caffeinatednurse

Med-surg gets a bad reputation overall. You'll find plenty of nurses out there who will say how terrible it is and how they would never work it, but the fact of the matter is that med-surg will provide you with the time management, critical thinking, and prioritization skills that are necessary for any specialty. If you can take care of 6 acutely ill patients with a variety of medical issues and needs, you can definitely transition to ICU or ER or any other specialty later on. Also, at this point I think it's important to take an opportunity where you can find one. If you're able to land this med-surg job, I would definitely take it. Especially given how competitive the job market is in your area. It will help prepare you for better opportunities down the road while also giving you the necessary acute care experience you need to land those jobs. Best of luck.

I always expel the air bubble before giving the med. Why take the risk?

Some floors have more drama and what I call “floor politics” than others. Not all units are created the same. Personally, I would advise staying out of it until you know what you’re dealing with. No need upsetting a good nurse who could be a resource for you because of some drama. To deter it, you can always say something like, “I don’t know anything about that” when confronted with gossip. All else fails, walk away. The preceptor thing is less worrisome to me, only because with staffing the way it is right now, it can be really hard to find a consistent preceptor for a nurse. I would just double check that they’re not giving you different preceptors because of complaints, etc. Sometimes we try out different preceptors if the orientee is really struggling to determine if it’s a constant issue or if the preceptor is the problem. Sometimes we like to get several different perspectives on what is going on with a nurse, if we feel like they’re not doing well or need more help.

Every new grad nurse feels this way at one time or another. I felt this way for a very long time, as well. You start feel like you’re investing too much of yourself with little return for your efforts. You think that how you’re feeling is unique and everyone else is doing so much better than you. You are and they’re not. They’re just handling things differently. It takes at least a year to feel more comfortable in your role as a nurse. You’re being asked to do things you’ve never done before and you’re being challenged constantly. The only way to get better at something is to keep trying. You’ll keep making mistakes and that’s OK, as long as it’s not the same mistake over and over again. Eventually, you’ll build a bank of knowledge and other people will come to you with their questions. But you’re not there yet, and you shouldn’t expect yourself to be. You’re going to feel wildly uncomfortable for a while before you find your style of nursing and figure out how to navigate your unit. The fact that you’re self-aware enough to recognize your own mistakes means that you’re still trying your hardest. Keep up the good work.

You probably have oriented a lot more people than me, but that doesn't mean that you're better at precepting...I think we've thoroughly covered that topic in this discussion. Experience does not always = better. I have already stated before that I was bullied as a new grad, so I know what bullying feels like. I don't think I need to cover that ground again. To get back on topic here. The preceptor is wrong for her comment after the code. But patient safety is 100%. As a preceptor, I would not have let my new ICU orientee take care of a patient that was going south. I would absolutely change her assignment if I felt she wasn't ready for that. And if I feel like they're doing something wrong, I would absolutely interrupt what they're doing, with the end goal being that I would explain to them later why I interrupted them and did it a certain way. Obviously, she and her preceptor are not a great match and if she chooses to stay in NICU, she should ask for a different preceptor. But ICU (and I do mean any ICU) is tough for a variety of reasons, and at my hospital ICU, we had a lot of strong personalities. So she's going to have to try to find a buddy on this unit to have her back if she plans on staying. Just be aware that not all units are the same...some aren't friendly and you'll never find that buddy...sometimes you're just staying because you love the specialty or the patients, etc. It really depends on the reason why you want to work NICU. There are my 2 cents, take it or leave it.

Me too. I left med-surg and the hospital entirely. Now I talk to patients over the phone. I imagine I'll eventually get tired of that, too, at some point. ?

You're not directing your comments at anyone in particular, but you just (poorly) summarized my initial reply to her, which was thoughtfully constructed because yet again, I. don't. blame. her. for. her. preceptors'. words. Let me say again for the one person not listening to what anyone is saying: no one is defending her preceptor. We are just adding some perspective to the conversation because that's what discussion boards are for. You're welcome to share your perspective, but you can't invalidate others just because you've met a few people in your past that remind you of her preceptor. Everyone's input is valuable as far as I'm concerned, like it or not. ?‍♀️

It's definitely not worth it!

I hear you. I quit that job last month. I just couldn't take it anymore. I used to work LTC and I swear I took care of less LTC patients in that setting, compared to your typical med-surg unit now. Confused people wandering out through the fire escapes, our drug ODs trying to leave with their IV intact and having to call security on them, and then one of your non-ICU but still sick-as-you-know-what patients coding in the middle of it all...yeah, I was done. I would have put in for a transfer elsewhere if I thought it was better, but the whole hospital was dealing with the same issues. ✌️

Just wanted to pop in and say that I hear you. Kudos to you for knowing when enough is enough. I hope your next nursing adventure is worthy of your time and efforts.

I'm not making excuses for anyone's bad behavior. In fact, if you go back and read through my reply, you'll see where I freely state exactly that. I've also been bullied as an orientee in a setting that was not nearly as stressful as ICU, so I know where the OP is coming from as well. But I also know how hard it is to precept someone when you're under considerable stress, you have a very sick patient, and an orientee. I can understand where her preceptor is coming from, even if I don't agree with the statements she made to the OP. Also, to be clear, there are A LOT of new grads who feel like they're being bullied, when in reality, their preceptor is being blunt and less-than-tactful with their criticism, but not necessarily bullying them. There are PLENTY of nurses who will give you the shirt off their back in a bad situation where the patient is crashing but if they feel like you're about to do something that could make the situation worse, they're going to tell you about it...how you interpret it, is up to you. It might hurt your feelings, but it also might be truthful. And sometimes our feelings get wrapped up in the situation as well, so it can be hard to differentiate between what is happening. None of us are there and we can't judge the situation. From what she's describing, it does sound like her preceptor has made some hurtful comments but also that there may be some things that she's doing that require correction.

Thanks for getting it back on topic. Also, thanks for the statistics. I'm glad that nationally, things are much brighter than they are here.

I've been on both sides of this situation. Obviously, I was a new grad at one point. I had a preceptor who was nothing short of a bully. I ended up leaving that floor not long after I started and took a break from hospital nursing altogether for almost 2 years. When I went back, I was lucky enough to have a *fantastic* preceptor who helped me get up to speed, trained me to become a charge nurse, and is still one of my best friends to this day. I have also been a preceptor for 5 years. Although we want our experiences with preceptors to all be the same, the orientation and training that a nurse gets really depend on what type of nurse they are and how they approach their orientation to a unit. I've had experienced nurses who thought they knew everything almost kill a patient under my watch. I've had nurses try to neglect a patients' basic needs under my watch. I've had new grads fake knowing what they're doing, only to miss a major issue and let it escalate, under my watch. As a preceptor, you become aware of what the nurse you're training is doing and more importantly, what they're not doing. And what they're not thinking about. It can be scary when you have an orientee who doesn't pay close attention to the patients, and you as the preceptor become very protective over your patients and the quality of care that is being delivered. Have I taken over the care of a very sick patient, instead of letting my orientee care for that patient? Have I told my orientee that I don't think she's ready to care for someone this sick on our unit yet? Absolutely. Because at the end of the day, I am responsible for what happens to that patient. You are in training, and my manager knows this. They would hold me responsible for what happened to a patient that was under the care of an orientee. I'm not suggesting that your preceptor is completely correct because it sounds like there is a lack of tact involved on her part for the way she is communicating this to you. It also sounds like she is under considerable stress, and that she may not trust you yet. But you are completely new to NICU, and she is responsible for you while you're in training. Perhaps more importantly, her main responsibility is to protect the patient. As a preceptor, she absolutely has the right to tell you that you're not ready to take care of that very sick patient. She has the right to change your assignment based on her assessment of your capabilities. It doesn't mean that you're a bad nurse, it just means that you're not ready. You're new, and that's to be expected. I've also worked with nurses who had a similar crunchy demeanor. Sometimes it's really important to have a thick skin and to not take things personally. I would, however, listen to the feedback that she's already given you. I have said similar things in the past to orientees, not because I wanted to hurt their feelings, but because I wanted them to realize where their weaknesses were and what areas they needed to work on. I would try to look at things from her perspective first. Look at your actions and behavior as well. Some things to ask yourself...are you doing things in the clinical environment that make her feel uncomfortable? Have you asked her what her expectations of you are, at this point? Have you proactively asked her how you can improve as a nurse on that unit? Have you asked her why she does things a certain way? Chances are, if she's jumping in there and interfering with what you're doing, you might be doing something incorrectly or it might not be how they do things on that unit. Again, her main priority is keeping that patient safe. Your learning/orientation comes second, so that's something to keep in mind. If you still feel like her behavior/demeanor is interfering with your learning, then I would ask the manager for a different preceptor first, before giving up a specialty altogether.

This statement doesn't even make sense. You're doubting that vaccination rates among nurses are low in the rural south, even though, in your words, southerners have "elected" to suffer? (By the way, I don't think anyone elects to suffer from COVID, even the unmasked, unvaccinated groups of people - they just suffer from lack of knowledge, which isn't made better by opinions like yours.) Nurses are people too, and they have doubted/continue to doubt this vaccine for a myriad of reasons. Obviously, I can't show you a study or any other "proof" on vaccination numbers. I didn't poll the hospital workers myself. That number came from our CEO. But I can tell you that the hospital I left mandated the COVID vaccine because the vaccination rates were so low.

Here’s the thing. I’ve had two jobs in the past where the manager tried the same thing. I actually had not told either of them anything, I was just applying and was doing interviews but they must have sniffed it out. In both cases, it was an attempt to keep a nurse who has been doing WAY TOO MUCH with a small pat on the back. I always felt that if I stayed, things just would have gotten worse. For me, when I decide to leave a place, that’s it. I’m done, there’s no changing my mind. So for me to stay, would mean that an employer does not have my 100% efforts or attention. If it were me, I would keep the easier job and take a breather for a while. I’m currently working from home in a telephonic nursing role, doing exactly that, because my previous employer burned me out at the bedside. I literally gave my 150% every day, all day. Sometimes you have to take a step back and take care you for a while. It doesn’t mean that this is forever…you probably already know that this isn’t what you want to stay in, and that’s fine. But you can take advantage of it for a while, until you figure out what your next step is.

At the hospital I just left, only 30% of the nurses were vaccinated. This was just before admin mandated the vaccine, so I imagine some will accept it and some will not. But no, most nurses are not vaccinated, especially in the rural south. Many don’t trust the vaccine, even nurses.

Everything you just verbalized is completely normal. If you’re new to 12 hour shifts and nursing, there’s going to be an adjustment period. I worked nights for 6 years and my body still has to adjust from time to time. Stop trying to do it all. Focus on work when you’re at work. When you’re at home, focus on you. Let the dishes pile up until you can deal with them. Prioritize sleep and self-care. Give yourself permission to be new at something…it’s OK to not know it all from the beginning. It’s OK to lean on others. It’s OK to be overwhelmed from time to time. Med-surg is a hard specialty at first but you’ll eventually get the hang of it and find a way to make sense of it.

More staff is one part of the solution, but it won't fix the problem. In most hospitals, "more staff" just means more new grads and more travelers. And no offense to new grads, but when a floor is already overwhelmed with new grads that just finished orientation and are barely operating on their own, and then another round of new grads are brought in...it slows down the existing staff that are pulling most of the weight. Travelers are great, but they're only around for their contract and then they're gone, to be replaced by new travelers that need an orientation as well. It's a constantly revolving door of new staff who need training, and not enough existing staff to train them. Let's say my hospital adequately staffed our units. That still wouldn't be enough to make me stay. The money-first attitude I saw during our first surge was unacceptable. Yes, there's some degree of this in all of healthcare, but our admin made us feel like our lives didn't matter at all. Ex: Rationing PPE, even though there was plenty in stock to protect everyone. Locking all of the PPE up in a central location and forcing nurses to rationalize to their house supervisors why it is necessary to take care of their patients. Not allowing nurses to use their own respirators and enforcing paper masks that were not even intended for medical use (true story). Forcing older nurses and nurses with pre-existing conditions to take care of COVID patients, or else threatening them that they would lose their jobs. Forcing med-surg to house orthopedics and then PCU because the COVID unit kept being shifted from one floor to another and effectively spreading it all over the freaking hospital. Enforcing unsafe "crisis" ratios and then continuing to enforce these ratios AFTER the surge was over because why not? We had already proved that we could do it once, why not keep doing it? Most of the nurses I worked with interpreted all of that ^ as admin not caring about the lives of the nurses and NAs working the frontline. So until hospitals can rein in their admin and start putting people in charge who actually care about the lives of the people they employ, it's going to be difficult to make anyone stay at the bedside.

After months of COVID surge, the admin suddenly appears in nursing scrubs on night shift, takes a patient (which happens to be the most ungrateful, foul-mouthed patient on the floor) to the bathroom, and then promptly leaves to never be seen in scrubs in again. Months later, they tell a local journalist that they worked "for months" at the bedside during COVID, and it is published in the paper. Fires a well-loved manager because of her unpopular opinions and then has another manager (who happens to be a dear friend of admin) brought in just 2 weeks later, even though there are multiple qualified candidates on the unit. Admin telling nurses and NAs with pre-existing conditions that if they refuse to take care of a COVID patient, or refuse to work the COVID unit, they will be without a job. (True story, had this actually told to me twice during our surge.) Admin telling nurses and NAs that if they're caught using extra PPE than what they require, they will be without a job. Admin employing house supervisors to "patrol" the PPE supplies, not allowing nurses to use NEW N-95 respirators but instead use the "recycled" OLD respirators as many times as possible until it is no longer usable. Admin telling nurses to wear the SAME dirty PPE gowns that they wear in each COVID room at the nursing station, because "everything is dirty down here and it doesn't matter". Hiring new grads during the middle of surge who spent the last 2 semesters online, and promising them that "we're turning things around and it's getting better" when 50% of the staff is in the process of leaving, the other 50% are travelers with contracts that are about to expire, and our manager is working every night or day because we're so short. I could go on for days. Thankfully, I've already left this place. ✌️

This could easily be a snapshot of the typical patient load on my med-surg unit. Seriously. It wasn't always like this on my unit, which is why I've been there for so long. We used to have decent ratios and a dedicated charge nurse (which we haven't had in over a year). But COVID definitely made it worse. ICU and progressive care units are easily overwhelmed with the influx of COVID patients requiring ventilators and intensive care, so they send the "less acute" patients (meaning they're not on a ventilator) to med-surg. Med-surg is also forced to take every non-ICU patient that enters the ER, including all of the confused patients, psych patients, overdoses, detoxes, and falls. We also take care of chemo and oncology patients on my floor, so that's an interesting mix to add-in. It has gotten considerably worse in the last month, and I'm not sure if it's because of an uptick of COVID patients in my area or something else. 1:6 is the goal but lately bed coordinators have been pushing us to 1:7 and even 1:8 "when there's no other choice." That quickly becomes a daily ratio. So yeah, things are bad. It's not just that unit. It's probably most med-surg units. And staff are leaving in droves, including myself.

Sounds familiar...do we work at the same hospital? ? Our hospital decided that PCU would make the perfect location for the COVID unit. PCU moved to med-surg. All other floors took the med-surg overflow because PCU overflow could not be sent elsewhere. Then most of the PCU staff left and it was just med-surg nurses caring for PCU patients.

That's when I know it's time to find another place to work.

An administrative position is not as difficult to break into as you might think. I worked on my unit for approximately 6 months before I was politely encouraged to be a charge nurse because there was no one else to do it. (By politely encouraged, I mean my strengths were emphasized and no orientation was offered.) I did that for 3 more years before a clinical coordinator position opened up. I ended up in that position for a while and was told that it was a stepping stone to becoming a manager one day. I've also worked in LTC before. I was there 3 months before I was promoted to a supervisor, and then 6 months later was offered a clinical coordinator position. I was also told then that a CC job would position me to be ADON or DON, eventually. The moral of the story...you can get leadership experience in a variety of settings. If it's not working out in acute care, consider LTC settings, where there tend to be fewer people with higher degrees and a greater demand for employees who can be leaders. With an MBA and an MSN, you are in a great position to take on a clinical coordinator, ADON or DON position. Also, make sure that you're communicating your professional goals clearly to your employer. Managers and directors aren't usually aware of your professional development goals unless you're very clear and specific about them. If they seem hesitant to talk bout it, ask them for their honest opinion of your current strengths and weaknesses and go from there.

This happens all the time on my floor. It's like a rite of passage for the oncoming shift to give the off-going charge nurse heat over an assignment, for some reason. I don't agree with it, but it's incredibly common. I have a few favorite responses to this: "If you don't like your assignment, you're welcome to switch with someone else. Just be sure to change it on the board, too." (Because it's not MY responsibility to deal with your dissatisfaction or to track down your assignment because you HAD to change it.) "We talked about this at huddle and this was the best decision. If you have any questions, feel free to let [my manager/house supervisor/etc.] know." Let it roll right off your back. No matter how hard you try to make the *perfect* assignment, there will always be one person that will take issue with it. You'll never make them happy so you might as well let them know that their negativity doesn't affect you. When they learn that you'll ignore them, they'll likely stop complaining (or they'll escalate their complaints and it will go nowhere). If they refuse to clock in and take their assignment, I call my manager or house supervisor and let them know. If need be, we can send that person home without pay and find a replacement. If we can't find a replacement, then everyone will have to work short. ? (They probably should have just taken that assignment, ya know.)

Go for it. Different people need more or less time in a specialty to figure out if it's for them. If you're interested in ICU, apply and ask for a lengthy orientation in order to feel comfortable in your new specialty. If you don't like it, you can always put in for a transfer back to med-surg. It's not going anywhere any time soon! ?