Switching units

Ruby Vee, BSN · Nov 24, 2018

I'm not sure if this is the right forum. Here is my background I'm an experienced ER nurse with my CEN. Recently (in September) I moved from my small level 2 hospital to a well known level 1. I was thinking I needed a change due to boredom and a level 1 would give me the learning and experience I was thinking I needed.
Now while I'm becoming comfortable there I'm still not feeling satisfied. Granted all the critical medical and trauma patients go to the bay which I cant apply for until I hit 6 months. Good policy but not what I was expecting. So I'm babysitting psych and low level 2s and 3s which makes for an easy day but adding to my current burnout.
I'm really interested in pursuing another speciality specifically OR/perioperative nursing. I've come to find I like critical cardiac and would be interested in CVOR in the future. My faculty is an LVAD and high risk cardiac surgery facility. How soon would it be appropriate to apply to an OR position since I've only been with the ER for 3 months? I don't want to burn any bridges and I want to stay with my current hospital for the benefits.
Thanks for the advice!

Your employee handbook should give you the guidelines for transferring to another unit within the system, but your manager (and HR) probably won't be happy with you if you apply for transfer after less than a year. Three months is definitely too soon.

You have been an RN for less than a year and a half, at most. So you're a newish-grad in your second job, looking to transfer into your third. I have very little sympathy for anyone with under two years of experience in the same job complaining of boredom. If you're bored this soon, you're not doing it right. Do you understand the medications of every patient you see: use, including off-label uses, dosing, administrations, side effects, toxic effects, drug interactions, diet interactions and precautions? Do you understand each and every lab value of your patients, including why this lab is being run on this patient at this time and what the result is telling you? There's a lot to learn in your present job. Stick it out for a full year, learn as much as you can and start developing contacts in the OR or the cardiac ICU. When your year is up, you'll be positioned for a successful transfer.

stoli914 · Nov 24, 2018

Thanks for the response however after 6 years as an army medic, 5 years as a paramedic and 8 years total in the ER I understand I'm a "newish grad" in some eyes as an RN but I've been in this environment for quite a while. I was planning on waiting at least a year. I was not looking for sympathy, I wanted an answer from others who have made the switch, not snark. I'm guessing you looked at prior posts of mine when I was stuck trying to take my NCLEX after finishing school but dont mistake RN education for lack of experience and knowledge.

I not only understand most of what you mentioned but also had to make the call on my own when I wasnt an RN. I can anticipate orders and confidently make suggestions countering a doc. I started in the ER because I was already working in the same ER and it was an easy transition.

JKL33 · Nov 24, 2018

So you have 3 more months until you can apply to work in the trauma/CC bays? Have you decided that is something you're no longer interested in?

I mean this sincerely when I say introspection is rarely the wrong answer in these situations. I would've written a reply along the lines of Ruby's; I agree with it. Maybe your self assessment is accurate, but common things being common, it would be more common for there to be a least a little bit that can be learned, and when people claim there isn't, there's a fair chance they don't know (or don't care about) what they don't know.

I'm not defensive of the RN role (I have my own serious qualms with it), but you can expect to encounter some offense/affront in real life if you're going to approach nursing with an idea that you already know most of it based on your past experiences. If your mindset is that you are "babysitting" every time your adrenaline isn't pumping, that will emanate from you and others will be able to perceive it. If you're not interested in learning any more about ED nursing, that's fine - - but know everything, you do not.

If it's just a matter that the ED was the easiest/most likely first RN position to obtain due to your previous experience, that's okay/understandable. But why not complete a year or so at your first nursing position? You can train in the trauma bays in three months - that will add a little more variety to the rest of your time in the ED. You also have to consider not just what people would think of you leaving the ED, but also what people will think of you telling them you want to come to the OR because you've mastered the ED in 3+ months' time of being an RN and are bored.

There's a post in one of the other subforums about someone worried about a possible poor reception in the hospital world d/t a long history in pre-hospital care. The advice was "Don't be that guy, [the guy who hip checks people out of the way 'cause he knows how to intubate, boo-ya!] and you'll be fine." I think in your situation you also don't want to give off any vibes remotely similar to that. You say you don't want to burn bridges. The best way not to do that is to get in there and learn, with a mind to excellence in knowledge and attitude.

Take care -

HomeBound · Dec 9, 2018

Hmmm. Soooo. I didn't take OP's post as anything even resembling "boo-ya I can intubate, therefore I am da bomb".

What I read was ....this Level 1 has a rule that prevents him/her from being in the trauma bays---for six months. OP is experienced and certified to do this job.

I have worked at a Level 1 that had this ridiculous rule--and it was because of a clique. An overbearing a*****e who ran the three bays, micromanaging, videotaping, spying, forcing the ones he did deign to "allow" into the trauma bays to do pretty much nothing but inventory 4 times per day--every cart, every bag of NS, every band aid in every cart, EVERY DAY. When a trauma came in....those RNs were nothing but one huge bag of destroyed nerves. He would swoop in "to the rescue" and make sure everyone knew how stupid they were and how great he is.

The OP is experienced and there is nobody who can say Medic or EMS doesn't give you a really good basis for what trauma RNs do. In fact....one Level 1 I worked for....the RNs were LITERALLY....put in a line, do a foley, hand over chest tubes/set up drain, put pt on monitor. The rest....the meat....was done by residents, fellows and attendings....specialists and their crews....and we were clean up or extra hands. Documenters.

She already said...."I am sitting psych or have 3's and 4's". Yeah. Pretty boring stuff when you have several years under your belt, whether you have that precious, all mighty RN after your name or not. Sorry. I didn't transform into a Super Human just because I got my RN. I had EMS as well as many, many years in trauma in another profession. My RN, CEN didn't change that one whit.

So....OP?

Level 1 isn't what you think. I actually wanted to step DOWN from Level 1, because this is what you get---cliquey groups who keep all the exciting stuff to themselves and make you "work for it"----because it's their turf and their resume and their ego. When you work a Level 2, maybe a critical access or inner city---you will get everything ....dumped at your doorstep and you are it, baby. There is no resident coming to push you out of the way and do that I/O. There ain't no RT sitting on standby to dial in that vent. You are primary and maybe you'll get a tech, maybe a second set of hands...but usually not. You and the doc. Is this what you're looking for? If it is...Level 1 ain't gonna do it for you, not for many, many years. The egos already there will make sure of that.

ICU is challenging. Any ICU. If you are in a Level 1, they usually have several...MICU/SICU/STICU/CVICU/CCU. Pick one and do a shadow. See what they do. It's intense. 1:1 usually, and these people are razor's edge all the time you have them...because if they weren't....they wouldn't be there in the first place.

I saw Level 1 Charges put experienced RNs on psych sitting duty...and it usually was because the core group of lifers felt threatened by said RN. The more interest they showed in trauma, the more they were shut out. Especially if they were good---or had military training. The egos in a level 1 are.....over the top.

You won't lose your ER experience if you change to ICU. Go and quietly shadow a couple of units....and talk to the NMs. I did the same thing and just very quietly left the ED behind. Never regretted the change. The collegiality is very apparent in the ICUs, because they need you to succeed. The ED....well....honestly.....the way things are going nowadays...I do know if I had wanted to be a psych RN, I would have applied to BE one. ED's should not be holding psych patients for weeks at a time (saw that a lot at my former level 1)---but they are---and with lack of leadership or cliquey units hoarding all of the exciting/learning cases---you as a new to the unit or threatening to the resident egos---are going to get stuck there. Your skills rusting away. They don't care about that. They have their core crew that does the traumas, and you aren't getting inside that room. That's the reason for the rule. As an experienced trauma RN, you will get frustrated and bored....and most likely leave. No skin off their noses. Next.

Stick with what you want. If you want challenging....go and find that challenge. If it's not in the ED...then I would suggest ICU. Different world, but extremely challenging. You won't be bored there.