Seeking Direction

[Ioreth, ADN, RN]

I've been a nurse for about a year and I just passed my 1-year mark on a highly specialized post-surgical unit. I love who I work with, but my unit has had some serious growing pains. We don't keep experienced nurses long, and brand new nurses are pressured into being charge at 6 months of experience. Through sheer dumb luck I have ducked that one. CNA coverage is patchy during the day and non-existent at night. Management oversight is a joke as our manager is also over another much larger and much higher acuity unit. In the year that I have worked here, I have never had a one-on-one conversation with any of the management. Our unit is on paper a step-down unit, but we work with Med-Surg ratios, and we are held to ICU standards. This all creates a great deal of stress among all the employees. I can't think of a single coworker that is not in management that has not either dropped to part-time or PRN or voiced that they are job-hunting. These issues have accelerated in the past year.

I'm also dealing with another problem that is exacerbated by the stress in this unit. I work nights, and I love the flow, the teamwork, the slightly different focus from days, and the managed chaos that comes from surprise ED admits in the middle of the night. Unfortunately, my body doesn't love it. Case in point, I'm writing this at 10 AM local, between shifts, and I really should be asleep. I have teenagers at home and one is special needs and struggling with highschool. Although I attempt to cluster my work days so I can have longer stretches of days off, I have never managed to switch well from being awake at night to being awake during the day, and back. I have this perpetual haze and overall sick feeling that lasts the entire time I'm off and doesn't get better until I'm working, but then I work myself into the ground trying to do it all over again. I was able to cope for a while, but I just can't keep it up. If not for the rest of my life, I would just stay on one sleep schedule days on and off, but as a parent, I can't do that, and I end up not even having a rest of my life. I recently had 8 days in a row off and I didn't sleep more than 4 hours in any given 24 hour period. This is taking a significant toll on my health and family relationships. 

Reluctantly, I asked to switch to day shift. I know this shouldn't be a problem since the unit just lost over half the experienced day shift nurses. Not only are the positions open, they are desperate for them, while night shift is usually in better shape for staffing. At 1 year, I still consider myself new, but I don't need hand-holding and I get it done. I'm a little slow at charting, but I rarely leave late, and when I do, it is always a patient safety issue that came up near shift change. Most of what I need from more experienced nurses are a little guidance when I'm doing something for the first time and a quick check to see if I'm the right track when I get a curve ball. Now I've not been on day shift since my new grad orientation at just over a year ago, so I don't remember how to discharge a patient and I'm a little fuzzy on some of the standards expected of day shift nurses, but with a little direction from my coworkers I'm sure I'll get there, even if it is a little awkward at first.

I never got a reply from my manager. She just ghosted me. This morning, a few days after my request, I caught her when she did her 2-3 times/week check in with the unit which is always early in the morning. She spends the rest of the day on the other, larger unit and is generally much less accessible. She told me she got my email, but didn't think I had the right time-management skills to work day shift. I was completely flabbergasted and I didn't even know how to respond. I haven't had problems getting things done on time since orientation, over a year ago. Sure I'm not as confident or as smooth as some of the newer nurses, and I'm not as good as "faking it until I make it". I do think that I am right where I should be in my judgment, nursing skills, and yes, time management for a 1 year nurse. She made some vague comment about how maybe a position would open up by January, but I may have to wait until March. We'll see. Meanwhile, we have 2 nurses scheduled a couple of days this week to care for a floor that averages 18 patients. She didn't wait for an answer from me.

This unit is a good place to learn because we have our own surgical patients and a good deal of med-surg overflow, so I feel like I can really get good at something while still constantly learning new things. But I don't see myself working here forever. My 20+ year vision of my nursing career culminates with being an in-patient palliative care nurse, likely requiring an NP by the time I get there. I don't think I'm ready for hospice nursing, though that's on my short list, and I don't want to do general med-surg, though I do enjoy the med-surg that I get. I would love to do oncology, and the ideal place for that where I live is in the "other" hospital system from where I work. That gets into a few hairy details as to how much of the 401K employer match I get to keep, but I don't have any contractual agreements to work a certain number of years in my current job. There's a few other nursing specialties I've been drawn to, but oncology keeps coming to the top of the list.

If you made it this far, I apologize for the book, and the length is likely due to stress and lack of sleep. I suppose what I'm asking for is impressions from anyone who has read this thing as to what I should do next. Is it too early to restart the job search? I'm halfway through my BSN, and at only a year experience I'm not sure what I bring to the table beyond enthusiasm. My unit's management is likely to get a shake-up soon, but right now all we have is rumors, and I'm not convinced that a management change would make a difference. I already feel like my current manager doesn't know me and hasn't made any attempt to get to know me. As long as I don't screw up (I haven't, beyond the usual new nurse goofs) or kill anyone (I haven't), I'm not only not on her radar, I just don't exist. I would rather put my energy and efforts into a purpose that at least knows my name. I'm open to all suggestions, insights, and comments. What would you suggest I do?

[RatherBHiking, BSN, RN]

Congrats on making it a year while going to school and raising kids all while working nights! That's an accomplishment right there!

It sounds like you actually like your job and co-workers which is great because many nurses don't have even that. Your biggest issue is the night shift. I was like you, in a perpetual state of zombiness and unable to sleep more than 4 hours at a time on nights. I felt sick and nauseated all the time as well so I understand that. There are many posts on dealing with night shift so maybe something there could help until you can make a change. 

When you say you're a little slow at charting after a year, I'm wondering why. If you're a little slow on charting on night shift then it's going to be an issue on day shift which is a much faster pace. Have you had regular performance reviews or evaluations? I'd think after a year you should have that down put unless it's just you're so swamped you don't have time to just sit down and chart. Yet once again this will be worse on day shift. 

If you really want to stay in this department then I'd schedule a meeting with my nurse manager and tell her you want to know what you need to improve specifically to get to day shift as fast as possible. She will know you are serious about it. Then improve upon those things and in 4-6 months ask again. 4-6 months in the scheme of life isn't truly that long. 

If you don't see yourself wanting to be here forever anyway, just go ahead and apply at some other day shift jobs even on oncology even at a different hospital. Your 401 k investments after one year won't be that significant anyway and you won't lose what you've put it. Most places don't match until you've been there a certain number of  years anyway but that would be the only thing you might lose and it wouldn't be a huge amount after one year anyway. You can roll whatever you have into a new retirement plan at a new place of employment.

You have a year's worth of experience so you have a good shot at getting hired somewhere else. 

If it were me I'd do both at once. Let my manager know I want to do what needs to be done to get onto days faster and what specific concerns she has and what she expects to see from you so you can work on that because that will help you with any job AND apply for and possibly interview for other jobs and just see what happens. If you don't get a job offer then you're already working towards moving to day shift. If you do get a job offer and you feel great about it then go for it! 

Best wishes!

[JKL33]

On 9/11/2020 at 12:39 PM, Ioreth said:

I'm open to all suggestions, insights, and comments. What would you suggest I do?

I would suggest that you lose nothing by checking out your options.

[Ioreth, ADN, RN]

Update:

I talked to a few of the charge nurses and more experienced nurses that I trust and all of them said that I'm exactly where I should be at 1 year experience. None of them think I have a time management problem, and none of them think I would have any problem with switching to days beyond the initial adjustment period. One of these nurses is desperately trying to convince me to stay and not look for a different job. All of the others indicated that they are looking, but being choosy about where they apply.

As for my own charting slow, there's several things going on there. First, I am very thorough in my charting, but I can pull back in a crunch. Second, I'm told by float pool nurses that the amount of charting on my unit is excessive and most of them just flat out refuse to do anything beyond what is in the orders and the hospital minimum. Again, since this is the only unit I've ever worked on, I don't really know any different. I do find myself envious at times seeing the float pool nurses done with charting before any of the rest of the regular unit nurses. This is a goal of mine, to become faster at charting, but it may just not be feasible on this unit.

So over the next week I continued to try to talk to my manager to get better feedback on what she thinks I should improve or maybe just a "Yes" or "No" even if she can't give me a date when the switch would happen. Crickets. Any time I tried to talk to her, she avoided me or ignored me. I tried talking to one of the two assistant managers and she told me that she has never thought of me as having time management issues and that she was also surprised at that feedback. She said she'd talk to the manager, but I never heard back from her. I asked the other assistant manager the following week and he got back to me the very next day. His response was that "This isn't a 'No', but we don't know when." This is at least something. He didn't have anything to say about the time management thing either. 

Meanwhile, two other nurses left abruptly for other jobs. We are now so far down in staff that we cannot staff our unit even on our least busy days. Every night that I'm off, I get an offer to come in for crisis pay. I haven't taken any of these extra days due to just sheer exhaustion. Last week I had two nights where I had double the unit patient to nurse ratio. I'm proud to say that I got everything done on time without overtime or anything being late, but I was so sore at the end of the night. These nights were also without CNAs. 

The most recent night I worked, my manager abruptly called me into her office after my shift. After report and wrap-up charting, I went to meet her. She said that she "didn't know how I misunderstood her when she told me I could switch to day shift". I remember every word of our initial conversation and a clear statement about what shift I would be on was not part of it. Then she went on about how I had problems when I was day shift before and she didn't understand why I would want it since I had hated it. I reminded her that I had never been day shift and I had worked nights since halfway through orientation. She looked at me like she had no idea who I was and continued to insist that I had been shadowed on day shift to identify time management improvement areas. I again replied that she was mistaking me for another nurse. The rest of the conversation was equally strange and one-sided. She rarely let me speak unless she was interrogating me about my sleep habits and what medications I'm using for sleep. She ranted about the poor staffing and how difficult it is to move a nurse from nights to days. She insisted that I would hate day shift because it is so much harder than night shift. She talked about the staffing on her other unit and how that needed to be prioritized. She told me she needed me to come in extra days at least weekly through the next month, the thought of which makes my bones ache and I felt physically ill. She occasionally lapsed back into referring to the fictional time period "when I was days shift". Then she looked at the clock and ended the meeting.

Late that morning she sent me a text of a picture of the schedule with another nurse's name scratched out and asked me if I could work those days. On day shift, starting mid-October. I told her I could, but would like to try switching one day on that schedule due to prior commitments. I haven't heard back. 

I'm feeling torn. I had a few days off between shifts and I just now feel like I'm recovered enough to start updating my resume and other documents for job search. On one hand, I've gone from self-doubt to the realization that my unit manager has no idea who I am, as long as I'm a convenient space-filler on the schedule. I'm no longer self-doubting, I'm angry and offended at these interactions. I know if I was to leave, the unit would be in even worse conditions, and I'm the type that is usually very loyal, but I also realize now that I am not valued as an employee and I have had many missed opportunities for growth as a new nurse. 

It hurts my soul to do this, but I am going to dive into the job search tomorrow (today?) after I sleep. If nothing else, I'll be on day shift during that duration, but I need to get out of this unit.