CJMR

I'm in the same boat as you. I am 8 months into my training and I don't like it. I'm going to try to stick it out until the 1 year mark but I don't see that changing things. I miss interacting with my patients. I feel like I'm losing clinical skills. Plus the bullying in my OR is the worst I've ever seen. It comes from every direction - surgical technicians, nurses, managers, physician assistants, surgeons. The only ones that are mildly pleasant are anesthesia and PACU. The flex nurses decide who gets breaks and when they will be provided. Since I'm new and not BFFs with the flex nurses, I don't get them while everyone else seems to get 4-5 per shift. I have to call a manager every day to beg for lunch. I've actually started drinking less water since I know I won't be able to pee from 6:30am until 2pm. I'm seriously considering going back to the floor. My boss won't like it, but I don't want to be miserable. They tried to get me to sign a 2 year contract when they hired me in the OR but I refused because it was one-sided (absolutely no benefit for me). They still hired me. I am expecting them to blacklist me hospital-wide if I do leave the OR. Because of this, I plan on leaving the hospital completely. I wish I would have never taken this position.

I actually caught someone red handed sitting in the break room halfway through eating my food. I confronted her immediately. This B had the audacity to say, "But I forgot to bring food and I'm hungry." I yelled, "I'M HUNGRY TOO AND YOU ATE MY FOOD! WHAT DO I EAT NOW?" Ugh. She looked like she didn't get it. Selfish. I made her give me $10. She argued that my basic lunch probably didn't cost me $10. I said, "We'll, it's costing you $10."

We have 2 patients to a room so at times it can be invasive. I work nights so at some time before the end of my shift I explain bedside report and ask if it's okay to do in the room, if they want me to kick out friends and family first, and if they'd prefer if I let them sleep. Other than that, I like it because I prefer show-and-tell. It's easier to know if you have a neuro change if you talk to the patient at the beginning of shift. And I've had 3 different occasions where I've called a rapid as soon as I walk into the room and had to transfer the patient to the ICU. One was in DIC and the outgoing nurse somehow didn't think that bleeding from every orifice constituted an emergency. We use a 1 page printed SBAR and I always update it every shift. I prompt the oncoming nurse to read that as we are walking down the hall into the patient's room. I can usually give report on 5 med-surg patients in 15-20 minutes.

I did this. I knew I was moving to another state after graduation. I took the NCLEX in my home state, got licenced there, then transferred my license to the new state. In retrospect I wish I would've just applied directly for the state I intended to move to since I had no intention of working in my home state. Initial licensing was quick (within 12 hours of taking the NCLEX) but the transfer took over a month.

At my facility we are given an SBAR with all pertinent information and we do bedside report. I update my SBARs every single shift with a narrative that has a very brief but concise history, treatment, and plan. I also clean up orders every single shift. I will give a brief rundown of my assessment but the oncoming nurse will do their own assessment when I leave so we are not doing it together at the bedside. If they forgot to tell me something re: assessment, I will find it during my own assessment. The oncoming nurse should also go straight to the source to review orders rather than getting them in report. If I do these things it takes me very little time to give report. I am out the door on time almost every shift. That being said, somehow there are nurses on my unit who take forever to give report and despite multiple attempts to help them cut the fat, they still can't do it. I think your facility has a few policies in place that slow report. If you have to wade through outdated, irrelevant orders to find the "real" orders, that is a problem. Both physicians and nurses are mandated to delete outdated orders at my facility to reduce mistakes. Most of the time the nurse does it, but if it is done every single shift, there are typically very few outdated orders getting in the way. And if the SBAR is used effectively and updated every single shift, you know you can rely on it to pass information so the nurses will know to read it before report, thus shortening report significantly.

I always look at the worst case scenario in every situation. I know my docs and I know how the situation will likely play out. If I call a surgeon at 3am not only will I NOT get the order, I will get yelled at, I will get complained about to management, and worst of all some poor patient is going to get surgery performed on them by a sleep-deprived surgeon. If I don't call the patient will be mad, they might complain about me to management, and they will take a vitamin a few hours late. So the worst thing in this situation is a sleep-deprived surgeon performing surgery because I woke them up for a vitamin. That is where I will rest my argument with the patient and with management if it goes that far. Surgical mistakes happen and sleep-deprivation is more likely to make them happen and if the patient doesn't like that...if they are so selfish that they can only think of their damn vitamin and not the other patients then screw it. It's not my first time at the rodeo and they cannot out-argue me on this issue.

I've found the area hospitals to have really open HR departments. If you call with questions they will typically give you exact figures.

Scottsdale Healthcare will hire new grads into med-surg or float pool (only floating to med-surg for the first year). There are a ton of applicants but do they hire throughout the year. There is quite a bit of turnover in med-surg and experienced nurses rarely apply for those positions. New grad supply and demand changes year to year so the picture could change by the time you graduate. Also, the starting pay info posted above seems accurate. Shift differentials as of Fall 2014 are $1.70 for weekends, $4.25 for evenings (working 4+ hours past 3pm), and $6.75 for nights. Comparing hospitals in the Phoenix area to Scottsdale Healthcare you will find Banner hospitals pay less and don't give raises, Phoenix Children's pays less but their nurses are really happy, Dignity pays more, and Mayo pays the most. If you work nights Scottsdale has the highest night shift diff and best night nurse/patient ratio.

All you are feeling is completely normal. I am 2 years into med-surg myself. The first 3-6 months I got anxious on my way into work. I felt like I was just barely keeping my head above water. Then things very gradually got easier. At 1 year I felt like I had grown and learned so much. At 2 years, even moreso and started to precept students. You will be amazed when you look back how much you learn in your first year or two of nursing.

As a med-surg nurse you will learn within the first year to set limits, not get walked on, and not believe everything a patient says. You will also get experience with psych patients. Is suggest staying in med-surg full-time at least 1 year, 2 if you can tolerate it. It really does build up your foundation nursing skills that you will use in any specialty.

At my facility when a patient is NPO it is the nurse's discretion what to give and what to hold unless the physician specified. I typically give all cardiac, seizure, diabetic, and similarly important meds. My hospital has pretty detailed protocol on diabetic meds so there is never a question as to what to do with those. They also have a policy to never hold any beta blockers for any procedure or surgery. Even if the physician says "hold all meds" we are still to continue those. I'll typically call and remind the physician that the patient is on a beta blocker and it will be continued, per hospital policy. I hold blood thinners, vitamins, probiotics, etc. Then I continue them after the procedure if they are up to it. The blood thinners I will ask the physician to specify when to continue.

My hospital recently changed policy. There is no longer on call pay but they only expect a nurse to be available for 4 hours. I think it's a nice trade-off. On my unit we make a list of people willing to go first if there is low workload. Usually that is sufficient but if not, they go by who hasn't had it the longest.

My behavioral health nursing professor told my class the same thing in nursing school. She didn't have any research to back it up but I did wonder. Personally, I had a very bad childhood. I was abused emotionally, physically, and sexually. Addiction runs in my family and quite a few members are alcoholics, drug addicts, or both. My father left when I was a baby. My mother has been married and divorced 3 times. Thankfully, I have been pretty resilient. Though I did move to the other side of the country as soon as I could so most of my family drama doesn't reach me anymore. I have no idea if my childhood had anything to do with my decision to become a nurse.

In my area when a patient dies the staff collectively makes sure at least one staff member goes to represent the staff at the funeral. They put it on the calendar and compare schedules to see who can make it. I don't see it as stepping over the line at all unless you feel your presence would somehow upset the family.

I can't imagine how depressing that must be for you. Someone who went to my school and graduated in 2008 and took the NCLEX every time she was able to and just finally passed at the end of 2011. And she found a job right away while I'm still looking! I don't know what kind of personality you have, but some people get into pharmaceutical sales. Some large corporations have employee wellness programs and hire people with nursing degrees. I wish you the best of luck.