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

[llg, PhD, RN]

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.

That sounds like a great plan. I am also very impressed with your attitude -- taking responsibility for having made a few mistakes -- but not letting that stand in the way of trying again. I would hire you in a minute and I wish you all the best of luck with your career. ..... and if you don't get lucky, then I wish you the patience, courage, and wisdom to handle whatever comes your way.

Please stay active on this board and let us all know how you are doing from time to time.

llg

[My409]

I'm sure there have been other nurses with worse experiences who picked themselves up and kept going.

It sounds like your intentions are good but your expectations are unrealistic and your idealistic view of how things *should* be is clouding your ability to use good logic.

The world is cold, hard, and unfair. At first I thought you may be just a young girl, maybe 20 yrs. old, but it looks like you are a mother and wife, hardly a person who should be so inexperienced with life. It would be wonderful if we could be coddled and walked through everything that made us uncomfortable, but that is just not reality. Just be thankful you didn't harm anyone, learn from the hardships and take that with you on your next nursing adventure.

I reread this after posting and want to edit because I realize what I said sounds tacky and flippant and I really do NOT want to come off as being an inconsiderate hag. I have been thrown to the wolves before and it isn't fun. It makes you feel inept and unworthy of being a nurse. My reaction to the harshness wasn't to run away. I got MAD. I got on my own high horse and those snooty nurses who rolled their eyes at me because I didn't know something came around after all. It was tough climbing upward when it seemed like there were those who would have been glad to see me fail. But I proved them wrong, and you can, too. Don't feel defeated and never feel like there is something wrong with you if you don't succeed at a certain job. We weren't all born in a nurse's uniform like *some* nurses.

Good luck to you.

[lady_jezebel]

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

My opinion:

I worked as a research assistant in my nursing school while doing the BSN program. I loved the job. However, I believe that it would have been a mistake to jump immediately into research (or something away from the core of nursing, ie. the bedside) after graduation. I have just completed 1.5 years of med-surg, and now plan to work 2 years in a med-surg/transplant ICU (just been hired). My plan is to gain a good foundation in clinical nursing before I move onto something else (in my case, NP program & writing/research). In my opinion, skipping this step before you begin your PhD program will ultimately make you a less effective nurse researcher. There is a reason those in the ivory tower seem "out of touch" -- they are! Without real clinical experience (the stuff you can't learn from textbooks or classes), a researcher will not produce work that fully benefits the bedside nurse or profession as a whole. Only through real experience can you understand what it is like to be a bedside nurse, think like a clinician, and intimately know what patients go through.

Personally, I think you should tough it out 1-2 years & choose a job that guarantees an excellent preceptorship. I also think you should select to work in a more general area (like med-surg, whether that's oncology, transplants, ortho, telemetry, etc... for they all demand that you learn basic nursing technical & assessment skills, and they all have overflow pts from general med-surg populations) in order to develop some skills. I would put your past experiences behind you & decide to do at least a year in the hospital. In the long run you won't regret the knowledge gained from that year, something that can ONLY be learned from actual bedside experience. It will give you an invaluable understanding of what most working nurses deal with & ultimately help you direct your research (ie. identify real problems, formulate hypotheses, interpret data, etc...).

[kcsun3]

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.

Hi DaMonk,

Great suggestion, and one I had considered, as I liked my psych rotation a lot. I believe I will give hospital nursing one more go first...one - to give me a chance to prove to myself that I can do this, and two - to get a solid foundation in the nursing world. Down the line, however, psych nursing may be a good fit for me :)

Steph

[kcsun3]

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

I will do that - and again, thank you for the wonderful support and encouragement - I really cannot express how touched and filled with hope I have been reading your post and those of others :icon_hug:

Steph

[kcsun3]

That sounds like a great plan. I am also very impressed with your attitude -- taking responsibility for having made a few mistakes -- but not letting that stand in the way of trying again. I would hire you in a minute and I wish you all the best of luck with your career. ..... and if you don't get lucky, then I wish you the patience, courage, and wisdom to handle whatever comes your way.

Please stay active on this board and let us all know how you are doing from time to time.

llg

Thank you, llg - I have so appreciated your insights and advice, and cannot adequately express my gratitude. Yesterday, I was feeling lower than low, and today, I feel like I can do this - I can learn from the past, move forward and start fresh. I am actually excited - so, thank you! :icon_hug:

Steph

[kcsun3]

I reread this after posting and want to edit because I realize what I said sounds tacky and flippant and I really do NOT want to come off as being an inconsiderate hag. I have been thrown to the wolves before and it isn't fun. It makes you feel inept and unworthy of being a nurse. My reaction to the harshness wasn't to run away. I got MAD. I got on my own high horse and those snooty nurses who rolled their eyes at me because I didn't know something came around after all. It was tough climbing upward when it seemed like there were those who would have been glad to see me fail. But I proved them wrong, and you can, too. Don't feel defeated and never feel like there is something wrong with you if you don't succeed at a certain job. We weren't all born in a nurse's uniform like *some* nurses.

Good luck to you.

My409,

You did not come across to me as an inconsiderate hag at all - the underlying message was a good one, and your follow-up touched me (plus it was filled with good advice). I posted here knowing I would get a variety of opinions and thoughts - not just all flowers and hearts. For me, that was the point - so I could soak in the insights of all the experienced nurses here to help me see where I went wrong and what I can do to turn things around. The deeply touching messages of support and encouragement were a bonus that I cherish. Thank you for your honest response - I really value and appreciate it.

Steph

[kcsun3]

My opinion:

I worked as a research assistant in my nursing school while doing the BSN program. I loved the job. However, I believe that it would have been a mistake to jump immediately into research (or something away from the core of nursing, ie. the bedside) after graduation. I have just completed 1.5 years of med-surg, and now plan to work 2 years in a med-surg/transplant ICU (just been hired). My plan is to gain a good foundation in clinical nursing before I move onto something else (in my case, NP program & writing/research). In my opinion, skipping this step before you begin your PhD program will ultimately make you a less effective nurse researcher. There is a reason those in the ivory tower seem "out of touch" -- they are! Without real clinical experience (the stuff you can't learn from textbooks or classes), a researcher will not produce work that fully benefits the bedside nurse or profession as a whole. Only through real experience can you understand what it is like to be a bedside nurse, think like a clinician, and intimately know what patients go through.

Personally, I think you should tough it out 1-2 years & choose a job that guarantees an excellent preceptorship. I also think you should select to work in a more general area (like med-surg, whether that's oncology, transplants, ortho, telemetry, etc... for they all demand that you learn basic nursing technical & assessment skills, and they all have overflow pts from general med-surg populations) in order to develop some skills. I would put your past experiences behind you & decide to do at least a year in the hospital. In the long run you won't regret the knowledge gained from that year, something that can ONLY be learned from actual bedside experience. It will give you an invaluable understanding of what most working nurses deal with & ultimately help you direct your research (ie. identify real problems, formulate hypotheses, interpret data, etc...).

Lady Jezebel,

I agree with you absolutely, which is one of the reasons why I deferred the start of my program until the summer of 2006 (which would have had me at 2 years of experience at the start of the program). The summer of 2006 also coincides with the start of their online courses for the BSN-to-PhD program. That will allow me to continue to work while "in" school. As I understand it, the program takes 5 years to complete, which would put me at 7 years' nursing experience by the time I graduate, and my hope is that, as you said, the work experience before and during the program will help develop and guide my research so that it is useful and applicable to nurses.

Thank you for the valuable and insightful post, LJ - I learn so much here and appreciate your advice greatly.

Steph

[BETSRN]

Dear Steph,

Reading your letter brought back memories of fear and trauma for me also. There is hope!!! I went to nursing school when my kids were 12 and 9. I always wanted to be a nurse and was also passionate during school. I even wanted to wear my nursing cap!!!!! I hated clinicals...I became nauseated at the thought. Loose stools the morning off clinicals and sweaty palms. Heart pounding dread. The nurses where mean, some of my instructors could be just as bad...After graduating with a 3.4 I thought I was ready. Wrong....I was eaten alive by the nurses. I was so naive...I thought everyone was in nursing to help each other and share in the experience of helping others get well. Irritable bowel set in.....I quit and took a very safe job in a clinic for emotional disturbed youngsters.. I was becoming board but also ill and developed Graves Disease. I THINK IT WAS ALL BECAUSE OF THE 3 YEARS OF STRESS. I took about 6 months off to get well. I was approached by a former class mate to take a job in a small pediatric unit. I was scared but did...and i had a great preceptor. I watched her and used her as a role model. I began to have confidence again and did a great job. Then I decided I needed a challenge and went to a tele floor and then to the emergency room. Mistake...or maybe not!!!! What does not kills you toughens you. They were evil and very political. While I was there my husband at the time was having an affair with a nurse on his unit....the whole event was devastating....I got caught up in crisis after crisis in my life. I felt I had to leave for my sanity and self preservation...physically, mentally, and professionally. I took a job at a nursing home. I fell in love with the elderly...and had a great time and learn alot and again regained my confidence, but was following a seriers of bad relationships which affected my self esteem....I finally got my personal life and professional life in order. Then I had a major auto accident and was in a major trauma hospital for 3 weeks...I was ready to met my maker and was ok with that...but here I am....Happy, healthy (maybe) and working in a small community emergency room and I am respected and my confidence is the highest it has been in years. I have survived the eaten of the young, divorce and illness. It has all made me a better nurse and a preceptor for nusing students. I promised I would help new nurses and employees to feel welcomed and valued. Take your experience and turn it around. Find what fits you as a nurse, your philosophy, and a place FEELS RIGHT. Always follow your gut and your intuition. There are a multiple of nursing roles. Best of luck to you and stay in touch and let me know if this helped..

cheryl(cpomb)

My such a past. You have done well. I,too, had a husband cheat on me and went through the whole divprce thing. But you know what? It was being a NURSE that got me through the whole thing. Thank God for my career. It sounds as though you have a job that you love as much as I love mine! Good luck to you!

[simao pt]

(...) 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. (...)

(...) a strong 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. (...)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. (...)

(...)but I just don't think you can beat a good med surg base.

I totally agree with Dixilee. Nursing can be very scary in the beggining but once you gain confidence everything becames easier. It happened to me too. I was lucky, because after six months due to reorganization of the staff I was sent into a different but similar unit. Even though they hadn't the best references (stated I was yet too "green") because I was more confident in my skills, capacities and knowledge things turned out nice and soon they changed their minds.

If you look confident, even if you aren´t that much, that will make things easier, too. Some nurses tend to be more agressive if they "smell" fear on others. Don't be upset if you hear remarks such as "You should know this already". It's always difficult in the beggining. And only after you passed that that you will find the beauty in nursing.

Good luck :)

[heart queen]

Everyone's advice is so excellent. I wanted to add a slight twist. from your OP, you showed yourself to be an expert as a nursing student. transfering from expert to novice "new nurse on the floor" is really hard, not only clinically, but in so many other ways. Know this from a 9 yr. ICU nurse who took a float pool position and caught a baby from a crack head screaming she was a month pregnant and miscarrying, took off the pants, caught the baby... had my own heart attack and screamed for help like a wild banshee.

I've been acoustomed to being the expert... it's a very hard transition to novice.. but it can be hell and fun too. you've got a good plan. With your history in our profession, you'll get through this bump just fine.

[kcsun3]

If you look confident, even if you aren´t that much, that will make things easier, too.

Simao,

I have heard that from experienced nurses several times since graduating...I really think that is part of it. I need to emote confidence - not that I know everything I need to know (which would be wayyyyy off mark), but that I am confident in my basic skills and assessment abilities (even if I am not), and know when to seek assistance. It's just harder to do than to say...but it is something I will continue to work on. Thanks for the great advice!

Steph