jennycRN

Fair enough. But whose employment am I in when I am doing this work? Am I working for them for free? Is my hospital asking me to perform work for another corporation in addition to my regular responsibilities?

Nurses on my unit are being asked (told?) to participate in a study of a medical device manufactured by a for- profit corporation. Non invasive medical device will be applied to our patients. The company reps are being compensated to be on hand to "in service" us. The study physician will get some type of authorship credit I suppose. And the staff nurses doing the grunt work? What do you think? Just part of the job? I don't like my labor on behalf of a for-profit company who is not my employer to be taken for granted.

As was mentioned already, being a team player is really important in this type of environment. The frequent travels to CT and MRI necessitate a lot of teamwork and you should be comfortable asking for help and being willing to help out. Likewise, attention to detail is extremely important. You have to be diligent in obtaining that neuro exam (maybe hourly, maybe more or less often) because changes can occur quickly that would require intervention. I would want to know if there is in-house coverage at night by advanced practitioners. It is so great to have that type of back-up around both for routine orders and most importantly when things are going south.

Often professional development seems to be driven by a concern for regulatory and compliance issues where in the academic setting we focus on teaching the fundamentals- assessment skills, pathophysiology, etc. An MSN focused on nursing education will prepare you for entry to either career. Plenty of nurses work in both jobs or move between these roles.

As a student, I hate 'death by PowerPoint' as much as the next person. I also desire to be challenged and engaged in the classroom. But now on the flip side as an adjunct instructor I also understand more of how the nursing education world works. Reality is that students learn differently, many haven't read or understood the material prior to lecture. In addition we have to ensure consistent presentation of standardized material across multiple sections of a course. Also, developing your "own" material takes considerable prep time, often over multiple semesters, and is made more difficult when instructors are bounced from course to course. So, yes, I love teaching, and like most instructors I would like students to find my class to be worthwhile and interesting. Maybe one day you will become the entertaining instructor you wish that you had. But you will also understand the multiple challenges and pressures involved in educating nursing students.

Adjunct positions vary quite a bit in terms of pay and expectations for the instructor. It would be good to get a ballpark idea of how much time you would need to spend per week in terms of grading and student interaction to determine if it is worthwhile to accept the position. I would also weigh other potential benefits--- experience, tuition reimbursement, etc.

I have tried to develop a thick skin. If the student won't address me directly with their comments, then I don't have cause to respond. Be prepared for some negative reviews at the end of the semester! Some people will grumble and undermine wherever they are.... And the stress of nursing school doesn't always bring out the best in these people.

I have worked night shift most of my career and do not "just have an understanding" with any provider. Who will have your back if you take an action outside your scope of practice and there is an adverse outcome?

This is just an example from a neuro ICU, but we don't hesitate to give a float nurse a "stable" patient with a "brain drain," knowing that there is more experienced staff to answer questions if needed. But we wouldn't give the float nurse a patient who is experiencing increased ICPs and needs close management from that standpoint.

What incentives or support are offered apart from "encouragement"? Attaining the CCRN credential represents an investment of time and money to study for the exam, purchase study materials and register for the test itself.

Also working at the bedside with an MSN like a number of my coworkers and teaching on the side. There is no hiring "prejudice" against nurses with higher degrees because we don't get paid more for having the MSN.

Agree with PP. Doctors Without Borders is not a good 'volunteer experience' for a new nurse. But if you have the skills and experience it is a good organization to work for. They paid all my travel and living expenses (except for those of the initial interview). They also give you a stipend, health insurance, and pay for you to attend job-specific trainings. I know several nurses who volunteer in developing countries (for example during vacations). Typically they pay their own way or go as part of a church group that fundraises for a short term missions trip.

First of all, I think it is a sign of maturity to be able to self-reflect and identify the factors which caused you to be let go from the ICU. And you are right that this process is necessary to help explain your termination to future employers. It speaks well to your character that you don't bear animosity toward the ICU that let you go. That being said... 3 months is a REALLY short orientation for a new grad in ICU. Of course you were slow and anxious and unsure in critical situations. Maybe it takes a different type of personality to succeed in that particular orientation. Don't be too hard on yourself-- ICU isn't for everyone, especially for new grads. Anxiety can be a consequence of being detail oriented and safety conscious. It's important to be able to understand what you are doing and why you are doing it. I think that many managers would appreciate a nurse who wants to learn how to be thorough and correct. You do have to think about and prepare for those critical situations, because they happen in med/surg as well as ICU. If a pt is dropping their pressure and you can't get IV access, instead of wasting energy panicking about how you are slow at IVs, think about who you can mobilize to get your patient what they need- is it your charge nurse, a supervisor, a rapid response team? The skills usually come with time. What most people want from a new grad is the ability to assess and identify when they need help and to be able to ask for it. So, your self-criticisms are true of many many new grads. It is possible that 3 months was not a realistic time frame for your ICU orientation. In my opinion, a hiring manager should understand you if you say that it wasn't a good fit as a new grad.

You did the right thing--- you had no answer and did not pretend to. I took a class in palliative care which helped me a lot with communication with families. So I definitely do (gently) let families know that their loved one could pass while they are in the bathroom! I tell them something like... 'If your mom needs you to be with her when she passes, she will wait until you come back. If she needs for you not to be at her side, she will wait until the one moment when you leave the room.' And then of course I add that I will be checking on their loved one frequently. I have seen dying patients pass when even very attentive family members leave for just minutes to meet their own needs. I feel like if I can prepare families for this possibility in advance, it can help them feel a little more at peace with the outcome if they are not present.

It is normal to feel all of those things--- self-doubt, anxiety, being overwhelmed-- especially at the point of coming off orientation. It takes time, much more than four months, to grow in confidence, build relationships with your team, and learn the time management skills. I think that most nurses can empathize with what it feels like to be a new grad wondering whether or not we can be successful as a nurse. However, we don't work with you so we can't answer for you whether you are just having the 'normal' new nurse anxiety or whether you actually have a problem providing safe care to patients. Hang in there, remember that safety always comes first, and be open to constructive feedback from your coworkers.