WestCoastSunRN

I am saddened to read you are dealing with such a situation. It is amazing and scary the kind of power others can exercise over us - especially when we are just doing our thing - the thing we are supposed to do. I'm glad you have the confidence that things will shake out as they should in the end. I understand what it feels like to be vulnerable in needing the check mark, approval, blessing, buy-in, agreement, etc.... of someone who may have a very different view of things than yourself. It is a lesson to me of how I want to be when I am the one holding the strings, pen, reins, power, etc. I know you hold to the same convictions. My good vibes come in the way of prayers - and you have them!

It can be a challenge for laypersons to vet the extent to which their providers deliver care based on the best evidence. And this is why watchdog organizations such as Joint Commission and other accrediting agencies are important to public safety. For the healthcare consumer, at some point you need to be able to put your trust and confidence in something/someone. That said, in the day of information-at-your-fingertips via anyone with internet access, many choose to put their trust in foolish anecdote because it is easy to find support for any number of personal beliefs that way. I am convinced there is nothing, on a global level, to be done about this as it reflects 'the other side of the coin' consequences of personal freedom and choice.

Well said and thank you. I, also, am an APRN getting my post-masters DNP. I did think about a PhD, but at the end of the day, I want to be a clinician who is prepared for translating research and leadership in community and population health. Because I am an APRN, my clinical hours must include expanding on my clinical practice by working toward/attaining clinical skills I did not get (or need) to graduate with my MSN. That said, my didactic DNP classes are leadership and research focused. It is all material I did not get in my clinically-focused MSN. My school has a separate DNP track for those with non-APRN MSNs, though many classes are shared in common. Now would I make adjustments to the curriculum? Yes. Do I think it should be like the PhD or put me at the same level as an MD? No.

First, if you are using your real name on AN, you need to change it. Secondly, nursing is a very difficult gig, such that we are not really prepared for it upon graduation. Night shift is really difficult on the body if you are not built for it (most are not), so you need to really implement healthy strategies for doing the best you can until you can get a day shift position. You need to take a deep breath and talk to your charge nurse if you feel the assignments are not fair. Really, you should be doing that before going to unit management about it. I doubt you are "burnt out". I think you are dealing with the reality of the job with this particular patient population. And it is tough, for sure. That said, there are supportive and non-supportive nursing environments and we cannot tell by your post where yours is on the continuum. But regardless, inpatient nursing is HARD. The first 1-2 years of professional nursing is HARD. These are facts. What you are hearing from co-workers is that, yes, the job is difficult and you won't feel confident in it for awhile. I am many years in. I do not know, on any given day, what awaits me when I get to work. I have been kicked, spat on, punched, groped, grabbed, cursed at, and even had a patient try to strangle me with IV tubing, once. I do not think to myself, "Gee, I'm super experienced so I shouldn't have to deal with this crap, anymore". I have cried in the bathroom, and prayed all the way into work on many, many occasions. I have cried in the shower when I get home. I know what you are talking about, and I would still choose this profession over again - for all the reasons and probably more, than what made you go into it in the first place. So if it is a pep talk you need, there it is. If you have a toxic work environment, (for real) that is different, but what you described sounds like a "day-in-the-life" typical experience of not only a new nurse, but thousands of nurses everywhere.

Great discussion! I agree, collaborative agreements don't bother me and I do not want to be out "on my own" in a provider role - even as a niche/specialty CNS provider. I do, however, want my salary to reflect the additional years of schooling - AND - I really think it should reflect the years of experience I have in nursing - bc I am an advanced practice nurse. One of the problems with APRNs is that the salary discourages nurses who have put in real time at the bedside to return to school. And yet, most nurses (I think) really value the idea of a somewhat seasoned RN in the APRN role. As for the DNP - yes, it is diluted. I am also attending a very reputable state school for my DNP, and I am determined to get my money's worth. So I am doing a clinical residency outside of my own specialty (and actually clinical hours are a requirement for my program, tho I guess these are different for non-APRN students). My capstone is no joke, either. In fact, the idea for my capstone was the impetus for me pursuing the DNP. But it shouldn't be a "it is what you make it" thing. As a profession, we can do better. Thanks for the topic!

This wins post of the week.

I am a fairly accomplished ICU nurse. I'm still a bit fumbly, awkward, and slow sometimes, dexterity-wise. I remember when I first started nursing, it was comical - me priming and setting up tubing, or getting ready to put in a foley, checking all my meds, mixing meds... but it got better relatively quickly just because at work (unlike school) I was constantly doing these things. Now, I graduated school in the dark ages, and "orientation" looked a lot different then - so there wasn't someone hovering (though there should have been) to see me bumbling about - so I saved face that way. But, really, don't sweat it, and don't worry about what others are thinking/saying right now. I know it's not fun to think that anyone on your team might be annoyed or impatient with your learning curve, but in new grad nursing (esp. ICU) the curve is steep and it's to be expected and the more veteran nurses are going to have to get a grip (they know this). You WILL get better and faster. Also, look at this time in your career as a way to learn how to do things safely and efficiently - the habits you develop now will be hard to break later.

I would abhor such a commute before or after a 13 hour shift. If you want to stay at mom-in-law's house for two nights - maybe that's an option, but for me ... driving that commute would be untenable.

This is the stuff healthcare reform should be made of.

Social media is a big big deal - for ALL professions. Nursing schools and hospitals are figuring out how to leveredge it to their advantage. Those nursing students are likely being encouraged to post what they do. Quite honestly, I think nursing, as a profession, should make the most of social media - it's here to stay. We do ourselves no favors by being the quiet, subservient handmaidens to the physicians and others (who are also posting on social media) - for some kind of 'honor'. Also, the "I'm-too-cool-to-be-excited-to-be-a-nurse" thing is tiresome. And I'm a (sorta) old nurse. I have every reason to be jaded and suspicious and tired, - but I try not to be - that is not who I want to be, ever. And, I post very little on social media about being a nurse, but I'm not going to knock it.

Well I'd go with the adult ICU and here's why - if you can cut it there and you still want to do peds later, you can do it. In my experience, adult-critical-care nurses are welcomed into the peds world a little more readily than the other way around. Also, I think the best time to work on your current peds floor as an RN - is AFTER you have spent some time in the work-world away from them. It is exactly for the reason you suggested - the transition from seeing you as CNA to nurse will be difficult for them. If you leave on good terms and go get some bonafide experience under your belt, they will be MORE than happy to welcome you back because: 1. You left on good terms 2. You left to get critical care experience 3. If/when you come back - you are coming back solidly as a nurse (with some impressive experience) in their eyes. Time away will help them disassociate you from the CNA role. 4. If/when you come back - it is an obvious huge compliment to that peds floor - that you would want to come back to them even after having other experiences. Not very many people can do both kids and adults and/or have experience in both. It may end up being a pretty highly valued skill set for you later down the road.

Wow. Reading this makes me angry on your behalf. I agree, you are NOT burned out. You are experiencing the moral distress ANY of us would in these circumstances. I hope you can find a new position soon. In the meantime, I echo the notion that you continue to stand up for yourself and your patients. It is the RIGHT thing for you to do. If nothing else, hopefully you will leave this unit and those who manage and work in it, with a solid understanding of what it feels like to be called out on unprofessional, unsafe, and unhelpful practices. By "calling out", I mean - escalating these unsafe situations up the chain of command until they are dealt with appropriately, exercising boundaries ("I can work this, not that", "I can be a sitter for one patient, or I can care for a group of patients that either have sitters or do not need them" -- sitters by the way are sitters bc they are one-to-one). And the CNA who pulled you aside ..... oh my. You are very kind in your assessment of that situation. I would have given her a "professional learning opportunity" right back. I hope you have some nursing friends in your life that you can talk to about this. What you are experiencing is not normal, not acceptable, and needs to be addressed by someone with the power to do it. That is not you, so I suggest you move on and wash your hands of it at your earliest opportunity.

What a refreshing post. A nurse who likes her job! Looks like you've found your niche - at least for now. You are young in your career - you can always branch out and try something different later - or you can just keep being a rockstar expert in m/s nursing. Others have said it well - m/s nurses are the backbone of acute care - hands down - and finding m/s nurses who are really good and experienced and passionate is like finding diamonds! By all means, get certified. I think you will have an even greater appreciation for what you do (and your knowledge) after studying for and passing the certification exam.

Hi! Very cool that you are doing Telehealth in Washington from Florida! (That's what I understood?) If I got that right, you are licensed in WA - and that is how you are allowed to do the telehealth visits? I ask, because since COVID many previous over-state-lines restrictions have been lifted to make telehealth more accessible. Has any of that impacted your practice, or do you see how it might (ie., allow you start seeing patients in other states?)

So to clarify, can you tell us briefly if they knew they would be intubating this patient when they assigned him/her to you? And why did the patient need to be intubated? When the intubation was happening, were you alone with the intubating provider and expected to know how to assist with the intubation - or were there other team members there with you? Were you left with this assignment after the patient was intubated and on the ventilator? Your situation may have been unsafe, indeed. I think the question here, and the crux of the whole issue of floating non-ICU staff to ICU - is what can/should be expected of a nurse in that situation - and how does that compare to what was expected of you?