CareerStudent10

I too am a new grad nurse. I am working in a trauma one CVICU. This coming week will be my fourth week off of orientation. I completed a 12 week orientation and I was previously a nurse extern for one year on the unit while in nursing school. I have seen experienced nurses with several years of experience in med-surg, ER, and even other ICU's come to this unit and struggle. Even now I go to work every shift with the fear of God in me. These types of units are not for the faint of heart that's for sure. I agree with several of the previous respondents in that your first step now is to have a realistic discussion with your manager and educator. It is not impossible for them to offer a lengthened orientation for you if they/you feel it could be beneficial. In regards to feeling uncomfortable on the unit or with the patients (new admits, surgical pts, crashing pts etc.) you, as I do, will continue to feel that way for the foreseeable future. As far as the assessment issues go, as you feel more comfortable the processes will start to become second nature. You will begin assessing the whole room, situation, monitor, patient and even visitors/family without even realizing it. The only other advice I have is to be proactive in everything you do. If you have an issue/question and your preceptor is not available there are multiple other resources on unit. Pod charge, unit charge, senior nurses, NP/PA, resident, fellow, etc. One of my preceptors told me something early in my externship that I have thought of at least once per shift as a nurse. I asked him if he thought that I should let the Dr. know about a change in a patients status relating to vitals. He said, "It is always ok to ask and to inform the team, it is not ok to miss something". Hopefully you will be able to figure something out that will be beneficial for you and the unit as a whole. Lastly, I have never heard of only eight weeks as an orientation in the ICU. Did you complete a classroom based portion first? Critical care classes etc? Best of luck!

When I began in CVICU I found that researching various medical device companies was very helpful in understanding the basic mechanism and functions of each device. Companies such as abiomed, syncardia, thoratec, medtronic, etc have excellent resources readily available. Edwards lifesciences also has an excellent YouTube channel with information ranging from swan-ganz placement and waveforms to flotrac and vigileo calibration. Depending on the services available in your specific hospital you may have a structural heart team, a heart failure team (for VAD/transplant workup),a transplant team, a cardiac surgical team, vascular surgical services etc. Often times various services are consulted for a single patient with one primary service managing care. I have learned a great deal from asking the providers and mid levels questions as to why treatment progresses one way or another. With the experience you have you will be able to recognize changes in patient status and identify patient needs. If you have a device or something you have not seen before ask the charge or another experienced nurse on the floor for tips/advice. I have also always asked what to do in a worst case scenario situation. Even now, every shift I mentally run through a code in my head. Whether it is clamping a disconnected ecmo circuit or turning an impella down to P2 during compressions. The more you float there the more comfortable you will feel. Hope this helps.

I find this to be an interesting topic as I am a male nurse who is also a new grad. I went back to school for an ADN after working in inpatient mental health/Social Work for several years. My wife is also an RN with a BSN. My wife makes more than I do simply because she has more experience. We both work in the same health system currently but have been employed with several in our area. Of the five hospital systems we have worked for between the two of us there are no pay rate differences between men and women. There are formulas in place that account for years of experience as well as education level. Gender has never played a role in our salaries in other positions in healthcare either. I am glad to say we have never seen this type of inequality.

I am currently in nursing school and working full-time as a mental health tech in a 6 unit stand alone psychiatric hospital. I currently work on our high acuity men's unit. I have worked at this hospital for about 2.5 years now and I began working on our child and adolescent unit. I have to say that the majority staff in the hospital I trust my life with. In terms of working in psych as a new nurse, I have seen that it is important to set boundaries with patients, staff and with yourself. It is important for us in a therapeutic environment to understand our own limits. It sounds as though you handled this situation well by reaching a compromise. It is also important to be aware of the dynamics of the milieu. I seen many times where one or two patients can change the environment and move the focus from treatment to chaos. I have also learned that many of my patients have been in the mental health system for years. These patient are fully aware of what to say and do to obtain what they want. I constantly remind myself that if it were not for those of us who are able to come to work every day and take care of these patients they may not have any other options. Every day is a new day and an opportunity to make a difference. Keep up the good work!

Having left a full time job at Costco in Marketing to begin nursing school and to work as a behavioral health technician I can tell you it takes about 10000-12000 working hours to get to the top of the scale with incremental raises every 1000 hours or so. The amount of hours depends on the year you start and the 3 year bagaining agreement you fall under. If you are part time you can expect about 8-9 years or so to get there. You have to start at Costco contingent pushing carts or assisting (boxing groceries) during the holiday season. Education does not matter whatsoever. If you are good enough they will keep you on contingent or part time. When I left in 2014 the split of full-time to part-time staff was about 50/50 in each of the three warehouses I had worked in. If by chance you got a full-time position you are still looking at 5-6 years to reach the top of the scale. Oh and when I started after being hired from a contingent position, I worked four evenings part-time at five hours a shift. 4pm-9pm making 12.75hr. I also started out pushing carts through November and December. (with plenty of snow) They do give you free hand and foot warmers and even let you use the snow blower. It is really a great company, but you must put the time in. No one goes there is just paid 21hr.

As someone who left a job at Costco in Outside Marketing to pursue a career in nursing, I would have to say that the the grass may not always be greener on the other side. This is actually my first post here as I am a long time reader. I have worked in human services for many years and began working at Costco on a contingent basis over one holiday season for a bit of extra money. Inside of one year I had been hired in part time, full time and then promoted to a clerk position. I had worked at three different warehouses and excelled in marketing/membership sales. I left my job with the local community mental health agency as well as my part-time position with a local school district in their post-secondary autism program. I was working full time for an excellent company (costco) in which I was guaranteed a raise every 1000 hours worked and ultimately received up to $4000 of a biannual bonus based on years of service. At this point I had seen many employees who made an excellent living with no options outside of Costco. One of my direct managers was a mechanical engineer by trade who had left the industry as a result of economic downturn. He began working as a forklift driver for Costco and never returned to his chosen field. I had met many talented young people who began working at Costco in college and never left because they made a decent living at Costco. In terms of income my previous position would have topped out at about $25 hr with time and a half on Sundays each week but no real over time. I am currently in nursing school and my present employer starts entry level adns at 27.96. I feel that Costco is an excellent company and I would still be there if it had not been for the opportunities I have had to work in inpatient psychiatric treatment and begin my nursing program. The dilemma for Costco employees is that their only option for a career change is within the same company. No other grocery store will pay you $25 to run a register. As a nurse you have many more options. If you don't enjoy the position you are in, you have the ability to change it. I have heard of Costco termed "The golden handcuffs" from employees. This is in reference to the fact the people hope to do other things with their lives/careers but they end up staying at Costco. Now make no mistake, I love Costco and I greatly enjoyed working there for the time I did. I still shop there weekly and purchase the majority of my household items there. It seems as though the question of whether or not an individual is satisfied in their current role has to with perspective. I know that when it was December and filled with hundreds of holiday shoppers, I was working in the warehouse waiting for the day to end. Oh and pushing carts in a snow storm... not the most fun I've had. In my current role(s) as full time mental health technician and full time nursing student I am busy to say the least. I have been assaulted by patients more times than I can count and I have had issues with clinical staff and physicians at times. However, I am currently doing what I love. I understand that the population I serve needs people to advocate for them. I understand that my choice to work in psychiatric treatment is not for everyone. My wife-who is also in nursing-works in the medical intensive care for the same health system. She has a job that i have no desire to do at this this point in my career. She in turn has no desire to work in behavioral health. This is the beauty of the profession of nursing. I hope that you are able to find a career that you truly enjoy whether it is inside or outside of nursing. It is great that you have empathy for your patients. I would encourage you to work to define your patient/practitioner relationship in a manner that allows you to continue to perform your daily responsibilities. Providing high quality care is vital to the treatment of our patients.