those hospitals, but I had done food service work through school. I think my lack of nurse work on my resume was a big factor in that. So I'm almost done with my orientation at this small country hospital. It's been kind of disorganized and it seems like they are inventing this orientation program for us and testing it out with us. It's 10 weeks and I feel like I'm being rushed off of orientation while the people in ICU and ED get longer orientations than I. They say I am doing great, but I am nervous about being able to do everything that is expected of me. Their census is very low currently, so I only take care of maybe 3 patients at a time right now. The med surg floor is staffed almost entirely by travel nurses who talk about leaving and not renewing their contracts. There is no charge nurse. There is very rarely a nursing assistant on staff. Some of the travel nurses have been very disgruntled there and outspoken about low satisfaction scores since they were taken over by a private corporation and the full time nurses all left. I'm just worried I've joined onto a sinking ship, and that I won't have mentorship there. I'm wondering if I should keep applying for jobs at bigger hospitals. I never thought I would do med-surg I thought I would do ED or labor and delivery, but it's very difficult to get new grad positions in those fields unless you had a preceptorship in them. I'm feeling a little restless and worried that maybe I should have stayed unemployed longer to look for "the right" nursing job at a bigger hospital with more resources. I've seen nurses cut a lot of corners there and sometimes it feels like no one is steering the ship or watching what is going on there. Is it disloyal for me to apply to other places while I work there? Is it ok to explore other options or does that look bad to other orientation programs? Thanks for any advice.

So I'm a new grad nurse and I am looking for some advice on the direction I am going, because I'm feeling a little uneasy about some of the choices I have made and whether they are helpful for me in the long run. I finished my ADN and took the first job I was offered, at a small rural hospital, after I was turned down by the first three jobs I interviewed for. I live in an area that has lots of big teaching hospitals, but none of them hired me. Most of the other students I knew had NA jobs already and got jobs in those hospitals, but I had done food service work through school. I think my lack of nurse work on my resume was a big factor in that. So I'm almost done with my orientation at this small country hospital. It's been kind of disorganized and it seems like they are inventing this orientation program for us and testing it out with us. It's 10 weeks and I feel like I'm being rushed off of orientation while the people in ICU and ED get longer orientations than I. They say I am doing great, but I am nervous about being able to do everything that is expected of me. Their census is very low currently, so I only take care of maybe 3 patients at a time right now. The med surg floor is staffed almost entirely by travel nurses who talk about leaving and not renewing their contracts. There is no charge nurse. There is very rarely a nursing assistant on staff. Some of the travel nurses have been very disgruntled there and outspoken about low satisfaction scores since they were taken over by a private corporation and the full time nurses all left. I'm just worried I've joined onto a sinking ship, and that I won't have mentorship there. I'm wondering if I should keep applying for jobs at bigger hospitals. I never thought I would do med-surg I thought I would do ED or labor and delivery, but it's very difficult to get new grad positions in those fields unless you had a preceptorship in them. I'm feeling a little restless and worried that maybe I should have stayed unemployed longer to look for "the right" nursing job at a bigger hospital with more resources. I've seen nurses cut a lot of corners there and sometimes it feels like no one is steering the ship or watching what is going on there. Is it disloyal for me to apply to other places while I work there? Is it ok to explore other options or does that look bad to other orientation programs? Thanks for any advice.