Stuck in an unfulfilling position

[RockinNurse2018]

For nearly two years I have been working in a SNF. And, while it's allowed me to develop some basic nursing skills and work with some good coworkers, it's just not satisfying. It's busy, it's hard work...but something is missing. The majority of my shift is spent passing medications, mostly oral medications. Occasionally a new skill will come up but it is rare. It's not challenging my critical thinking or expanding my knowledge. I was working on some advanced cardiac CEUs...and those were quite fascinating. Organ transplant is interesting as well. Problem is, I'm unable to break into an acute care setting. It's frustrating because my current nursing position is not what I'm looking for, but I can't get anything else. Anyone else relate? Any suggestions are appreciated. Thanks!

[Ruby Vee, BSN]

Why can't you break into an acute care setting? Lack of opportunities? No acute care setting within a reasonable commuting distance? Not getting interviews? Getting interviews but not getting job offers? Getting job offers but don't want to take them because the hours don't suit you? Your question is to vague for us to help you.

[RockinNurse2018]

There are several acute care settings in the area with many jobs available. So opportunities aren't lacking, or don't appear to be anyway. I had a couple of interviews, neither of which resulted in a job offer, with no more interviews since. The only feedback I've gotten is they are hiring someone more qualified.

[KatieMI, BSN, MSN, RN]

There was/is a user with nickname "purplegal" who started several discussions about the same subject. There were tons of good advices from other users, as the situation is common and far from hopeless.

Overall, it comes to:

1) Network, network, network

2). Get ACLS/arrythmia/ECG course/PALS/whatever required for acute care nurses in your chosen specialty and keep them current

3). Explore "borderlines" (LTAC, acute rehab, chronic respiratory SNF with vents), which are easier to get into

4). Go into a different specialty which would give you access to acute care . There are plenty to choose from, from dialysis to hospice to outpatient centers. The key should be an opportunity to develop contacts with acute care and develop new skills. It might be not a direct shot. One might need to spend a couple of years in outpatient HD before moving into acute one

5). If have to contact acute care in your current position, like when calling report to ER or rounding with providers, be friendly, efficient and super-useful

6). Become an expert in one thing you have and like to do right now (for example, wound care or care for demented patients), then make it a hit point for your resume

7). If you are brave enough, join an agency supplying staff for short-term assignments. Start from acute rehab, then move on as you feel your skills developing

8). If nothing else works and you are desperate enough, use recruiters and move for a year or two for experience

9). Do not go right up for "fascinating" things. Get at least a couple of years of "normal" med/surg before jumping into transplants

Good luck! You are not the only one who was there - you won't be the first to do it, either.

[RockinNurse2018]

There was/is a user with nickname "purplegal" who started several discussions about the same subject. There were tons of good advices from other users, as the situation is common and far from hopeless.

Overall, it comes to:

1) Network, network, network

2). Get ACLS/arrythmia/ECG course/PALS/whatever required for acute care nurses in your chosen specialty and keep them current

3). Explore "borderlines" (LTAC, acute rehab, chronic respiratory SNF with vents), which are easier to get into

4). Go into a different specialty which would give you access to acute care . There are plenty to choose from, from dialysis to hospice to outpatient centers. The key should be an opportunity to develop contacts with acute care and develop new skills. It might be not a direct shot. One might need to spend a couple of years in outpatient HD before moving into acute one

5). If have to contact acute care in your current position, like when calling report to ER or rounding with providers, be friendly, efficient and super-useful

6). Become an expert in one thing you have and like to do right now (for example, wound care or care for demented patients), then make it a hit point for your resume

7). If you are brave enough, join an agency supplying staff for short-term assignments. Start from acute rehab, then move on as you feel your skills developing

8). If nothing else works and you are desperate enough, use recruiters and move for a year or two for experience

9). Do not go right up for "fascinating" things. Get at least a couple of years of "normal" med/surg before jumping into transplants

Good luck! You are not the only one who was there - you won't be the first to do it, either.

Thanks! May have to check out those threads.

Also thanks for the reminder to not jump too far ahead of myself. I found that I was understanding the CEU presentations, but obviously real life application could be different. Plus there's no reason why I can't apply some of that information to my current position. We do get patients with cardiac diagnoses but they are usually pretty stable; probably a good time to really learn all the medications they are receiving while they aren't in such critical condition. Also I probably should remember transplant patients are generally very sick so you either really need to know what you're doing or be an extremely fast learner. At this point, I'm pretty competent at caring for a large number of relatively stable patients but maybe not so much unstable. I also probably am not ready for the steep learning curve that comes with critically ill patients.

[Ruby Vee, BSN]

Thanks! May have to check out those threads.

Also thanks for the reminder to not jump too far ahead of myself. I found that I was understanding the CEU presentations, but obviously real life application could be different. Plus there's no reason why I can't apply some of that information to my current position. We do get patients with cardiac diagnoses but they are usually pretty stable; probably a good time to really learn all the medications they are receiving while they aren't in such critical condition. Also I probably should remember transplant patients are generally very sick so you either really need to know what you're doing or be an extremely fast learner. At this point, I'm pretty competent at caring for a large number of relatively stable patients but maybe not so much unstable. I also probably am not ready for the steep learning curve that comes with critically ill patients.

You have a really good grasp of the possibilities here; something that wasn't evident in your first post. The very first thing I would advocate is applying your knowledge to your current position, and acquiring new knowledge that you can also apply to the current position. Learn about the pathophysiology of cardiac disease, pulmonary issues, renal failure, etc. Apply that knowledge toward your patients. Learn the medications, the interactions, the side effects, the toxic affects and know them inside and out. In doing that, you'll find you have a natural affinity for liver problems, for example, or cardiac or cancer. You might also find that limiting yourself to just one specialty would feel too restricting so maybe you want Med/Surg or Medical ICU rather than cardiac or renal.

The idea of becoming an expert in something such as wound care of demented patients or de-escalation or skin care for renal failure patients is a great suggestion. Katie has a number of great suggestions.

Take purplegal's threads with a grain of salt, though. She's solicited a lot of advice; doesn't seem to be following an of it. So look at the responses to her posts more than her posts. There's a lot of good information there.

[KelRN215, BSN, RN]

I would say think outside the acute care box. There are many opportunities in nursing that aren't SNF or acute care.

Home care is almost always hiring. LTAC would get you closer to acute care than a SNF and could be a stepping stone to acute care if that is your goal. Private Duty Nursing is also always hiring and could give you more skills like vents that could be a stepping stone to acute care if you spin it the right way. I do agree with Katie that your best bet is to network. Get on LinkedIn if you aren't already, recruiters will contact you if you mark yourself open. I get contacted all the time but don't respond to most recruiters since I'm only interested in pediatrics but there might be an opportunity that hasn't even occurred to you. I didn't apply for the job I currently hold, for example, I applied for a different job with the company and then when the General Manager saw my resume, he contacted me and asked me to interview for this position.

[RockinNurse2018]

You have a really good grasp of the possibilities here; something that wasn't evident in your first post. The very first thing I would advocate is applying your knowledge to your current position, and acquiring new knowledge that you can also apply to the current position. Learn about the pathophysiology of cardiac disease, pulmonary issues, renal failure, etc. Apply that knowledge toward your patients. Learn the medications, the interactions, the side effects, the toxic affects and know them inside and out. In doing that, you'll find you have a natural affinity for liver problems, for example, or cardiac or cancer. You might also find that limiting yourself to just one specialty would feel too restricting so maybe you want Med/Surg or Medical ICU rather than cardiac or renal.

The idea of becoming an expert in something such as wound care of demented patients or de-escalation or skin care for renal failure patients is a great suggestion. Katie has a number of great suggestions.

Take purplegal's threads with a grain of salt, though. She's solicited a lot of advice; doesn't seem to be following an of it. So look at the responses to her posts more than her posts. There's a lot of good information there.

Yeah, I noticed that poster seems to go back and forth in her posts. But like you said, other posters offered a lot of good advice. Also thanks for the reminder to keep my mind open. While I have some units/specialties in mind, they may not become reality or there may be a better fit out there. 22 months of working as a nurse isn't necessarily enough time to decide where I want my entire career to go. So, for now, I'll try applying my new knowledge to my current position, and just keep looking for other opportunities to arise.

[RockinNurse2018]

I would say think outside the acute care box. There are many opportunities in nursing that aren't SNF or acute care.

Home care is almost always hiring. LTAC would get you closer to acute care than a SNF and could be a stepping stone to acute care if that is your goal. Private Duty Nursing is also always hiring and could give you more skills like vents that could be a stepping stone to acute care if you spin it the right way. I do agree with Katie that your best bet is to network. Get on LinkedIn if you aren't already, recruiters will contact you if you mark yourself open. I get contacted all the time but don't respond to most recruiters since I'm only interested in pediatrics but there might be an opportunity that hasn't even occurred to you. I didn't apply for the job I currently hold, for example, I applied for a different job with the company and then when the General Manager saw my resume, he contacted me and asked me to interview for this position.

Thanks for your suggestions! My networking skills are not currently strong but maybe that's something to work on