4th Week of Med/Surg Orientation -- First Time in Acute Care Setting -- Help!

Ruby Vee, BSN · Oct 25, 2016

You certainly took on a lot at once! I'm not sure I think that's a good idea, but that's not what you asked. Most people who decide to get the advanced degree to do advanced things in Med/Surg have done some med/surg first. You were in Psych and you didn't want to get the advanced degree in psych? I confess, I'm flummoxed. How do you know you'll like Med/Surg enough to want to teach it?

You're a psych nurse, you know this better than I do. Manage your stress. MANAGE YOUR STRESS! You cannot learn new, exciting and perfectionist things if you're anxious about killing your patient (unlikely -- patients seem durable enough to survive some pretty ugly errors as long as you notice the error and set about to mitigate the damage immediately thereafter) or losing your license (again unlikely -- unless you're diverting narcotics while charting that you're giving them to your patient.).

I hesitate to use this word, but I'm going to anyway. Crazy. Germaphobia is crazy. You're going to run into germs, you're going to take some home and some may rub off on the produce you're squeezing in Walmart. It's just going to happen. A few germs never hurt anyone. Ebola isn't running rampant in hospitals in the US anymore, and most of the germs we have here are easily defeated by a healthy immune system. Your immune system is healthy, isn't it? You're in far more danger from the germs that six year old brings to YOU. Get over the germ craziness.

No one became calm and competent without putting time and effort into it. You're putting in the effort, now give yourself the time. And manage your anxiety. You probably have some very good ideas how to do that.

nrsang97, BSN, RN · Oct 25, 2016

I agree that a change in job and starting grad school probably was not a good thing to do at the same time. You need to give yourself time. It takes time to become proficent in a new setting. You definitely need to manage your stress. Use those skills that served you in your psych position. Being that germaphobic is not healthy. Being exposed to a bit of dirt is healthy. Your immune system will handle what you have been exposed to as long as your immune system is ok.

Remember not everything has to be absolutely perfect.

kiszi, RN · Oct 25, 2016

I get that you're a perfectionist. I can be, too. But you're in most respects a new nurse in a new specialty. Things are NOT going to be perfect, even when you're not so new anymore. There will be many a day where you wish you could've gotten this done or could've done that better or could've given a better report. Rather than beat yourself up, focus on what you can work on for next time.

Be well. Good luck to you.

Libby1987 · Oct 25, 2016

You left a big window for comment so here's mine..

I don't understand how one has a desire to teach something they don't yet know themselves. You want to teach people how to be nurses before you know how to be a nurse yourself (or at least well rounded and able to function outside of a narrow specialty and actually have the wisdom and experience to lend). Like, I want to learn how to ride a horse so I can teach others how to ride. Usually one would learn to ride before they think themselves good enough to teach others. The aquired skill comes before considering teaching it.

I suppose traditional teachers could be put up as an argument, but they are reading proficiently long before they graduate themselves and their training is more geared to learning how to teach reading rather than learning how to read themselves.

It's kind of a naive arrogance to me.

I would just want to be able to perform the skills myself before entertaining any thoughts on teaching it to others. It wouldn't occur to me to do otherwise.

Good luck in your orientation, it would certainly challenge me.

happy.persimmon, BSN, RN · Nov 17, 2016

Greetings! Thank you so much for your comments, I appreciate them and the time you took to write them. I think we nurses are blessed by a forum where we can express ourselves and be supportive; allowing ourselves to be vulnerable and explore together. So thank you so much; I hope no one ever takes this forum for granted.

Agreed, I did take on a lot with the new job, grad school, and moving, and the jumbled mess that it was has begun to finally straighten out. I do not see myself making a decision like that ever again if it can be helped. We live, we learn. Life is like cooking; you experiment and try new things, and sometimes they are amazing and sometimes you want to put as much distance between you and the monstrosity on the stove. I can finally laugh at the last month and a half, and shake my head without being stressed. :)

Yes, being a psych nurse helped A LOT. I recognized that I had many cognitive distortions, so I was attempting to put the facts in front of me to revert myself back to realistic thinking. That helped! Also, one of the ways to combat my anxiety was through group therapy, and without a physical group to do that with, I sought out this forum. And I'm telling you, I felt so much better after reading multiple posts and posting this original post that the next day at work was one of the best days I had, and I didn't even see your responses yet! And it wasn't that the workload became easier, but the anxiety was finally expressed and addressed so that it wasn't clouding my thinking anymore. Great things happen when we put our feelings into words so we can truly identify what is happening.

The germaphobia also decreased to a reasonable level, at least what I consider reasonable. Some of the staff think I'm odd for wiping the keyboard with sani-wipes before using them. But, hey, I'll do me and they can do them. No biggie. As long as we can all work to the best of our abilities and be comfortable. Those keyboards are nasty, but am I going to freak out if I don't wipe it and start typing on it? Nope. However, if I have the time, that thing is going to get wiped, flipped, and rubbed down. No shame, no game.

As for being hard on myself, I'm still a perfectionist, but I'm learning to give myself time. My course instructors would not have allowed me to move forward if I was not competent or safe. My preceptor is great, super detail oriented, and he also wouldn't be allowing me to move forward like I have unless he thought I was capable and safe to do that. I have so much to learn, but I look forward to that process. Reading different posts on this forum and your replies have been very helpful, as well as my preceptor's encouragements and much prayer.

As for going into grad school in acute care vs psych, I left out some information that I probably should add in. Psych was always interesting to me, but I was not interested in psych as a career. I loved my acute care rotations as a student, especially when it came to wound care, cardiac units, and oncology. Those units peaked my interest and I did very well in them! The goal was always to work in one of those areas or at least with those demographics in med-surg, ICU, or the ED, but as a new grad, you take what you can get and I was blessed to have a psych nursing job open up. I don't regret the time I spent there, as now I can communicate and build rapport with patients quicker than I ever had before along with other amazing results. Also, through the psych clinic there was a lifestyle program clinic which they had me work part time for a diabetes and cardiac program while there, and working that demographic was rewarding beyond words and only made me more interested in working with them more.

While I was an undergrad in my last quarters of nursing, speaking with different faculty and to the dean of my nursing school, as you do, I shared with them that I was open to where to go for graduate school. I knew that I definitely wanted to move forward and continue in my education, but I didn't know where I would see myself flourish (for lack of better word). I knew I didn't want to be a CRNA or NP, but I knew I wanted to move forward. So I figured I would just become a wound care nurse while maybe being a public health nurse on the side, to be involved with acute care while also helping different communities learn healthier practices. Or even working in a correctional facility, though with its risks it also had its rewards. Each one of the individuals I mentioned above encouraged me to consider teaching in the hospital and institutional arena. I loved teaching and led many groups on campus and in the community, but I had never considered teaching in nursing. So to hear about that opened my mind up to different possibilities, especially in a field that truly sparked my interest.

Do I think I'm one hundred percent qualified to teach at this very exact moment, NOPE. However, I don't think that nursing students are qualified to be nurses while still enrolled in undergraduate nursing school either. Qualification is made up of the training, education, and experience, and all those come with time and effort. I spoke to my academic counselors, asking them if this was the right time for me to go into grad school or whether I should wait a few years and gain more experience. I spoke to faculty members, some having waited until they gained at least five to ten years of experience until they applied for grad school, some having gone into grad school straight from undergrad with zero experience under their belt. They ALL reassured me that I would be just fine especially since I had already a year of psych/primary care under my belt (with primary care being where nursing and healthcare in general are heading anyway), and would be getting acute care experience as I was going through grad school. Grad school will take me about five years. I plan on working in the acute care arena for a majority if not the whole of that time. So I will have around six years of RN experience before I'm even done. That's promising! Which also means, that if I wanted to start a family, I wouldn't have to worry about finishing too many years of my education since it would already be done. Stress management, baby!

Do I expect myself to be more qualified once I graduate, well I certainly hope so. Whether that still leaves me as someone naive or arrogant is something I will leave for others to decide, but all I can do is my best and strive for the goals I have set. I don't have zero experience, I just need more which I am getting, and I thank you all for your feedback to encourage me as I go through these experiences which we all go through at some point.

Thanks again for your time. Hope these posts were as entertaining as they were revealing. I appreciate the feedback and I hope that your nursing experience continues to be rewarding and full of adventure!

Blessings and prayers!

Been there,done that, ASN, RN · Nov 17, 2016

"So here I am, starting grad school AND starting a new job on a Med/Surg floor"

You need to chose. Which is it sister? You can't do both.. God does not give a rat's pattotie. it's up to YOU.

happy.persimmon, BSN, RN · Dec 2, 2016

thank you for the input, and it was not a wise decision nor do I recommend it. :)

HouTx, BSN, MSN, EdD · Dec 2, 2016

You seem to be a very high energy person - I really admire that.

I have been a (non-academic) educator for plenty one years. I can't think of a better job in the entire healthcare universe. We're involved in all facets - from the executive suite to the bedside. Every "improvement" or process change has an educational component, so we always have a seat at the table. We need a very broad skill set to keep all the plates spinning. In addition to mastery our own discipline, we need to be competent in the discipline of education, we have to have in-depth knowledge of employment law, health care regulations, instructional design, etc. I also design and develop eLearning, administer a very complex Learning Management System, so high-tech skills are a must.

On my (non-academic) side of the fence, career progression is always a step-wise process. No one hires education leaders who have no relevant experience. Most of us begin as unit-based inservice coordinators or CPR instructors... moving on to become service line/specialty educators, department directors, and so on. In my organization (like most others) MSN is entry level for full-time staff education roles. Salaries are comparable to other leadership positions - in large organizations, 6 figure salaries for the (frequently doctorally prepared) education leader are not unusual.

Welcome to my world! I'm glad you came.