if you're on a unit not by your choice how do you cope?

DeLana_RN, BSN, RN · Oct 9, 2010

Hi, again, I have so been there, starting with my very first job (so no, this is not new. Nursing has always eaten its young.) No matter how wrong they are, unfortunately, you - the victim - will usually end up beating yourself up and wondering, what have I done wrong or where have I failed? The answer is, nowhere and nothing, but now you have to convince your crushed spirit of that. But it will get better, I promise.

Now for the positives, although they don't appear that way yet. You have been offered a transfer, which is already arranged. Believe me, that's good, because many nurses in your situation are simply let go (unfairly) with that to explain on their employment record. So take the transfer, with the goal of getting out of it what you need (which is a few more months of employment history at this hospital - 11 or 12 total should be enough to "look good". In fact, many places will let you seek a transfer to another unit after only 6 months and you can certainly make plans for that! You are not a brand new grad, having had LTC experience.) Also, your NM told you she would have transferred you to the ICU if she had a position; so she obviously thinks you're a capable nurse (but IMC is just not a good fit; it is, in fact, a very difficult unit; you have very sick pts, many of whom should be in the ICU, and of course you have more of them with fewer resources than the ICU nurses usually have.)

Don't worry about handling the floor; if you can do LTC - medicating so many residents, along with all the other responsibilities - the pt load of med/surg should not be a problem. Yes, you will have more pts, but you will also have a charge nurse to assist, take and check orders, etc. You can do this!

Wishing you the very best,

DeLana

netglow, ASN, RN · Oct 9, 2010

Kitty, seems this happens a lot in nursing. People will flood your thread saying you should be grateful... yes in a way. But I understand your frustration. Nursing is really messed up -- when it's so important that it not be. So many threads I've read. Yes it's scary. So many stories from friends.

Here's what you do. Get your paycheck. Do the new floor. If it seems your new gig is not dangerous for you or your patients, and you are able to work with people who are supportive just enough for you to go in every day, keep on keeping on. When I feel trapped like you are feeling, eventually I will say to myself that I need to stop thinking, and just put my head down and do it for a while for my own sanity.

One thing I'd do, is get a rec letter from your previous NM. Yeah, your still in the same facility, and you don't right now know what you would need it for, but you might need it someday. The saying is, that the first thing you do when you start a new job is update your resume etc. for your next.

Zookeeper3 · Oct 9, 2010

OP, geeze, I am so sorry. I'm an ICU nurse, so don't hate me from the start. Where my peers failed you was first a too short orientation. I can't make you successful in that short of time. I would have needed to provide you with ICU classes on vents, art lines, drips, hemodynamics, multisystem failure, that alone is 4 weeks... then at least another 6 weeks of orientation.

I'm so sorry to say that your system failed you and did not set you up to succeed. It is NOT, NOT you... I've been training ICU nurses for 15 years, I can't get you there in that short of a time and let alone provide the needed classroom training. YOU did NOT fail... THEY failed YOU!!! Got it?????

It is impossible to succeed with what you've been allotted unless you've been an ICU step down nurse for a solid year or preferably two. It can't be done!!!!!

Unfortunately, many preceptors lack the ability and training to give feedback. One, it's uncomfortable, two in your situation there was little chance from the start for you to succeed. So you were fed to the sharks.

While I've never worked a floor, at least you are still gainfully employed, can gain incredible learning exp. here and have time to adjust to a new facility policy and procedure, forms, charting and docs. You didn't loose anything but a unit that lacked the ability to support your growth..... so did you really loose much? Sure they did you wrong, but look at the opportunity to stay there, get exp. get your feet wet and learn the basics before you can re-apply and jump into the complicated.

OP, this is NO snub to you, but very few people can go from ltac to ICU in the setting you described. If the ICU is your dream, read, read, study and read more. Become proficient in your area, expand you knowledge and better prepare for the next run.

Never let a failure stop you from your goal, it is simply going to take you a touch longer, and you'll be better prepared to succeed and provide the care that your patients require. It took me two years to be ICU worthy... and it was a tough road for me. You're not a failure, you've just been reset the the right learning curve to do right by your future patients. You will learn much on an ortho floor, I call them regularly for advice.

You didn't fail. Accept that, learn and grow.

hiddencatRN, BSN, RN · Oct 9, 2010

I'm confused- you were on orientation in an ICU, were told you were doing well, and then are being downgraded to an ortho floor? How long was the orientation supposed to last? You only got good feedback but they moved you anyway? Did they say why?

Sometimes you can make a long story *too* short

Rabid Response · Oct 9, 2010

I'm not sure I understand what happened with you. From what I gather, you got a job in Long Term Care right out of nursing school, worked there for seven months, and then accepted a position in an ICU. After five weeks orientation in ICU, your employers decided that you weren't going to work out in that position and transferred you to an ortho floor?

Is this correct? If so, I am very sorry for the stress and anguish you must be feeling. However, in my opinion, you are still much better off than you were in that LTC job. You still have a nursing job, and the job is in an acute care setting. No offense to LTC nurses, but the longer you had stayed at that job, the less employable you would have been anywhere else but LTC. You are closer to your goal of working in critical care than you were before. Many hospitals would have simply let you go rather than transfer you within the hospital.

Accept your transfer with all the grace you can muster. Do not grouse to management or co-workers, despite how you are feeling. The way you comport yourself now will go a long way toward furthering your career at this hospital. In my ICU, we had several nurses who were hired right out of nursing school, did not work out, and were transferred to med-surg floors. One quit the hospital altogether (but couldn't find anything but med-surg jobs at other hospitals), one decided that she loved med-surg and has worked there ever since, and another worked m/s for one year then transitioned back to ICU with no difficulties and has worked there for the past four years.

This is not the end of your dreams. This is an opportunity for you to shine! The organizational skills you mastered in LTC will serve you well in your new position. The information you got in your (albeit too brief) orientation to ICU will also give you the advantage of a different perspective.

I know you are upset and feel betrayed, but don't make any rash decisions based on these extreme emotions. Take some deep breaths, relax, go for walks, get a pedicure, whatever it takes to feel a little bit better. Open yourself up to what life is offering you right now. Defer making any big decisions until you are feeling balanced and clear.

Kitty Hawk, ADN, RN · Oct 9, 2010

Zookeeper, actually my big desire eventually is to do some type of ed. for the well population. Pain mgmnt greatly interests me and did even before I got hired here b/c they deal with alt. therapies and not just pharma.

I like your background w/the ER. How does it compare to the ICU? Is it more intense? I have an interest in ER as well b/c I like the get 'em in get 'em out. TBH I see now titrating drips is huge in CC I don't know that it has a strong appeal for me. It seems some really enjoy that aspect of playing w/just the right amt to get the HR/BP in the right parameters. Anyway I wouldn't think ER would take someone w/ only general nursing even for a year or so...I'd think they'd want step down or something. But they do all seem to have nice long orientations.

I'm going to be 46 in a couple weeks. Not that it's a bad thing. I didn't let age get in my way and I'm in pretty decent shape execpt for needing to rebuild my biceps and get my anemia back under control, but I really only wanted this IMC for about a year to have critical care under my belt. My goal is definately out of the hospital. I just thought this would be needed experience to move on, but maybe not.

The ER would be a good stepping stone for my goals. Honestly critical care isn't a dream for me. I think the knowledge base is really cool. But it seems most CC nurses I've met either love it and are there to stay, or are using it to get to CRNA. Neither is for me and at my age I don't want to waste time on things I know I don't have a true desire for. It seems if you've done ICU you can do anything.

See right now it was okay to get that year in CC in...but by next year, I will have wanted to move on maybe ER or closer to pain management. I hope that makes some sort of sense! I just think the ER would want way more exp from the start, thus the starting in IMC.

Hiddencat...I'm trying to keep my posts short! ...I'll answer you're q's following this.

PostOpPrincess, BSN, RN · Oct 9, 2010

Going from an LTC to ICU and only oriented for 5 weeks is not fair to you. The Ortho floor is a good place to learn.

Give it a year, and then proceed to the ICU again.

I once oriented a nurse who just wasn't ICU material from the onset. He wasn't getting it.

After 3 years on the floor, he ended up in the ICU and is now a CRNA. A darn good one.

He needed time. Regardless of your age, you still need the time. It's not an instant thing, unfortunately. You sound like you're working against your own "inner clock". In nursing, it doesn't work that way, and yes, ER can be as tough--and you have to be STRONG in your assessment, critical thinking skills. You're not there yet.

Whether or not you want to be in the hospital, there are still dues that are to be paid to GAIN the skills you want.

Sorry--it's just the path. You must reconcile to it.

Kitty Hawk, ADN, RN · Oct 9, 2010

I'm confused- you were on orientation in an ICU, were told you were doing well, and then are being downgraded to an ortho floor? How long was the orientation supposed to last? You only got good feedback but they moved you anyway? Did they say why?
Sometimes you can make a long story *too* short

Okay, longer short story! I graduated June '09. Couldn't find a job for many mos after got LTC Dec. worked there for 7mos, got hired for the IMC.

The IMC/ICU here are closely linked. Same NM for both. and you can be floated to ICU aft. 6mos. Important to note, the NM there now is not the one who hired me. People say it's complete chaos right now b/c the prev. NM is known to be awesome. She left to another hospital in the system to literally clean it up and get it functioning the way this one did. I didn't involve myself in the drama as people gossip, it's all about perspective and there's good and bad in everything.

It was supposed to be 6 weeks of orientation one of which is the ICU, so 5 on IMC. I got four and that was even broken b/c the one class started on a Wednesday so I'd have one day that week on the unit, counting as unit time not class time, even though the rest of the time was in class.

She told me flat out that she wasn't about to lose the investment that she had in me. That I'm where I should be skill wise, and I'm expecting more of myself than they are. She feared b/c the ave. exp of the nurses in IMC is 2 years, I'd have no one to really go to for questions! I'd like to know what really changed between all of her encouraging talks and now. It's not like it's new knowledge they're not really experienced nurses.

She met with me at least twice a week to touch base. She apologized profusely for setting me up with the wrong IMC preceptor in the first place and setting me off wrong. (previously she said this) I never complained about said preceptor, it was found out she wasn't right as to how she taught me to do some things...they were incorrect. This was found out 3 weeks into my orientation. I had no idea I was being taught wrong, I was new!

If she would have said, considering my background and the intense circumstances she had concerns and wasn't sure how this would go but let's see...I would have appreciated/respected that.

She didn't do that, she lied to my face repeatedly telling me I was doing fine and all the things I was experiencing was normal. I sat with my ICU preceptor the day before going over my book were you're rated 1-5 on things like time management/priortizing/indepence etc.... She went through point by point saying "you're fine there, no problems...this one, you need to work on a little bit more, but you'll get there I have no doubt" etc....She flat out said if she didn't have faith in me and think I was doing fine she wouldn't tell me I was!

I would have rather had upfront info so I could have decided on my own if I wanted to transfer, instead of feeling like this. I get it's probably stupid to feel like this, but now Monday instead of the blue scrubs I had to go buy, I go back to wearing white as was mandatory in my LTC...my hours changed completely so I feel like I've been demoted.

Really though I do see that I don't have near the knowledge base to take on this position, trust me I get that. I'm ticked of the handling of it. Of the misleading. I shouldn't have been literally forced fed that I'm going to do great and they'll help me in anyway and on and on....to then just pull a rug out. Maybe I dodged a bullet, but today it doesn't feel like that. :crying2:

tntrn, ASN, RN · Oct 9, 2010

You have gotten good advice from the other posters. If you are interested in Pain Management, I can't think of a better place to learn than an ortho floor. Having had several orthopedic surgeries and having nursed my DH through an ankle that now has 13 pins and 3 plates in it, I can tell you that orthopedic pain sucks.

And I agree that put you nose to the grindstone and learn everything you can there. It will only help you when you are able to go to another unit.

And just so you know, this kind of thing happens to ALL of us. Where I work, we get floated to units we've never been in before. I am a Labor/Postpartum nurse with 33 years experience, and when they float me anyplace else, I have to wonder exactly what do they think they are accomplishing, other than to have a body where they didn't have one before.

Good luck.

madwife2002, BSN, RN · Oct 9, 2010

Dont think of it as a demotion I must be different to most RN's because I certainly never saw ICU nurses as being the heirarchy of the hospital. It is just a different type of nursing. You can learn so much on the ortho floor I used to love it therre when I was floated over the atmosphere was always much more light hearted. I also agree with the other poster that you can learn so much about Pain Management there.

Kitty Hawk, ADN, RN · Oct 9, 2010

Going from an LTC to ICU and only oriented for 5 weeks is not fair to you. The Ortho floor is a good place to learn.
Give it a year, and then proceed to the ICU again.
I once oriented a nurse who just wasn't ICU material from the onset. He wasn't getting it.
After 3 years on the floor, he ended up in the ICU and is now a CRNA. A darn good one.
He needed time. Regardless of your age, you still need the time. It's not an instant thing, unfortunately. You sound like you're working against your own "inner clock". In nursing, it doesn't work that way, and yes, ER can be as tough--and you have to be STRONG in your assessment, critical thinking skills. You're not there yet.
Whether or not you want to be in the hospital, there are still dues that are to be paid to GAIN the skills you want.
Sorry--it's just the path. You must reconcile to it.

Thank you...that's it....it was set up to fail from the beginning...all knew this except for me apparantly, I would have appreciated the heads up that's all. I have no problem paying my dues. There was nothing lower acuity that I applied for believe it or not, this just sort of landed in my lap in 1 week's time. I get I'm not there yet, that is evident I just don't appreciate being flat out lied to and pushed that it's all going to work out, when in fact I do need more experience. I just wish I didn't start out there to go back it's embarrassing..I addressed my concerns on the interview...I was hired anyway although not by current NM.

It's sort of funny b/c this ortho floor that's taking me also took one of my co-workers who was in orientation with me. He's a really great guy with 3 years experience and has worked at a few hospitals within the system inc a critical children's hopsital. He was set to go to the ER and is finishing up his MPH for Aids and the last day of basic hospital orientation he shows up in "white" (all other nurses but CC wear white) he opted out of the ER last minute b/c he decided the stress would be too much while finishing his degree. He wants out of the hospital eventually too. But see he was able to make that change before anyone knew anything. This is a small community hospital and I can't even believe my previous NM is encouraging me to lie to my new unit. (that I started elsewhere and failed she wants me to say I just walked in from LTC)

I can't believe she encourages that. I have no probelm saying to anyone there that I do feel I was misled. That I agree I need more basic knowledge skills made much stronger...that I wish they would have presented it like that. I have no shame in that and don't think that's disrespecting my previous NM, why I have shame in going back to wear white I have no idea. I wish we were like some other hospitals in the nation and nurses wear purple or black or something.

It'll be good to see my co-worker from orientation, he always had good advice for me. It just seems funny this floor ends up absorbing all these people yet never has jobs posted. It's like the land of the misfit toys!