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Discussion

Seeking Advice - Please!

Hi all! Before I get started I want to thank all of you for taking the time to read this and to let you all know that I'm stuck at a crossroad with no idea how to proceed, I apologize beforehand if this post is a bit lengthy.

So, I will be graduating with my RN in August, prior to this my work experience has been; 7 years as a CNA with 3 of those years being in the ED. Currently I'm working as an LPN on a set-down ICU unit (almost 1 year). My goal (3-5 years from now) is to be a Flight Nurse, and possibly waaay further down the road - look at PA/NP school.

I know in order to do flight I need a few years of ICU experience under my belt, and I would prefer to work in the ER as well for a year or two after that just to be confident in myself and my skillset. I have been offered positions on two different units; burn and respiratory intermediate.

Currently I am completing my internship hours on the respiratory intermediate unit - they deal with complex lung diseases, transplants, trachs, recently extubated/hard to wean vent patients, optiflow, and everything else in between that deals with respiratory. I get along well with staff and like the complexity of patient cases that I work with- however according to the recruiter who is handling my application, although the unit is part of the 'Intensive-Intermediate Service' division- it is not actually considered an 'ICU' and it is seen as a step-down unit.

Burn is a highly specialized ICU- with any burn patient that is admitted to the hospital immediately bypassing the ED completely and being taken straight to the unit. Nurses on this unit handle traumas, intubations, ventilated patients, dressing changes, hydrotherapy, IV meds, PT/OT, etc. pretty much daily.

(I'm sure you can see where I'm going with this)

I also have my position secured on the current unit that I am on - as I would simply transition into an RN role. On my unit we see a wide range of patients (CABGs, lobectomies, pneumo-/hemo-thorax, MVAs, patients on drips (amio, dilt, heparin, insulin, etc.), psych, ETOH, etc...) anything that you could think of being admitted to the ICU comes straight to us after they are deemed well enough. The only problem with this unit is turn-over, we've had too many nurses to count that have left during my short time on the unit- and most days we're stuck with 5-7 patients. Which would be fine under any other circumstance - except a lot of these patients are high acuity.

Another minor detail is pay; I work weekend package at my current job, the pay that I make now is significantly higher than the pay Burn/Respiratory is offering me. I would be taking a major pay cut and working more hours for overall less than what I make now every pay period. Not to mention the other two positions are at a hospital that is 45-50min away from home and I have to pay for parking.

It essentially boils down to experience vs. pay, the internship RN I follow says that this will be experience I gain anyways, over time, that I should consider trying to negotiate with either unit to see if either one offers me a better deal but....I don't know what to do. What would you do in this situation? Would any of the three units (or two - Burn/Respiratory) be more favorable considering my career path? Please help! Any advice is appreciated, and thank you for taking the time to read this!

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    I'm a bit of a dinosaur but I've never been in favour of minutely planning one's life way into the future.

    It sounds like your current situation works for you quite well, if you can handle the stress of high acuity and short-staffing.  Do you have any assurance your other opportunities will be adequately staffed?

    It would be a shame to have to deal with the same stressors (not to mention commute and parking) for a drop in pay.  It also sounds like your unit gives you all kinds of experience that should stand you in good stead for whatever you decide to do next.

    Is your current situation "broke" enough to need fixing?

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    I would stay put. Learn the RN role in the unit you are on. Plan one year at a time... you are going to far out. A lot can happen in that year.

     For me, a long commute and a cut in pay is not worth any additional experience you could gain, yet.

    In the end only you know what is best for you.

    Best wishes.

     

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    • Author
    1 hour ago, TriciaJ said:

    I'm a bit of a dinosaur but I've never been in favour of minutely planning one's life way into the future.

    It sounds like your current situation works for you quite well, if you can handle the stress of high acuity and short-staffing.  Do you have any assurance your other opportunities will be adequately staffed?

    It would be a shame to have to deal with the same stressors (not to mention commute and parking) for a drop in pay.  It also sounds like your unit gives you all kinds of experience that should stand you in good stead for whatever you decide to do next.

    Is your current situation "broke" enough to need fixing?

    Unfortunately the staffing issues on our unit are only getting worse - we haven't been able to hire any additional nurses because any new applicants/hires hear how bad our turn over is and end up accepting positions elsewhere. We're looking at hiring 4-5 travelers but even so - it will take a few months to get them onboard. 

    It's gotten to the point where we've been put in dangerous situations; a lot of nurses have made the comment that something will end up happening either to a staff member or to a patient, before serious changes are made to the unit. 

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    • Experts
    9 minutes ago, SummerNurse said:

    Unfortunately the staffing issues on our unit are only getting worse - we haven't been able to hire any additional nurses because any new applicants/hires hear how bad our turn over is and end up accepting positions elsewhere. We're looking at hiring 4-5 travelers but even so - it will take a few months to get them onboard. 

    It's gotten to the point where we've been put in dangerous situations; a lot of nurses have made the comment that something will end up happening either to a staff member or to a patient, before serious changes are made to the unit. 

    That's horrible.  I take it you don't have a union so you have no unsafe staffing forms.  But all is not lost.

    Research "safe harbour" legislation.  Even if there is no such thing in your state, you can still provide written notice that having made all appropriate requests for help, you are now accepting an unsafe assignment under protest.  You state that you will do your utmost to provide care but you cannot be ultimately held responsible for negative outcomes.

    Keep a copy for yourself, give one to your manager and ideally you give one to whomever your hoadd pital answers to.

    You will likely get flak for doing this, but it is an ultimate license-saver if anything hits the fan.

     

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    I would think that the varied patient population of your current unit would be more of an asset for your long term plans that the highly specialized patient population of either the respiratory or burn unit.  You will end up with exposure to a much more diverse range of diagnoses where you are than is possible in a more specialized setting. 

    Turnover and higher than is ideal patient to staff ratios seem to be pretty common on any floor nowadays so if that is something that will affect your decision unless you know for a fact that either respiratory or the burn unit are much better than you are now I would take any statements from the nurse managers about ratios and turnover with a grain of salt. They are not going to bend over backwards to tell a prospective employee that ratios are awful and staff turnover is high. 

    Besides that factor in the longer commute and the lower pay either alternative offers and my advice is to stay put unless you find something about either one of those positions so compelling that you just really want to try it. 

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    Lots of good advice here. First of all, flight nursing is a goal of many people. It's a really prestigious and cool sounding job. I have a friend who is a flight nurse. I have high respect for flight nurses, they are the ultimate Hot Shots.

    What you need to do is concentrate on your next step. If you are interested in ICU, stay put. I personally would never go to a burn unit. That is very stressful work and many of those nurses are subject to burnout. Of course you would learn a lot about procedures, many of which are excruciatingly painful. Fluid management is of the utmost concern with burn patients. But, as others are saying here, it is highly specialized.

    The respiratory unit sounds interesting but it is also highly specialized. If I were you I would stay put.

    Although flight nursing is a really cool goal, if I were you I would get my feet wet in nursing and take it from there. 1 gal I know ended up having a baby in scaling back her nursing career a bit. I know of another fellow who was very qualified but just wasn't able to get the job. There is a lot of competition, and it boils down to the fact that they want someone that they like since there is a lot of downtime in the station while they wait for calls. If they hire somebody who is not easy to get along with or does it fit in with the group, things don't end well.

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