Where do i go from here?

Myxel67 · Mar 11, 2007

My last job before becoming a diabetes educator was Critical Care. In my view, that really is a place for younger nurses. My problem wasn't the accuity of the pts, but the physical demands of the job.

Psych nursing is a good field--perhaps that might be a good fit for you. Not all psych facilities are the horror stories you read about. The hospital where I work has an ATP (Addiction Treatment Program) that has always seemed interesting to me.

I'm surprised you couldn't find a way into nursing informatics. But as you said, sometimes it does take connections. Have you tried making some? Join a professional group and network--you have experience in so many different areas.

I would try to find something that will use your current knowledge and experience, rather than going to school again for something different. What about teaching some classes in nursing school?

PM me if you want to chat at a certain time and we can meet in a chat room.

Tweety, BSN, RN · Mar 11, 2007

What did your manager say? Did he she/he agree with you that you're not good there and need to find a new job/career?

Responding to critical situations on medical floors doesn't happen often enough for us to become experts at it in just one year. Many of us get scattered and nervous and loose our edge. I saw this as a charge nurse. It doesn't mean that we can't learn to handle the situations as they arise. It's a tough situation for us, which is why many hospitals are going to rapid response teams, to give us resources and help.

Learn from your mistakes, take a good look at yourself and how can you do better in these situations, get feedback from others and perhaps consider hanging in there a while longer without beating yourself up.

llg, PhD, RN · Mar 11, 2007

I really respect you for being honest with yourself about your strengths and weaknesses and for the way in which you are approaching this situation. Many people come to this website and say something like .... "I am perfect, but the rest of the world makes it difficult for me to be a nurse. etc. etc. etc."

Is there someone at work who can give you some good feedback about your development as a nurse? I don't mean simply your current skill level, but rather your development over time. There is nothing "magic" about 1 year. Some people take a little longer to feel comfortable. Have your skills improved over the past year? Are you getting better? Are you continuing to grow? If you are continuing to grow, it might be a good idea to give it another few more months and then reassess.

How have your employee evaluations been? Do your manager and educator believe that you are on track in your development? In other words, are you truly behind in your development or are you just feeling insecure? Your post did not say. Those are 2 different problems.

Another thought is that you are working at a very high level hospital where (as you say), they have patients whose acuity level is beyond what it should be for the type of unit and resources available. That's a particularly challenging situation. You might be more comfortable at a different hospital or different type of med/surg unit -- one in which the patients are not quite so much like intermediate or intensive care patients -- perhaps more of a "community hospital" setting. Yale New Haven Hospital is a big university tertiary care center. Not everyone thrives in such a setting.

What aspects of nursing do you enjoy? Are there aspects of nursing that appeal to you and for which you seem to be well-suited? If you like talking with the patients, teaching them, assessing them, etc. in a less acute setting .... perhaps you might enjoy community health nursing.

You might also enjoy hospice nursing ... or rehab nursing. These are areas in which the emphasis is not on the high-tech rescue of a patient with a rapidly deteriorating condition. I work in a children's hospital that has 2 inpatient units that people in your situation often enjoy and do quite well in. One is our rehab unit. The other is a unit for kids with chronic respiratory conditions: most have oxygen therapy (cannulas, trachs, or vents), but they are stable. I'm sure there are similar units for adults, if you prefer working with adults.

Keep us posted,

llg

Career Columnist / Author · Mar 12, 2007

First impression is- you sound mature in a good way, meaning

insight into self, grounded, and caring.

You have so much to offer because of life experience & maturity.

Second impression is- one year is not that long, esp in nursing-

then again, only you know yourself, and if you feel it's not for you, it

may not be. But one year is too soon to despair that nursing overall

is not for you.

In my experience, So many doors open up in nursing

if you do nothing but..just be patient. Keep your ears open,

and become a great networker!

I think you can find your niche without having to

start all over in anew career.

Best of luck and please keep us posted.

Dayray, RN · Mar 12, 2007

I agree with t the posts above that say you should consider another area of nursing. You have a good base from spending a year on a medical floor. Your patients are so verid and the loads are high so you probably have allot more under your belt then you think.

differnt spcialties very so much, they are completely differnt jobs. you do sound like a people person so psyc or even case managment might be worth some thought. I've worked in a varity of areas and they are so differnt I am sure you could find a fit. what other area are you interested in? maybe you could float for a while and see if you find a home that way.

WolfpackRed · Mar 15, 2007

How about nursing informatics? With your computer science and nursing background this may be a nice niche. You may need to advance your degree to an MS level, but it would be worth it.

CRNAorBust · Mar 19, 2007

First of all I want to thank all of you who responded to my query. I'm impressed at how supportive you're all being.

Myxel, I have thought about psych nursing but would not be thrilled about dealing with Schizophrenics. I also don't like the notion that smiling is often interpreted by patients as you making fun of them. It would really crimp my style since I really enjoy smiling and joking with my coworkers etc. I was interested for a bit tho in becoming a Nurse Psychotherapist but seems to do that I'd have to have some experience on the psych floor tho I'm not sure how much and again not thrilled about working around Schizophrenics.

Tweety, my manager was feeling I was being defensive towards her telling me I was not handling these situations well ( I was actually very frustrated that I had three critical issues in three days which threw me and made me want to quit). She said she was just being concerned and was very upset at my responses. But she did not make any effort to make me feel I could overcome this. She simply said she'd want to try to implement some precautions till I could find something else. The bulk of what she's done so far is to try to make sure I get assignments which won't be as likely to put me in those kinds of situations again, but of course its hard to do that all the time. And of course my nite shift hours have been drastically reduced because she doesn't want me working with minimal supervision. And finally I've been working the same days as my original preceptor has so that I have a "resource" person I can turn to when I need them. Again, its not perfect and not always possible but this is the jist of things so far. She also talked about creating scenarios that even the other nurses can go over to help me aclimate to these kinds of situations but that hasn't materialized. But she hasn't been asking me where my search has taken me and its been about three weeks now since all this has occurred. So no big push is underway to get me out of there. They are always short of nursing staff it seems and I have enough facility so they can at least count on me for basic coverage.

IIg, I feel I have grown over the year but I still have tons to go and not enough constant information about how to handle this or that to make me feel I'm going to grow anymore at this floor. The load is to high there and its' considered one of the harder / crazier floors to work on. Tons of orders flying by, lots of meds not coming the floor in a timely manner, and when patients get needy you can easily fall behind at the bewitching hour of 3pm when the 8 hour shift nurses go home and we can all gain more patients usually up to 6 or 7 till the end of the shift. So there's really very little time to do "improvement" work. Tho I did a few weeks ago create a new sheet to help me summarize what's happening with my patients so I could give a cleaner report. But the really important thing is I want a job where I feel I'm doing more focusing on a job I can do well than on a job where the most important thing is focusing on getting what you need done for the shift before it ends. To much rushing. It makes for a quick day but not always a satisfying day.

And regarding my evaluations. Only had one at the six month point and they felt I was where I needed to be. Then these 3 critical issues came up and it all seemed to go to pot. I'm suppose to sit down again in April but if I don't remind my manager she'll let it pass. Naturally that's not so great for moral or feelings of satisfaction on the job.

In terms of things I enjoy doing I'm really more a project oriented type of person. I do enjoy tracking things which is a heavy part of the nursing day, but I'm not thrilled about tracking things under the stress of time constraints such as those on a hospital floor. I also enjoy teaching, but being a nurse educator usually rerequires doing clinicals at some point which I'm not thrilled about. But I still might give it a try.

Community health seems a little dangerous to me where you may run into non compliant schizophrenics, or communicable diseases. Hospice nursing sounded a little more my cup of tea but something seemed to be missing in it for me, not sure what. To laid back maybe? The clinical we had with it was not something that left me feeling a big want for it. And rehab strikes me the same way. The pace and interactions could make my day feel like their dragging. But perhaps I need to shadow someone to really find that out. That's what I really need to do more of. Finding situations where I can shadow to get a feel for what its like in other areas. Thought of doing OR also.

Hawkesbe, I agree with your assessment of my need for patience. I am constantly telling this to myself. But the patience has to come with action to make it go quicker. And my going to the schools to check out programs was my initiation into networking. I intend to do a lot more and in doing it will pass more time on the floor I'm at now. Plus as I said above, shadowing other department nurses will help me as well. So I'm already following your very good advice. I also ALWAYS keep my ears open when I hear about what departments NOT to go to with nurses who are NOT willing to work together. IF nothing else our floor is very good at doing that. We all cover each others back and help whenever we can. Thanks.

Dayray, Case Management was one of the first things I thought about when all this began. But it doesn't seem varied or challenging enough to me. Thanks for the input tho.

Sorry for the detailed reply but I wanted to make sure I responded to everyones helpful points. Once again thanks for all the help. If anyone thinks of anything else I'd love to hear about it.

Tweety, BSN, RN · Mar 19, 2007

Good to hear from you again. Good luck in whatever you decide. Hang in there, we need good caring nurses in whatever capacity is best for you. :)

RedCell · Mar 20, 2007

I understand theory

You understand theory?! That is a start man. I never could figure out that stuff. Seriously though, if I were you I would start asking tons of questions to physicians and nurses concerning patients with difficult and challenging dx's. Go through scenarios in your head regarding what you would do next if a problem should arise with a patient you are responsible for. Also, try to obtain CEU's that deal specifically with the patient population on your floor. Finally, read up on current literature in the nursing and medical world. Hope things improve for you.

gitterbug · Mar 29, 2007

Psych nursing can be demanding but rewarding, not all psych patients feel you are making fun of them if you give them a smile. I wonder if you have given any thought to rehab nursing. I swear I loved my Traumatic Brain Injury patients, I miss working with them very much. These type of patients are more stable but need care and need reinforcement of their physical therapy and daily living skills. I have simplified the job but just a thought.

anonymurse · Mar 30, 2007

I'm holding my own there but I'm not great at responding when a patient becomes critical. Sometimes my focus is off and my critical thinking skills are lacking.

This is interesting. Can you post an example or two to illustrate how you came to the above conclusions? Maybe it's something entirely different that someone here has already worked through. Or maybe there's a non-obvious fix that's easy. Worth a shot!