Transferring with 6 months experience?

[Rainbow_RN, BSN, RN]

Hey all,

I have been at my job since July 2018. I am on a busy ortho/geriatric med/surg floor. I know some people have a more difficult time so I don't mean to complain. And I love my co-workers and patients. But my ratio is consistently 6:1 and up to 7:1 lately. I feel unsafe taking 7:1 but I've had to, due to either being the most experienced RN besides the supervisor or nobody else being able to pick up.

I have had two coaching forms, which go on my file. One is for not following up a blood pressure and the other is for not removing a nicotine patch. I am worried about this paper trail. I'm not sure what these forms exactly entail but I feel like 2 is a lot & I'm making mistakes like this from being rushed or not sleeping. I have also forgotten to scan narcotics before administration once recently, and remembered hours later, which really worries me. For all I know they might drug test me for that (it will come up clean but still hate the thought of making mistakes like this).

I don't know if I'm worrying too much or what.

Normally our organization allows transfers after one year. I think it is one year from hire date, but it may be one year since I was assigned to the current floor. Rarely they will make exceptions. I'm told these "coaching" forms will not affect a transfer but I am unsure.

I think I want to transfer to a different floor that I trained on at the beginning. (Edit: that floor is surgical & has a 5:1 ratio or rarely 6:1). I'm afraid I made the wrong choice..I only got 2 weeks per floor to decide. I don't think that's enough to really know what I wanted.

Do you all think I should see if I can transfer early? I have extreme anxiety about going to work because I never know what I'm walking into. I lose sleep and then I make mistakes. I haven't eaten a full meal at work since orientation. Sometimes I don't even snack. I drink a lot of really strong energy drinks and I'm worn out. Please send advice. I need to know if these are real concerns or if I just need to suck it up.

Thanks for reading if you got this far.

[Ruby Vee, BSN]

I don't think you should transfer early.

What you are describing is what we used to call "reality shock". Nursing school doesn't really prepare us for the reality of being a nurse. It takes about a year with a new job -- any new job -- to be comfortable. In nursing, it takes about two years to be come competent. (Patricia Benner's book, "From Novice to Expert" may offer some insight.)

I had a rough start to nursing -- I was the first BSN hired at Mediocre Medical Center, a smaller community hospital that boasted their own diploma program. (Obviously, this was a long time ago.). The diploma grads hit the floor running -- their clinical were 8 hours a day three days a week, and their capstone class was team leading. As a BSN, I'd had 8 hours of clinical a week, with one patient at a time. I had no time management skills to speak of -- no other skills either. But I had plenty of book learning and I aced the licensing exam. (Called "state boards" in those days.)

I didn't know ANYTHING when I started, anything that wasn't in a book. The lovely nursing assistants I work with taught me everything they knew, and then the LPNs started teaching me what they knew. With my BSN, I was supposed to be a team leader, and I could barely function as a team member. I was anxious before work, after work and especially during work. I'd hide in the employee bathroom and cry when I had to do an injection, because I was so afraid I'd hit the sciatic nerve and doom someone to a lifetime of pain. I wasn't confident in my assessments, which was good because I wasn't competent, either.

I learned -- it takes most people about a year. Some of us take a little longer. About 15 months in, something "clicked" and things started falling into place for me. I understood what I was doing and why, and instead of just doing tasks, I was caring for the whole patient. Once that happened, I was less anxious and the crying, worrying and sleepless nights tapered off. I was a whole lot happier and more pleasant and my colleagues suddenly became "nicer".

The transition from student to nurse is miserable, and we've all been through it. The only way to GET through it is to GO through it. Stick it out for a year or so. (A year after your orientation finished.). Then decide. You'll also be a much better candidate for the floor you want.

[TriciaJ, RN]

First of all, lose the energy drinks. They're just making it harder to sleep than it already is. Just hydrate and try to get in a little protein when you can.

Your 2 write-ups or "coaching forms" are laughable. If those 2 things are the worst mistakes you'll ever make, you'll have a much more stellar career than I ever did. If you're currently the most experienced RN on your unit, they will certainly be reluctant to let you transfer. They need you. The Mickey Mouse write-ups may even be an attempt to make you stay put for awhile. (But don't mind me; I see ulterior motives everywhere.)

Other than that, RubyVee gave you excellent advice. Hang in there. It does get less overwhelming.