Should my wife languish in Med/Surg or go to small town ICU?

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My wife has worked in a large midwestern city at *** on a Medical Surgical, trauma care floor for seven months. She has tried to find an ICU/NICU/SICU position at all of the major city hospitals without success. In addition, she has tried to transfer within the hospital, but has been told by other unit managers that her particular unit manager fights intra-hospital transfers tooth and nail and that it won't be possible for at least a year and possibly two. She has been offered a position in the town of *** just North of the large midwestern city in the ICU. She plans to apply for CRNA school in early 2008 with the hopes of starting around Aug 2008 (she will finish her BSN in 2007, and I will graduate with my BSN in 2007, but we plan to "bank" my nursing salary for a year before moving out of state). She plans to apply at CRNA schools primarily in Texas and Florida (although I had urged a move to Pennsylvainia since they have the most schools she has vetoed me on this to this point).

I have advised her to take the smaller town ICU position and work there for six months to a year before reapplying to the bigger city ICU positions. The down side is that she will likely incur the ire of her present hospital for leaving after only seven months and will have to repay $2,000 bonus money. She will also probably make the smaller hospital unhappy when she leaves for a bigger ICU in six months to a year (my hope is that she will at least be able to get her CCRN certification if she stays a year). We are rather aged at 34 and 36 respectively (she being younger than I) so time is an especially relevent consideration. Did I give her good advice? Should she consider going to the smaller ICU and not leaving until CRNA school or not going to the smaller ICU at all?

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I think she should work out whatever contract she has with the large hospital and let her manager, and the director of nurses know she will be leaving at the end if she doesn't get her transfer.

Then make the transfer to the small hospital with no guilt and without having burned her bridges. Work in the ICU for at least a year, and then go to school or transfer out to the unit she wants or to school.

You never know what the future might hold, and burning bridges is never wise.

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Specializes in Oncology/Haemetology/HIV.

She should do what she wants to do and what will be most fulfilling to her.

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Here's why I advised that she change:

1. The contract is for 24 months so she would have another 17 months. Although she was told she could transfer when hired she has since talked to other nurses who have not been able to do so. Indeed, one of these nurses said he has been on the unit for eight years and claims that the manager is giving him a bad reference not only to keep him from transferring, but also so that he is not able to find another job (he actually just accepted a job in another large midwestern city over an hour commute each way since it was the only one he could find).

2. A big part of the reason that she took the job (24 hours weekend only) was due to the promise that she could work an extra shift during the week and get incentive pay (approximately $34.00 rather than the $24.00 she earns for her 24 weekend hours). The hospital has since changed the policy so that you are not eligible to work at the higher pay rate until you have worked at least 40 hours. In addition, there have been almost no extra shifts available on her floor (and she is not yet eligible to cross train for different floors). Because of this she has had to take a second job with a home health care agency two days per week just so that we don't lose our home. I find this ironic given that *** and **** in particular boast about being a "magnet hospital" and therefore a more attractive place for nurses to work.

3. I think that getting "your foot in the door" of any ICU will make getting future ICU jobs. Furthermore, I think that three years of ICU experience looks stronger to CRNA schools even if only one or two years is in a "busier" ICU than does one year at the larger ICU (which is what she will have at most if she completes her two year contract).

4. Carole Belle, obviously she will do that which she wishes however the question is what decision makes the most sense in light of our objectives and situation.

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If they gave incorrect information during the interview about what her options are, and she has found a spot she likes better, I say move on.

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I think that three years of ICU experience looks stronger to CRNA schools even if only one or two years is in a "busier" ICU than does one year at the larger ICU (which is what she will have at most if she completes her two year contract cetarus paribus).

I agree with this statement. I also agree that it is best to avoid burning bridges. I believe the benefits outweigh the risks in this case, but that is ultimately up to you to decide, with your eyes open to the potential risk involved.

(I think what you are considering is not what is best overall, but what is best specifically aimed at anesthesia school admission.)

loisane crna

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Specializes in Critical Care.

It's my understanding that you have to have 2 yrs of recent ICU experience to qualify for CRNA school.

Every year she waits is a year she has to wait for CRNA school.

There are downsides to a small ICU. She will not learn as much as in a bigger one. It's a simple matter of, to quote the TPTB, throughput. There's not as big and varied a turnover in smaller ICU. Also, there isn't as large a variety of staff members, each of which can provide different insights and perspectives. Also, a smaller ICU doesn't have the resources to 'preceptor' as well or long as a larger ICU. ICUs are known for thier clicks or rather, the ummm, assertiveness of the nurses there - it's a side effect of what attracts people to ICU (hey, I'm assertive!) - this is likely to being even more pronounced in a smaller ICU.

But the downsides should be offset by moving towards her goal. She just has to keep an open mind and take some time to learn the lay of the unit.

Especially if you plan to move, I wouldn't worry too much about the ire of 1 employer. But don't be surprised if they try to recoup her bonus from her last check.

Finally, as a matter of semantics, I would dispute that your wife is 'languishing' on med/surg. There are amazing learning opportunities there. The fact that remaining there is contrary to her long term goals doesn not mean that the experience she is and has gained hasn't been worth her time and energy.

~faith,

Timothy.

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I have worked with multiple individuals who when push came to shove didn't have to repay that "bonus" - primarily because it was offered w/ false pretenses - or promises they were unable to fulfill. If she is not happy and is not getting the needed experience she wants - then leave. The truth of the matter is that in the general nursing population - "burning bridges" isn't AS big of a concern - there are nursing jobs everywhere - and might i mention for much more money than what your wife is making. (especially on the east coast.) :)

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I have worked with multiple individuals who when push came to shove didn't have to repay that "bonus" - primarily because it was offered w/ false pretenses - or promises they were unable to fulfill. If she is not happy and is not getting the needed experience she wants - then leave. The truth of the matter is that in the general nursing population - "burning bridges" isn't AS big of a concern - there are nursing jobs everywhere - and might i mention for much more money than what your wife is making. (especially on the east coast.) :)

She is going to make one last stab this week at finding something ICU related at ***. She said that there were positions open in PACU, but I think that even small town ICU walks all over PACU in the experience Dept. (especially given the fact that she will be transferring to one of the larger ICU's in six to eighteen months). I think she's anxious to go somewhere. Last night she said that they gave her four barrier isolation patients again (they generally give the newer nurses the isolation clients) one of whom had an open abdominal fistula from a bad case of necrotizing fasciitis/gangrene. It seems that the previous shift had "forgotten" to drain his fistula bag and when she went to complete the task it "erupted" about eight ounces of contaminated drainage all over her face. It's funny you should mention the bonus being recouped from her last paycheck because that's exactly what her former preceptor warned her might occur last night (personally I don't think that is legal under Indiana law normally an employer must assert a claim independently of pay. For example fast food employers in this state have been found liable for witholding pay for not returning uniforms). I told her if that's a real possibility then simply don't give notice since losing a paycheck right now might very well cause us to lose our home (and me having to drop out of nursing school). She has said that leaving without giving notice is something she's never done and hates to do. However, ultimately I would argue that it is a business decision. In the same way that *** decided to change their pay structure with scant notice she too is making a "business decision" dictated by the demands of her objectives.

As an aside I think her experience illustrates one reason why nursing has a so called "shortage". Working bedside/ especially med/surg at larger urban hospitals is so miserable that a high percentage of nurses quickly leave for something else. As a result hospitals have trouble staffing adequately (espcially when the overall economy is good) unless a nursing surplus exists.

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Specializes in Maternal - Child Health.
Here's why I advised that she change:

2. A big part of the reason that she took the job (24 hours weekend only) was due to the promise that she could work an extra shift during the week and get incentive pay (approximately $34.00 rather than the $24.00 she earns for her 24 weekend hours). The hospital (***) has since changed the policy so that you are not eligable to work at the higher pay rate until you have worked at least 40 hours. In addition, there have been almost no extra shifts available on her floor (and she is not yet eligable to cross train for different floors). Because of this she has had to take a second job with a home health care agency two days per week just so that we don't lose our home. I find this ironic given that *** and *** in particular boasts about being a "magnet hospital" and therefore a more attractive place for nurses to work.

If the hospital has changed its policy regarding extra shifts, then they have altered the work agreement that your wife made upon being hired. I would check with an attorney to see if she is eligible to break her contract without having to repay the $2000.

I am a firm believer in NOT staying in positions that one finds unacceptable.

Good luck to you both!

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