Traumatized by nursing - advice needed

[kcsun3]

Hi all,

I apologize in advance for the long post, but I am devastated right now and need some guidance. While I have never been a big poster here, I have been an avid reader of this forum for over 5 years. Those who know me will appreciate the irony of my story.

I am a new grad (May, 2004). Nursing was a dream of mine for as long as I can remember. When my children were old enough, I started to consider nursing school. I read everything I could, made a web site to share the information I found and sought to encourage others. I even wrote a book and was hired to write a weekly advice column for nursing students and potential nursing students (very ironic...). Once in nursing school, I set up a mentoring program, pairing alumni with interested students. I organized a peer tutoring program. I held game show challenges to help junior students through the bewildering first semester. I coordinated the junior-senior "buddy" program. I was passionate about nursing and wanted to support others on the same journey however I could.

I did very well in school, but knew that the real learning was to be had after I graduated. Great grades do not automatically equal "great nurse." Great nurses become so only with experience. Knew all about the stages of reality shock, nurses eating their young, yadda, yadda, yadda. But the idealist in me held out hope that a positive attitude, a willingness to ask questions, a willingness to jump in and try, and a desire to learn would be...well...helpful at least.

First job out of school: I went to a large metropolitan teaching hospital and worked on the pediatrics unit weekend nights. Horrid. While I was blessed to have a great mentor/preceptor, I dreaded going in every shift. I spent most of the week recovering physically and emotionally before heading back in again. It was so stressful, I had six MS attacks in 6 months. Never called in sick until the end...just carried on as best as I could.

My second day off orientation, I was floated to the NICU - the NICU! "Oh, they'll only give you feeders and growers - you'll be fine." Yeah...no orientation to the unit AT ALL - we did computer charting, they did paper charting. Their equipment was different. Their protocols were different. Their patient acuity was higher (obviously). I asked the charge nurse for a brief tour of the unit at least before diving in...but she was busy. I was stuck in a side section separated by a WALL from the rest of the unit by myself - no other staff there - with 3 NICU babies getting complicated (to me) drips. Again I asked for help - charge nurse said she would be over in a minute. She came over 6 HOURS later, and of course I had done everything wrong, not having the first clue about NICU. I just thank God the babies didn't suffer any harm. Scared the crap out of me.

Anyway, the rest of my stay at that hospital was horrible. More floating to NICU, with a devastating near-miss. I did not have the option to NOT float, so I started calling in sick on nights when I was going to be floated. On my own unit, I was given patients whose care needs were way above what I felt comfortable or even remotely competent with (i.e., chemo patients without having had any chemo classes, etc.). My self-confidence dropped and dropped and dropped. Each week was worse than the last and every day my license was on the line.

Then, out of the blue in December, I received an e-mail from the manager of a hospice where I had done a clinical rotation. Hospice has always been my nursing dream - I love everything about it. She wanted to hire me on, said they loved me during my rotation and that I had a great future there. I was so excited - here was a way out of the hospital and into a job where I could be the nurse I had always hoped to be. I called my preceptor from that rotation to tell her the great news. She told me that she no longer worked there, and said, "Don't do it...That hospice will use you, burn you out and drop you." Did I listen to my mentor? No...

So, I quit my hospital job - didn't even work out my notice, which I have never done before - but I was terrified that I would lose my license - so unsafe there! On I went to hospice, heart filled with joy and elation. I should have listened.

I received all of 2 days of orientation, riding around with another nurse, and then was handed my caseload and sent out on my own. On my own, out in the field, with just 6 months of nursing experience under my belt. Can you see the disaster waiting to happen? I asked for support, help, guidance - anything - but my supervisor, manager and peers were all perpetually swamped and not available. I tried my very best, worked as hard as I could, researched every diagnosis, all the appropriate interventions and tried to expand my knowledge fast enough to be able to meet the needs of my families. It just wasn't enough.

Friday, my supervisor called me in for an afternoon meeting. I asked what was up - she said, "I would rather talk to you in person." Not good...not good at all. As I feared, I was being asked to voluntarily resign. She said she knew I had tried really hard, but I didn't yet have the confidence or strong personality needed for being out alone on home visits with no support. She felt bad that I hadn't received a decent orientation, but they just didn't have the time to do that. They needed experienced nurses who could hit the ground running. Of course this makes sense - obviously! But then why did they seek me out and hire me in the first place? I should have seen the red flags, but I was so excited about hospice...

I am devastated. What do I do now? Where do I go? I shudder at the thought of going back to a hospital setting - I am still traumatized from my first job. In fact, my confidence in my nursing abilities is so low right now, I am terrified to start again. I cannot get a reference from my first nursing job, and I am not so sure on the second, either. Any guidance or suggestions would be greatly appreciated. I just don't know what to do, and I am broken-hearted.

Steph

[crjnursewarrior]

Hello there KCSUN...

I read your post on your traumatic experience as a new nurse. My heart goes out to you. I had a similar experience five years ago after graduating from nursing school and beginning my first job. I was taught, in nursing school, that if you needed help, all you had to do was ask...hee hee hee! That's funny, looking back on it now. I took my first job at a long term care facility,,,not my dream job, but close to home...the first night I worked was an experience close to yours. The nurse who was "orienting" me was an ex-Army nurse...she said that she had found that the best way for a nurse to learn the job was to go do it...on your own. She sent me on med pass by myself. The one time she did come to check on me was when I was going in a room to administer an insulin injection. I was putting on my gloves and she said "Why are you putting on gloves? It's not like you're starting an IV!" I told her that I had been taught to wear gloves with any invasive procedure, including SQ injections and that if it was all the same to her I would continue that practice. Needless to say, she and I never did see eye to eye...I worked there a total of 3 months...my suggestion to you in your search for a new job is to be honest. Look for a place that encourages lengthy orientation(I know...that may be an oxymoron in today's nursing market), but shop around, be choosy. And tell them right up front in your interview that you feel you need considerably more guidance than what you have been given, and explain to them what happened to you at the other jobs. If you are up front about explaining why you left those other jobs and why they may not give you a glowing reccomendation then I think any other prospective employer will understand. Especially since it sounds like, to me, that you are very intelligent and thorough, and that those other two jobs probably cannot complain about your actual job performance. It sounds like you did a really competent job. You just don't have the confidence yet that will back up your competence. That will come with experience. You will meet some nurses (and other people) in your career that will inspire confidence. You will meet others who only seek to criticize. Wipe your feet on the mat at the door before you leave work after your shift and leave it there. Hope this helps! :)

CRJnursewarrior

[Dixielee, BSN, RN]

Hummmm, you have yourself in a pickle now, don't you? Do you think you can get a decent reference from the hospice since they seem to be aware of the problem being you did not have the experience needed. Maybe a nurse refresher course or an internship would be available. I would hate to see you continue to spiral downhill on the self esteem ladder. Your story is exactly why I always advise new grads to do at least a year of general med surg. Specialty units are just that....special, and require special knowledge for special situations. While med-surg is not easy by any means, you will have the opportunity to see a wide variety of situations both acute and non acute, and will be handle the specialities later. It gives you a chance to see how the flow of the floor goes, learn the lingo, fine tune your skills, learn to prioritize, etc. without so much pressure.

I think if you are honest with a recruiter, come with some good references from school, some of the things you did in school and ask for a chance to gain some confidence and skills, you will be well accepted. Good luck. Nursing is tough, I will not discount that, but you can do it if you have the will to do so.

[Heartman]

Dear Steph,

I agree with crjnursewarrior.

We all have bumps in the road. Dust yourself off and keep trying.

You need to shop for a good orientation program.

I've neen a nurse since '81 and I'm sure I wouldn't have been comfortable in a hospice situation with my own caseload without a proper orientation.

I recently changed from a general MICU/SICU/CCU to a Cardiac SICU. I had never taken care of open heart pts. before and needed orientation. I started in early January and am just getting off orientation this week. The nurses in this unit are very proud of the work that they do and want to make sure that the new guy (me) is up to their standard of care before they let me go it alone. Even though I am presently comfortable taking a post op CABG I know that if I run into trouble I have people around me to back me up.

I guess what I'm trying to say is that there are places that have good orientation programs and supportive staff. Keep looking and I'm sure you will find one.

Walter :redbeathe

[kcsun3]

CRJnursewarrior,

Thank you for your warm response and helpful advice - it is greatly appreciated. I am also encouraged to hear that you were able to move beyond your initial negative experience and on to something better. Thank you for sharing that with me *hugs*

Steph

[kcsun3]

Hi Dixielee,

Thank you for sharing your advice and insights - it is greatly appreciated. My hospice supervisor said I could use her as a personal reference, and I know that I can call on several faculty members and the dean at my nursing school. The hospice folks gave me a listing of all the job openings at the hospital they are affiliated with, and said that they would help facilitate a transfer over if I let them know what I am interested in by next Friday...

I don't know though...while it is not the hospital I worked for previously, it is the hospital where I did most of my clinical rotations. The staff did not seem to be very welcoming of new grads and it has not gotten a good review from my cohorts working there now.

Your solid advice is the gold standard, I know...but I really did not like working in a hospital setting, and there's the rub. Can I do anything without 1 year of hospital experience? Thanks again...I value the input.

Steph

[kcsun3]

Hi Walter,

Thank you for the pep talk and encouragement - I appreciate it greatly. I hope that I can find a place with a good orientation and supportive staff - and I am glad to hear that there are such places out there. Sounds like you work with a great bunch of nurses, and that is encouraging :)

Steph

[Dixielee, BSN, RN]

but I really did not like working in a hospital setting, and there's the rub. Can I do anything without 1 year of hospital experience? Thanks again...I value the input.

Steph

I can't think of anything that comes close to a year of med surg in terms of pure experience. Almost any job you can get outside the hospital would be easier if you had a solid foundation. I am afraid if you did start something outside the hosptal, i.e, office nursing, public health, etc. you will never gain the skills you really need to succeed. Maybe I am wrong, but I have done home health, and while it has been said it is "easy", I am here to dispute that. You need every bit of your assessment skills. You are going into a home with NO back up. You need to be confident that if you hear rales on your little old lady, and call the doc for a lasix order, that she really needs it. You must rely on your skills or you will miss some subtle signs.

I have worked dialysis, again, a stong background in med surg will help you pick up changes before they become life threatening. Of course, with ER, ICU, PACU etc,. you must have a strong base to support you.

I guess it depends on your long term goals. If you would be happy being an office nurse for the rest of your life, then by all means, bypass the foundation and move on. But this is your best opportunity to learn. All new situations are scary. I have been a nurse for 31 years and have worked in a variey of settings. I have been traveling for almost 5 years and am apprehensive at the beginning of EACH contract. It is not unusual to question yourself, that is healthy. But don't run away from the many opportunities nursing can offer, because you are afraid of failure or you don't want to do hospital nursing. Maybe you need to consider it "paying your dues", sort of an internship.

Are there other good hosptals in your area that you can check out that may have better orientations. Teaching hospitals are usually pretty good at offering good ones. Good luck. I may be all wet and others may have better solutions, but I just don't think you can beat a good med surg base.

[Hellllllo Nurse, BSN, RN]

Steph,

Many, many of us have been through similar situations. I hate to say it, but what you describe is pretty much how nursing today is.

This is why the California Nurses' Assoc is so active in trying to change things. This is why there is a nursing "shortage".

When I read posts from some of the many people on this site who have good careers in business, computer science etc., who are planning to leave those fields to go into nursing, I groan. I feel that many of them will be where you are now, and will really regret giving up their current jobs for nursing.

I've been a nurse for 12 years. If you really want to stay in nursing, my advice is to be really tough. Do not let any employer or manager push you around. If you are promised an orientation, insist on getting the full orientation. Absolutely refuse to work otherwise. This business does and will continue to chew up and spit out nurses.

IMO, the only way to make it is to be very assertive, and stand up for yourself at all times and in all situations.

Good luck to you.

[Hellllllo Nurse, BSN, RN]

By the way, Steph-

I worked in med surg at a horrible hospital for 3 mos. I've never been back to the hospital setting, and I now have a well-paying career as a travel nurse.

As I stated, I've been a nurse for 12 years.

A year experience in med surg is a great idea, if you can find a tolerable job in med surg. If not, you can still have a career without med surg experience. I started in sub-acute rehab, and moved around to different areas in nursing from there.

[kcsun3]

Hi Dixielee,

Good advice and insights, as before - thank you. There are many hospitals in my area, but...gosh, I need to really think this through. 12-hour shifts have a significant negative effect on me physically I found - more so than I ever expected. 8-hour shifts would be more conducive to my health, but I'm not sure if any of the hospitals around here allow 8-hour shifts any more.

At any rate, my career interests hover in three areas:

* Hospice

* Teaching

* Research

I was accepted into the BSN-to-PhD program at the state university this Spring and deferred my start to the Summer of 2006 (felt I needed to get experience in the profession before pursuing graduate studies of any kind...) - but that is my road map to teaching and research.

Need to figure out what I should do now, in the interim...thinking, thinking, thinking...

Thanks again for your advice - I really do appreciate it.

Steph

[gerinurse10]

Are there any inpatient Hospices in your area? I went to one right out of school because I couldn't find a job in a hospital (no shortage in '94). I had a great orientation, didn't stay there because Hospice just wasn't for me. It was the best experience I had and I was taught by some of the most compassionate nurses around. Good Luck!