sleepyjane

I was in exactly the same situation a year ago (BA in psych, AD in nursing). MGH and BWH will not hire new grad ADNs unless you have worked there as an aide preiously. However, once you gain a years experience they will consider you although having a BSN or having enrolled in a BSN program will definately give you an edge. I found it really tough as a new grad in Boston, lots of new grads to compete with this time of year. I landed a job in rehab after sending out countless resumes and am now making the move to med surg in a community hospital which is where I wanted to start from the beginning. You will here different things from different people about who will take ADN and who will not. I think the best thing to do is to call nurse recruiters directly and be as agressive as you can in your job search. Good luck!

I agree that waiting until my year was up would have been the best thing to do. Unfortunately, my year is up in August and I was afraid that I would run into the same problem as I did last year when looking. All new grad positions are taken, and the fact that I don't have a BSN puts me at an even greater disadvantage. At this new job, I will be getting the same orientation as a new grad since I haven't had a full years experience and this is what I wanted to do from the beginning. My nurse manager reacted as I had expected, and rightfully so. "We invested so much in you and I thought you would do the same for us" (4 weeks orientation I don't think is that much of an investment). The head nurse told me what an awful place I was going to and how bad of a reputation they have (I have of course heard the opposite). The other nurses on my floor were very happy for me. Some even asked me to help them get a job at the same place. Its really tough to get a job in my area, and its very competetive, so I did not want to pass up an opportunity to do what I wanted. I hope I made the right decision, and I hope my nurse manager doesn't make the next four weeks of my life a living hell. I really do feel guilty about not putting in a full year, and because of it I'm sure my current NM won't give me a very good reference in the future. Honestly, I was miserable at this job and it is a relief to know I am leaving. There are some things I will miss, but overall its something I knew I didn't want to do from the beginning. I took the job more out of necessity with the hopes that maybe once I started I would like it. I remember having a gut feeling when I went for the interview that it wasn't for me. It takes a very special person to be a rehab nurse, and I just don't think I was cut out for it. I worked for this hospital for over 6 years (only 8 months as an RN), I think I have paid my dues and its time to move on.

Thank you everyone. I got a call yesterday with a job offer for the med/surg floor I interviewed with last week and I am going to accept it. The position is 40 hrs, 8hr shifts, and days! There is a 3 month orientation as opposed to the six weeks I got fresh out of school at my current job. The hardest part is going to be telling my nurse manager. She is not the most approachable person and I have seen her treat other nurses badly if she has any kind of issue with them. I will be giving 4 weeks notice, and I don't want my last 4 weeks to be hell. But I guess if its the price I pay to hopefully be happier in my carreer, then it will be worth it. Life is to short to stay in position that makes me miserable, especially when there is something that can be done about it. Thats one of the great things about nursing...there are so many options! Good luck to everyone else in similar situations and thanks for your support.

Has anyone else changed jobs within the first year? I am currently working in sub-acute rehab and I am miserable for a variety of reasons. I wanted to go into med/surg since I graduated and was assured that rehab would get me my experience. Yes, I have gained some good experience without a doubt, but I know this is NOT what I want to be doing in the long run. I had an interview last week for a position on a medical floor. The nurse manager seemed wonderful and the other nurses all seemed very nice and supportive. I would still be entitled to their new grad orientation, and I know I will get a lot of good experience. Not to mention that since it is in an acute facility, there are many more professional opportunities than their are in rehab. Honestly, I think I will take the position if it is offered to me. But I am so nervous to make a change and would feel horribly guilty for leaving my current job so soon. I guess I just need a little encouragement and I would love to hear from others who have been in similar situations.

My nurse manager once in a meeting with all the RNs told us the other staff (therapy department mostly) think all we do is give pain medication. I would like them to walk in my shoes for a day and when they go home bone tired and emotionally spent, they might want to reconsider. I honestly don't think that anyone except us nurses (and sometimes patients) really have any concept of how hard we work.

I've been a nurse for nearly 7 months now. After months of searching and countless resumes sent out, I reluctantly took the first job offered to me at and acute rehabilitation hospital on a general rehab/musculoskeletal unit. As a new grad, I really wanted to work in med surg or telemetry to gain as much experience as possible and then decide if I wanted to go into a specialty. But do to such a high influx of new grads and recent requirements (Jan 2008) made by area hospitals that all new hires have a minimum of a BSN (I have an AD with BA in another field, graduated May 2008, go figure!), my options were limited. I was promised that I would get the med surg experience that I needed on this unit. Definately not the case. Our patients are stable for the most part, post surgical, burns, trauma and amputees mostly. I had 6 weeks of orientation (including 2 weeks classroom, so only 4 on the floor) with my preceptor who had only been a nurse herself for only a year. She quit my last day of orientation. I work days with an average of 6-7 patients who are in 3 hours of therapy on my shift. My time management skills have improved tremendously since the patients are on the floor such a limited amount of time. I am great at dressing changes, pain management, passing meds and teaching. I have only had one patient with a trach (which came out the day after he was admitted), one G-tube and one NG tube. No chest tubes, no vents, occassional catheterizations and IV medications. RNs need to take a class before they can start IVs and the class has not been offered since I started. RNs don't give IV push meds or piggyback infusions on my facility. There is no telemetry. I have yet to hang blood. The primary diagnoses are almost always the same thing (hip, knee, amputee) and I have the same patients for 2 or 3 weeks. RNs are not valued members of the team...theraists and MDs see us as only passing meds and wiping butt and to be quite honest there are more days where I feel like this IS all I do. To sum it up, I am clearly unhappy at my present job and have been looking for something else. My biggest concern is that because I am 7 months in to the profession I have already missed out on a really good new grad experience. This first year is where the most learning takes place. Now I'm not saying that I haven't learned anything...I just haven't been exposed to much. So I wonder if hospitals will still consider me a new grad and offer me the same orientation, or if they will see me as an experienced RN and expect me to be at a certain level (in which case I will probably fall flat on my face). I expect to be honest with potential employers of course and I don't know if this will help or hurt my chances. I am really discouraged and kind of depressed about all this. I was so excited to get in the profession and now I feel like I have missed out and can expect to encounter more roadblocks looking for a new job. Has anyone else had a similar experience?

I have only been working as an RN fro 5 1/2 months on a busy musculoskeletal/vascular floor at a free standing rehab facility. I am on days, and my patient load usually consists of 6 patients some s/p joint replacement, amputees, vascular, SCI, burns, and some stroke. I work days, so we are working around the patients 3 hour therapy schedule. Before 0800, the nurses are expected to get report, check orders, get vital signs (NA's are too busy to do them, but we're not???) and administer insulin before breakfast. Then we have to make sure all of our patients with severe mobility issues are up, toileted, washed (we often are assigned ADLs for at least 1 patient) before their first therapy at either 9 or 10. At some time while the patients are on the floor, we have IV meds, wound vacs, PICC dressings, incisional dressings, burn dressings, duoderms,etc (my assignment has all of the above-days are expected to do all the dressings). Pain meds are administered to most patients every 3-4 hours. Patients have to eat and use the bathroom at some point. Call lights are going off like crazy. I overheard a patients family member ask another nurse "so, you're not really a nurse, but one of those maids, right?" He was totally serious because half our day we are wiping butt and fetching things for patients. Then we have to document everything and take off orders, collect specimens and call the pharmacy every 10 minutes because we don't have the meds we need. If I don't leave on time or take my breaks on time for their full duration, I will be spoken to. If I do a half assed job and don't document well, I am spoken to and feel like a lousy nurse. Can't win. Today I made my first med error because I was interrupted while getting my medications ready (to toilet someone because they were yelling and no one was around) and forgot to go back to get a med I didn't get out the first time. I realized this at the end of my shift and could give the med late although not ideal (oral hypoglycemic agent) but I still had to do an incident report on myself. It is impossible to get everything done and do it well. I am stressed out and exausted. I want to persue my education so I can teach eventually, but I have absolutely not one ounce of energy left after work. The general consensus I have gotten is that it is like this everywhere. Is it? If it is, I'm not sure I am cut out for nursing. I am really upset because this is a second carreer for me and something I really thought I wanted. I am just having a really hard time handling the constant chaos and stress that goes with it.

I've been working at a free standing acute rehab hospital for about 4 months now. I have noticed that in my facility, the nurse is not valued as a member of the rehab "team". I had patient for a month and a half with 3rd degree burns over 80% of her body...the dressing changes took me nearly 1.5 hours per day. On the day the patient was leaving, the PT,OT, MD and case manager all came in to the room as I was finishing up the dressings(not expecting me to still be in there). They presented a gift to her from the "team" saying they all pitched in for this little something. I had no knowledge of this, nor did they expect me to still be in the room. I felt like all the hard work I put in for this patient was completely undermined by the other staff, as if the care I provided to this patient wasn't important (which I know is not true). I see this lack of respect on a daily basis. I've had therapists come up to me while I have my hands full of meds or dressing supplies, clearly in the middle of something, to tell me that so and so needs to use the commode. Since when, in a rehab hospital, are therapists above toileting people? I can't say this is true of all of them, but it happens often. I am just wondering if any other nurses find this true of their facility and is this something I should just get used to? When I took the job, I was so excited to get to be a part of the team, but I certainly don't feel that way at all.

So here I am, 4th week off orientation...one of my patients was severely burned (80%burns) and has a very time consuming dressing change. I have been doing her dressings, along with another, more experienced nurse, for the last week or so. I did the dressings, alone, for the first time Sunday. As I am getting set up today, feeling confident that I can do this alone, in walk 3 first semester nursing students who were told by the manager to observe the dressing change. I felt like a complete jerk...I have such a hard time organizing myself, and to have students observe me just made me uncomforable. If they were there to learn, they certainly didn't learn a thing from me...I am still filled with questions myself. It was just awful, I felt bad for them. I wanted so badly to explain that I am a brand new nurse and I'm still learning a lot of these things myself but at no time would that have been appropriate to say in front of the patient and to degown just to step out of the room to say "hey, I don't really know what I'm doing here" didn't seem right either. So the entire time, they just stood quietly and watched me fumble, I tried to explain what I was doing but I know I was not very thorough. I didn't address this with the nurse manager, even though maybe I should have...I imagine her response would be "this is a teaching hospital". But is it my reponsibility to teach these students?

Hi, I am new rehab nurse and one of my primary patients has over 80% TBSA chemical burn. She has daily wound care: cleaned with a gentle soap and water then tripple antibiotic and xeroform to open areas and A&D to closed. The wound nurse helped me and the nurse coassigned the first day we had this patient and I was told that sterility was not necessary, but then another nurse who helped me one day said that I had to be sterile. Being a new grad and having never worked with a burn patient, I am unsure what to do. I am inclined to do what the wound nurse instructed me to do. I have read that individuals in the rehabilitative phase of a burn injury do not require sterility (???) Also, how on earth do you identify pressure ulcers on a patient who is burned so badly? I worry that my novice assessment skills won't pick something like that up. One more thing...this patient has a foley catheter that the MD wants taken out as soon as possible. The women has open wounds on her buttocks and between her legs and I worried about her skin and it being exposed to urine. Not to mention that bladder scanning would be impossible to check for PVR. Also, I don't think I would be able to strait cath her if she is not able to void because her lady parts was so badly burned. Yikes...I think I am truly in over my head. But can I just tell you that it truly humbles me to work with a patient who has been through so much hell and yet her attitude remains positive.

I have only been working for a little over 2 months now in a rehab hospital and I can honestly say that I have never felt so physically and emotionally exhausted in my life! I work full time days which is great. Like all of us, I am constantly running. I am off orientation now but still feel like I don't know a thing so I come home at night and question everything and try to educate myself on my own time as much as possible. I have a patient right now with burns over 80% of her body...spent 2 hours on her dressings today...and I cannot stop thinking about her and the hell she has endured. I worry about whether I missed something with the other 4 patients I was assigned because I devoted so much time to this one patient. Anyway, that aside... I come home just about everyday from work just bone tired. My boyfriend who lives with me is starting to think I am a lazy sack because I come home and I am too tired to do anything. I go to the gym occassionally...not like before when I had a less physically and emotionally demanding job. I've been eating like crap...but somehow I've managed to lose 5 pounds! And I go to bed rediculously early and still feel like I can't get enough sleep. Is it normal to feel this way? I feel so unbalanced right now but I am too TIRED to do anything about it. My life is revolving around this job! Any advice would help!

I am a new grad RN, too and I can definately relate to some of what you are saying. Maybe you could look into an acute rehab facility. Not as stressful as med surg for a new RN since the patients have been stablized for the most part. I am currently working as a rehab nurse and at first I was afraid that I would lose a lot of my med surg skills but its quite the contrary! I see lots of PICCs, wounds, VACs, trachs, burns, etc. And the patients come in with all sorts of comorbities so you get exposed to a lot of different medications. Time management is something that you become a pro at (not me, not yet anyway!) because you have to plan your day around your patients therapy schedule. And the best part is that you get to develop a relationship with your patients since they are there for at least 2 weeks and the difference you see from the time they come in to the time they go is amazing and rewarding! I am only just beginning my 3rd week off orientation and I find that I am learning so much everyday. I work with a variety of age groups. Since LTC is something you are interested in, but also want med surg experience without that big hospital environment, I thought acute rehab might be something you would like. Keep your chin up! Being a new nurse is tough...hang in there!

Thanks for the words of encouragement. Even thought I am a new nurse, I expect to know everything and when I don't I tend to beat myself up relentlessly. My preceptors last day working a regular schedule was my last day of orientation so I need to turn to other nurses for support. They are all wonderful and encouraging and entertain all of my "stupid" questions. But they are all so busy and sometimes I feel like there is no one to turn to when I have a question. Its definately sink or swim, and I don't know if its like this everywhere. I love the patients that I have, but I am having a hard time adjusting...I still don't even know where to find supplies half the time. Anyway, I am hoping it all comes together soon. I am good about remembering primary dx, but comorbities escape me half the time and when I am questioned, I stammer. Se la vie...I hope I get good at this eventually...Thanks again!

I am a new grad nurse just off orientation (4 days) after 4 weeks with a preceptor at a rehab hospital. I am on a general musculoskeletal/neuro floor and we see a lot of stable post-op patients. One of my patients was admitted with a s/p aortic valve replacement and had a pacer put in for paroxymal a-fib. He was in sinus rythm when he came and up until yesterday there had been no issues. He was taking atenolol 25mg tid and lasix 20mg QD. Three days ago, I held his 1300 dose of atenolol for a bp 92/55 but his pulse was 94. There were no parameters listed so I paged the MD asking for parameters. I never heard back and got busy and well, I just didn't get around to follow-up before the end of the shift. The next few days there were no issues with his BP so I didn't follow-up on the parameter page I had sent the MD. My bad, I know. Yesterday, I took the patients BP and pulse prior to his 1300 dose of atenolol. He pulse felt slightly irregular so I took an apical pulse and got 104 and thought I heard some extra heart sounds. Being a new nurse and not having much experience with cardiac patients, I'm not sure about what I'm hearing. I paged the MD with this info. She came to the floor, saw the patient and asked me if I had him to hold his breath...no, was he having pain...he asked me for pain med shortly thereafter. She said he is fine, his heart rate has been in the 100s. The fact that he was in pain could have caused an elevation and the lung sounds could have gotten in the way of what I was hearing. I felt really dumb. Today the patient was due to be discharged. The MD verbally told me the parameters she gave to the patient was to not take the atenolol if SBP was below 100 and to call his MD. I reinforced this teaching with the patient and wrote it down for him on the teaching sheets we sent with patient and put in the chart. He was due to go home at 1000, family called stating they couldn't come until 1230. At 1220, patient is asking for some pain med so I bring him 1300 meds, too, except the atenolol, because the MD has him starting 50mg BID when he leaves. At 1315, patient was still there and c/o funny feeling in his chest. I took his BP and apical pulse and his pulse was 125 and irregular. I paged the MD who ordered an EKG. EKG showed patient was in rapid a-fib. Nurse manager chewed me out in front of charge nurse, peers, PT/OT and patients for not giving atenolol two days ago and the 1300 dose today when no parameters were written and somehow felt that I was also responsible for the other nurses over the weekend who did not give the atenolol for SBP below 100, telling me that this is what caused his current state. I feel awful and worry that I am not a safe nurse because before today, I thought atenolol was a medication that was primarily used to control BP, not heart rate. I know next time to alway get parameters and to trust my gut. The other thing I didn't do was document the conversation that I had with the MD yesterday about what I thought was my "foolish" assessment. One dose of his atenolol was held by me 3 days ago, and prior to that the weekend nurses held 2 or three doses. Could all of this contributed to this situation? I feel like I really screwed up bad and I need to know if I should feel this way. I worry that after the way my nurse manager spoke to me today I might be getting fired. Thats not the only thing that happened this week where I've screwed up. I had a patient that was getting discharged and the patient left before the MD saw her and there was no order written. MD came down 2 hours after the patient was on the board to leave. I finished my teaching with her, case manager went in, patient left. I did not tell her she could go, nor did I know she was leaving, but I was blamed because there was no order written. I definately feel like I am going to lose my job. 2 big mistakes in 4 days. Not off to a good start. Thanks for listening. I know as a new nurse I am still learning a lot. But I don't want my lack of knowledge to harm someone and I am worried that it already has.

Hi all. I'm a new grad and just finished my first week of orientation on an ortho/post-trauma floor. I am just wondering if anyone else has felt completely stupid and incompetant when they started their first RN job. My first day I went on the floor to meet my preceptor after some classroom stuff and within two hours I think I had done more than I ever did in school. Lots of dressings, trach care, tube feedings, etc. A lot of basic skills I felt so unsure about since in my clinical rotations I may only have had the chance to do certain things only once with an instuctor talking me though it the entire time. I still have never inserted a catheter! Has anyone else ever felt this way?? I don't want everyone thinking I am an idiot when in fact I just may not have had the opportunity to do certain things. I have been trying just to go with the flow and keep an open communication with my preceptor who seems very patient and kind. So far I have had a really good experience with the staff and the patients, I just want to make a good first impression and right now I have no confidence in myself and my abilities.