OutspokenRN

I live in Sacramento and am considering moving to Phoenix to be closer to family. I am a dire-hard emergency nurse (ER, ED), but have previous experience in ICUs, flight nursing, trauma. I've been teaching nursing (away from a traditional bedside job for 4 1/2 years) but have been teaching clinicals with students. Suggestions for hospitals (especially ED's)? Maybe a breakdown of the major Magnet hospitals: Banner Health versus HonorHealth. (Mayo is not hiring, I already checked).

You may have benefited from spending at least a year on the floor, before transferring to the ED. It really is a whole different ball game, where every pt comes in WITHOUT a diagnosis. Yes, there are MD s around, but you have to multitask to get your work done. Focus on the big stuff. Are you pt's safe? If so, who looks sickest? (attend them first). Send off labs and other w/u stuff asap, since that will determine the diagnosis faster. Know what and when you can delegate tasks to others. Stay on top of your charting so you're never behind. Work WITH your patients for calm, flexibility and understanding that you are working as fast as you can but must care for several patients at once. Also, try working on off shifts, when it's not so crazy. For example, the 11p-7a shift usually chills out more. Seek our your educator if you need some objective advice on how to improve your speed and organization. Notify your CN when you get a heavy pt (maybe a septic work out) who you know will take a good hour in the room to assess, place lines, labs, BC's, foley, and start IVFs), same thing if it's a Peds work up. Ask for help when you need it. They should have float RNs to help put out fiers when acuity exceeds the resouces of just one RN. And then make friends, help each other out. When you're not busy, jump in and do tasks for your peers. They'll be much more likely to reciprocate.

My dear friend: whenever changed jobs or specialties always "get" the job closest to what you were doing and are good at. Then, once you are established, begin networking inside the organization to meet/greet/spend down time in those other units that you'd like to work in. With established internal seniority and a personal connection to the workers and/or manager, they would surely interview you when you apply. Some just are not wiling to take chances on people they don't know, are new to the organization, and have not been proven to be a success in the organization. Best of luck.

I can a lot of great advice has already been given. I especially like JDougRN (if remember his username correctly). If you did well in a BSN program and are a good student (and based on your lack of much good clinical experience in school-no uncommon with BSN programs) there is much hope for you. Do not give up after all that time/work/effort, despite your husband's comments. There is, and has always been, a HUGE chasm between school and the real world. As a critical care RN and now a nursing educator (clinical mostly) I see it a lot. I think that is why so many progressive hospitals are doing a really slow, structured classroom/clinical nursing residency (like MDs do). Not sure what area you were working in, but as other have suggested you have to WALK before you can RUN. I see many that want to jump into critical care or other specialty areas and they've barely done ANY of the basic skills. Do NOT go into education or start your MSN until you have "paid your dues" as a bedside RN. You will not "get" the MSN stuff without it, and as an educator NOBODY will respect you. Last I read you were interviewing for an OR residency, which as someone pointed out, is great IF you really have an interest in OR. Bolster your confidence by taking other outside courses, like maybe ACLS, etc (as a new ED nurse I remember driving to another STATE just to take one of the first versions of PALS). Best of luck.

The problem is not moving to CA (I moved from Chicago back in 1998 and LOVE it). But,....you are graduating from nursing school and MOST positions require 1 year of acute care experience. New grads in CA are a dime a dozen. Yes, there are some, highly competitive new grad programs, but they are hard to find/get into. Pay in CA is generally high to match the cost of living. If you are willing to work in a less than perfect job/place on nights, you can choose wisely and have a little money to spare. Just be very careful not be running up your credit cards, etc. You may fare much better to get a job in PA (where I assume the market might be better, maybe not) and after a year or two, apply and interview at various hospitals. If you really want to CA, than just put your efforts into do it. Even if you have to wait a year. CA will still be here in a year and you might find a lot more job options then. Also, BUILD your CV. Take certifications (depending on your area). For example I tell new grads that want to do ED or ICU, to take ACLS, PALS, TNCC, etc. SET YOURSELF APART form the other applicants. Also, create a PORTFOLIO. A binder with your CV, letters of recommendation, examples of lecture or projects you've done, any CEU's you've done, awards. Just HAVING a portfolio will BLOW them away. Trust me. Good luck.

Everyone orients differently. I've oriented countless RNs to ED and ICU and one has to learn to adapt to the situation and learner. I applaud you speaking up about not being able to go faster with risking making an error. Don't fee like an ass. But also, don't be afraid to have daily "chats" away from the patients to find out what is going well and where she and you feel you can improve. Open dialogue is the key. Be glad you have such a great, passionate preceptor, but don't be afraid to speak up. Best of luck.

Being Spanish-bilingual certified and a complete Gringo, I started slowly, taking classes in HS, then college (the conversational ones are best), and then started working per diem in a highly Latino hosptial (in the ED) where the staff were all native Spanish speakers. It's amazing how much one learns LISTENING to native speakers interpret. It's a process that will take YEARS. But putting yourself out there, learning, practicing, and challenging yourself will BUILD your skills. Buenas Suerte!

Wow, I'm amazed at how many said do the ED. As an ED/critical care nurse of 28 yrs, and now as a nursing instructor I say Med/Surg/Trauma unit. You need to BUILD on your, likely limited, clinical experience from school. Even if you were a tech in the ED or something, it's VERY different in a fast paced Level I Trauma ED. Keep your eye on the prize, but give yourself at least a YEAR on the floors to refine your skills, and build your knowledge base and confidence. The ED will be there when you're ready. I waited 7 years before going to the Level I Trauma Center. Build your resume, take ACLS, PALS, ENPC, TNCC. You have your whole career ahead of you. Best of luck.

As a clinical instructor, I think that was uncalled for, especially if you'd only had 3 days with them. Even if you were unsatisfactory in meeting the expectations, the prudent thing would be to have a constructive meeting with his/her boss to come up with a plan. That session would also allow you to voice your side of the story. With only 8 days left, I'm sure you probably made it through, but words can really sting. I've had good and horrible instructors in my Bachelor's program. One TRIED to fail me, but I persevered. I'm marked 28 wonderful and fulfilling years in nursing. Stay strong. Work WITH the instructor as much as possible. Best of luck.

Everyone THINKS they like 12's with supposedly 4 days off, but then people start working extra shifts or second jobs, and then you're hooked. One tends to spend what one earns. I've been doing nursing for 28 years and now prefer 8-hour shifts. If you're young and fit, 12's might be fine (I personally think that 16 hour shifts endanger the well being of your patients). I worked one job that required four 8-hour shifts as "full-time" and that was really reasonable. I think having to work FIVE 8's in a row would prove monotonous, although with childcare issues, I think it's a smart move. Best of luck.

Kaiser Pemnanente, Santa Clara, CA $77/hr baby! Hard to beat that.