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

[jnette, ASN, EMT-I]

The title of your post is close, but not quite accurate. I doubt that you were traumatized by nursing. You still love nursing, don't you? Otherwise, you wouldn't have been such a proactive student.

Would you have loved your job if you had had the proper orientation? I think you would have.

I'm only being nitpicky because you're (rightfully) upset and because you have just learned something about nursing that nurses have been trying to fight for many years now--management sets the goals, management dictates the numbers.

It hurts us. It hurts the patients. And nurses have no power over it. It's thrown us into an adversarial relationship with our employers. We have to fight for our patients. We don't have time to fight for ourselves.

All I know is, we at the bedside need nurses like you. You're green. Your post proves to me that you are not incapable nor incompetent!

You're green.

And there's hope.

Pretend you're developing another clinical skill--it takes a couple of times to get certain skills right, as you know. Make it a challenge. Trust me, it's like riding a horse. This is not the time to go back to school. This is the time to declare war on your inexperience and become the nurse you were meant to be.

Call this clinical skill--Survival. It's a complex one, involving several of your competencies.

Your research skills are needed to get you into the best possible clinical setting. Look for nurse longevity. Some nurses stay due to inertia, but if you see a pattern of many nurses staying for years, it's probably because they love where they work.

Usually, you'll find the types of problems that you encountered with for-profit facilities. So a non-profit might be better.

Try hospitals with Magnet status.

Be assertive, as someone else said. Don't accept less than you were promised, and get those promises in writing. Float to another unit? You can't refuse?

Yes you can! It might mean your job, but it won't mean your license. My first job tried to float me from Med-Surg to Tele without orientation or experience. I went. Duh. It took another new grad to talk to our manager and get us out of that.

So look where I work today! That's irony. But I chose to make war on my inexperience, and got the orientation that I needed. I was on orientation for a few weeks, then preceptored for a couple of months, and now, we have a mentoring program that rocks. So getting all this stuff is not impossible, ok?

In reviewing your post and seeing all you have accomplished up to this point, I'd like to add a couple of other things.

I'm not the best nurse in the world or even on my unit. There are many others on my unit that are clinically more capable, more intelligent, and have a better personality. That doesn't mean that I can't have the goal of doing my best, whatever my clinical level of expertise is at the time.

You've been dreaming about this for too many years to let it go. You had different ideas about some things than you actually encountered. So you now have a choice--to remain Nurse-Ideal, or get real and be Nurse-Beginner.

I'm here on the other side to tell you that Nurse-Ideal always looked good to me--until my first successful Code. Then I was hooked. Still scared s***less, but hooked, and ready to deal with the realities of nursing.

You'll never be more involved in a job--body, mind, emotion. You'll never imagine how far you can stretch, physically, mentally, spiritually. But it can be done.

Yes it can.

And if ever there was a new nurse who I really believed could do it, my dear, it would be you.

Best wishes, whatever your decision.

Absolutely beautiful post, and I couldn't agree more. :)

ksun3... from reading your original post, I must say I was deeply touched, deeply moved.

You HAVE what it takes.. and THEN some. I can see that, so can the others here. Now YOU just need to see it ! Do NOT be defeated.. do NOT allow anyone .. any hospital, any management, any situation to defeat you. Stand up for what you KNOW about yourself, stand up and fight for your dream !

There IS a place for you, and you SHALL find it ! And I know that you will excell ! :kiss

[llg, PhD, RN]

I have had a few traumatic experiences in nursing as well and know that it can take a lot out of you -- and take a long time to fully recover emotionally. I know how hard it can be to have to struggle to "save your career" at a time when you are emotionally exhausted. I'm happy to read that you are getting some of the emotional support that you need now from other participants in this thread ... because right now, you need to dig down a little deeper and find what it will take to put your career back on the right track.

I'll share 2 lessons that I have learned through my long and sometimes tumultous career journey that might help you. You might not like it all ... but I hope you understand that I am giving it in the spirit of being helpful and supportive in a way that only someone who "has been there" can.

1. You need to take some responsibility for your previous troubles in order to avoid making the same mistakes again. Regardless of how "unfair" and/or "unreasonable" the floating to the NICU was, you need to acknowledge that you did not successfully problem-solve the situation. I recommend going back over it in your mind in detail to identify things you could have done differently. You said you had a great preceptor/mentor. If she were that great, why wasn't she helping you through this situation? Why did you wait 6 hours for the NICU charge nurse to come to aid? Did you have meetings with your manager and/or eductor about it? Did you adequately document your concerns to the appropriate people in the hospital?

While you may not have been able to "fix" the situation, a different approach may have left you feeling a lot less traumatised. You might have been able to resign your position in a way that would leave you with your self-respect and self-confidence intact. As it was, you snuck around, calling out sick to avoid your job assignment and then leaving without without giving proper notice. A different approach to problem-solving that situation may have improved things a bit -- and if not, it might have given you a better ending to your first job.

You need to learn from the mistakes you made in that first job so that you can be a better problem-solver in the future. Every job will have it's problems. The people who succeed are the ones who can work through those problems in a way that keeps their careers moving in a positive direction. The way you handled the problems of your first job did not do that -- and you need to learn from that experiecne.

It sounds as if you were a very successful nursing student who entered the professional world accustomed to being successful and being "on top and in control." You went from that school environment to the work world, where you were at the bottom of the totem pole and not in control. Thriving under those different conditions requires different skills. You need to learn to establish productive relationships with people who can serve as resources when you need them. You need to learn how to protect yourself and how to handle difficult situations with grace. You didn't learn those life lessons in school because you were such a successful student. It's time to learn those lessons now. Learn them ... and then use them to be the great nurse that you want to be.

After running away from the problems of your first job, you latched on to a second job without thinking the situation through. You had a former preceptor give you a clue that you should avoid the job -- but you ignored it. Before you take any job, you should fully investigate it to be sure that you will get the proper orientation and that you are a good fit for the job, have the skills and experience needed, etc. You seem to have liked the idea of doing hospice care so much that you ignored some of the crucial practical realities of the job itself. Again ... learn from that mistake and don't do it again.

2. One thing I have learned over the years is how important it is to work with people I like and respect (and who will treat me well). I have found that the quality of the people I work with is one of the most important aspects of a job. To me, it matters a whole lot more than money or work hours ... because I know that if I am working with good people, we will work together to resolve any problems that arise. Look for that in your next job.

My recommendation is to seek a job in a supportive environment that has a good reputation for treating its staff well -- even if it means being flexible with regards to the specialty, pay, hours, etc. You need a job at which you can succeed -- and that will require a good orientation and supportive colleagues. Then you are just going to have to "suck it up" and do the job -- put one foot in front of the other and take it day-by-day. Use your problem-solving skills and work through whatever problems arise. Sometimes that is hard to do when you are feeling insecure and devastated ...

...but that's what strength and courage are all about.

Good luck,

llg

[medsurgnurse, RN]

There is nothing wrong with you. There is something wrong with the system of orienting new nurses. I don't know why hospital administration thinks it is Ok to float nurses ( especially new nurses) to a unit were they have no experience. Everyone has hadf bad experiences. that does not make you a bad nurse. From every thing you said. it sounds like yopu would be a great teacher, or mentor, or hospital educator one day. Go to work on a low acuity med-surg unit for a while and build your confidence.

[Town & Country]

Excellent post, llg.

Agreed.............

[kcsun3]

Thank you all for the support, encouragement and excellent advice. It is deeply, deeply appreciated. I have had a good night's sleep, and spent most of today looking at my situation as honestly and rationally as I could and thinking about the best way to come back from it.

SO...here is what I am going to do - an action plan based on all of your guidance, one that I think may work:

Tomorrow, I will (despite my hospital phobia) go over to the hospital where the hospice said they would help facilitate a transfer. I will visit each of the units with openings and talk with the managers (or set up a time to talk with them). I will be open about my experiences, what I feel I would need in terms of orientation and support to be a successful, contributing member of the team, what my assets are, and what areas I will need help with. I will be looking for a lower-acuity adult med-surg unit. My hope is to find a unit that would provide the right environment and support to help me rebuild my confidence and gain some solid experience.

Now some personal notes to all of you who have graciously taken the time to advise me and share your thoughts/experiences:

llg: I appreciate you sharing your insights and experiences - you posted so many valuable things to honestly think about. I will say that at my first job in nursing, with the floating situation...I did express my concerns to my preceptor, my peers, my charge nurse, my direct supervisor/manager, the manager of the NICU, and the director of all the units in our "float family" - in that order. It did finally result in a change in policy where new grads were not to be floated at all, and experienced nurses would have the option to not float. I am happy that that change happened, but it was not implemented until right before I left, and other issues on my unit had worn me down in ways I cannot express.

With regards to calling in sick to avoid floating...I should have clarified that somewhat. I did so at the direction of my preceptor and the director - it was not "sneaking around it" so much as it was an accepted (at that institution) practice. So, one did not have the option to not float at that time unless they called in sick and had paid leave time to use. I did, however, leave without finishing out my notice - not professional at all, but what I had to do for me.

Why did I allow 6 hours to pass before the NICU manager came to help me? Lack of cajones, not wanting to make waves - but bottom line, not standing up to my professional responsibility to my patients. I agree with you there.

Regarding my second job - again, you are absolutely right. I jumped in without thinking it through, ignoring the advice of my preceptor at that organization and ignoring the red flags I saw. In hindsight, even if I had had an excellent, extended orientation and support system there, being out in the field on my own requires a significant practical foundation with a wide range of experience, which I am years away from having.

Anyway, I thank you from the bottom of my heart for sharing your insights and experiences, and for the solid advice. *hugs*

(more personal notes to other posters on the next post...)

[mattsmom81]

I am so sorry to hear stories like this. Just wanted to give the OP a hug, and some encouragement to do some instrospection and healing, and come up with a good care plan... for YOU.

[kcsun3]

More personal notes of thanks:

Gerinurse10: I think there is an in-patient AIDS hospice here, which could be something to pursue down the road...but for now, I think I will bite the bullet and try med-surg, if I can find the right spot. Thank you for sharing your experience and thoughts - I appreciate it!

BETSRN: Thank you for the warm response. While I do agree that there were issues with poor management and policies, I also take responsibility for my own role in this. I have taken your advice to heart and will shop around to find the right place :)

Tweety: Thank you for the warm wishes and encouragement.

Gerilou: Outstanding advice - thank you so much!

Stidget99: Good way to look at things - that helped me immensely today. Thank you!

Angie O'Plasty: Thank you *hugs* for your moving, compassionate post. Great advice, great insights. Thank you!

Trauma-R-Us: I agree and will search to find a really good orientation program. Thank you so much!

KPrice: I so agree about not being out in the field this new - years of experience should be required. Thanks for sharing your thoughts and insights with me.

cpomb: What a horrible series of experiences you had, but how heart-warming and inspiring to learn that you overcame it all and have found happiness and success - your post was very helpful, and greatly appreciated!

SunStreak: Thank you for the warm post and support - and I agree completely about CNAs - they have been my best allies and friends in nursing.

VeryPlainJane: Would you mind if I PM you to get some local advice? Thank you so much for your post :)

Joyful Nurse: Excellent advice, and greatly appreciated - thank you!

Jnette: *hugs* Thank you for the support and encouragement - I cannot express how moving the responses here have been for me - how encouraging and how much hope it has given me.

Again, I thank all of you from the bottom of my heart - for the support, the guidance, the warmth, the insights, and how you all have shared your experiences and helped me to feel not so alone. You have given me hope and helped me find the courage to try again - I cannot thank you enough.

Steph

[UM Review RN, ASN, RN]

:icon_hug: No problem, Steph. Feel free to update us prn, ok?

[kcsun3]

Oops - a few more...

Medsurgnurse: Great thought you posted, which gave me much comfort: "Everyone has had bad experiences. That does not make you a bad nurse." Thank you for that. Also, excellent advice on low-acuity med-surg, which is what I plan to look at tomorrow. Thank you!

Mattsmom81: Thank you for the warm post and encouragement - it really means alot, and I am so appreciative *hugs*

[gerilou]

Hey Angie

The world and the Steph's of the world need more nurses like you. You write beautifully...I bet you reached the heart of not only Steph but the rest of us oldtimers as well..... :balloons:

The title of your post is close, but not quite accurate. I doubt that you were traumatized by nursing. You still love nursing, don't you? Otherwise, you wouldn't have been such a proactive student.

Would you have loved your job if you had had the proper orientation? I think you would have.

I'm only being nitpicky because you're (rightfully) upset and because you have just learned something about nursing that nurses have been trying to fight for many years now--management sets the goals, management dictates the numbers.

It hurts us. It hurts the patients. And nurses have no power over it. It's thrown us into an adversarial relationship with our employers. We have to fight for our patients. We don't have time to fight for ourselves.

All I know is, we at the bedside need nurses like you. You're green. Your post proves to me that you are not incapable nor incompetent!

You're green.

And there's hope.

Pretend you're developing another clinical skill--it takes a couple of times to get certain skills right, as you know. Make it a challenge. Trust me, it's like riding a horse. This is not the time to go back to school. This is the time to declare war on your inexperience and become the nurse you were meant to be.

Call this clinical skill--Survival. It's a complex one, involving several of your competencies.

Your research skills are needed to get you into the best possible clinical setting. Look for nurse longevity. Some nurses stay due to inertia, but if you see a pattern of many nurses staying for years, it's probably because they love where they work.

Usually, you'll find the types of problems that you encountered with for-profit facilities. So a non-profit might be better.

Try hospitals with Magnet status.

Be assertive, as someone else said. Don't accept less than you were promised, and get those promises in writing. Float to another unit? You can't refuse?

Yes you can! It might mean your job, but it won't mean your license. My first job tried to float me from Med-Surg to Tele without orientation or experience. I went. Duh. It took another new grad to talk to our manager and get us out of that.

So look where I work today! That's irony. But I chose to make war on my inexperience, and got the orientation that I needed. I was on orientation for a few weeks, then preceptored for a couple of months, and now, we have a mentoring program that rocks. So getting all this stuff is not impossible, ok?

In reviewing your post and seeing all you have accomplished up to this point, I'd like to add a couple of other things.

I'm not the best nurse in the world or even on my unit. There are many others on my unit that are clinically more capable, more intelligent, and have a better personality. That doesn't mean that I can't have the goal of doing my best, whatever my clinical level of expertise is at the time.

You've been dreaming about this for too many years to let it go. You had different ideas about some things than you actually encountered. So you now have a choice--to remain Nurse-Ideal, or get real and be Nurse-Beginner.

I'm here on the other side to tell you that Nurse-Ideal always looked good to me--until my first successful Code. Then I was hooked. Still scared s***less, but hooked, and ready to deal with the realities of nursing.

You'll never be more involved in a job--body, mind, emotion. You'll never imagine how far you can stretch, physically, mentally, spiritually. But it can be done.

Yes it can.

And if ever there was a new nurse who I really believed could do it, my dear, it would be you.

Best wishes, whatever your decision.

[Da Monk]

I noticed that you exposed yourself to nursing situations where you are working around foks that are severely ill where you are sticking things in them, hanging IV's, and whatnot. Plus in hospice folks are dying and on chemo floors folks are fighting the crab. Plus little babies who are bad off enough for NICU can drop like flies sometimes. In the first part of your post, you seemed to be quite creative in the description of your activities. Have you considered psych nursing? I can be, but is not so technically oriented and being creative is a plus. Most of the work is done between your ears and with your mouth, not your hands and back. While you work with the suicidal patient and there is always the chance of a patient acting out, the pace is usually slower than with the critically, physically ill. It's a right brained world there. It might be just the place for you. Good luck.

[UM Review RN, ASN, RN]

Hey Angie

The world and the Steph's of the world need more nurses like you. You write beautifully...I bet you reached the heart of not only Steph but the rest of us oldtimers as well..... :balloons:

:flowersfo