Where do I go from here?

madwife2002, BSN, RN · Sep 11, 2015

Welcome to allnurses!

enytsyrhk572 · Sep 11, 2015

I felt the same way as you when I started applying for jobs. Though I started out right away in acute care, I purposely chose the largest hospital system in my city - there are nine affiliated hospitals with this company. Due to their size and the volume of nurses they hire as a company, they have a VERY good orientation policy for new grads. I did this because, like you, I wasn't confident on some of my skills, and my clinical rotations had been average at best- some were observation only and not hands on. So, I admit, I'm a baby, I wanted my hand held. I wanted to ease in slowly. I didn't choose critical care or specialty areas, and I chose night shift exclusively.

Choosing the wussy way out, worked. My transition to my first job seemed slightly easier than other people I read about on here, and while it wasn't easy of course, and not my first choice of areas to work, it was less stressful than it could have been.

So perhaps your city has something similar? - a big hospital system that has a formal orientation program that you can get into. My medsurg orientation was eight full weeks of a preceptor right by my side. I know also that some hospitals will offer a new grad residency even if you aren't a new grad, but also if you are a nurse wishing to switch specialties. So for example if you are a med surg nurse and want to become NICU, you can apply to a residency program as if you were new to be trained to switch specialties.

Annaiya, NP · Sep 11, 2015

Have you done counseling for your anxiety? If you are picking your career path, because you're worried about your anxiety, then it's something worth thinking about. My best friend is a nurse and has bad anxiety, and I can't imagine her now without all of the therapy she did when she was younger. Critical Care probably isn't a good choice, but there are lots of jobs in a hospital that could be a great fit for you.

You passed NCLEX and take care of 18-22 patients, what makes you say you wouldn't be ready or smart enough for a hospital job? After what you've done, how hard can it be to take care of 5 patients? Any decent unit will train you on what you need to know. We all learn something new every day at our jobs, so you aren't expected to know everything. You just need to be willing to work hard (which it sounds like you do already), ask questions and learn. If it is something you want to do, then I say go for it! But if you're worried about your anxiety, make sure you have a therapist before you start, so you have support as you go through the transition process to a new job.

kristin10 · Sep 11, 2015

Thank you both for your advice and supportive words. The anxiety is something I know I need to work on and have considered talking to someone about...maybe especially now if I'm going to transition jobs.

Some days where I work really aren't that bad and it makes me realize why I chose nursing but some days are so bad I want to scream or just leave the building so I can cry for a couple minutes. Granted, I'm sure all nursing has these ups and downs but I can't take care of 18 patients the way I want to and that is what bothers me the most.

Many of our patients come from med surg floors and I like that type of patient. Would a med surg floor in a hospital be a better place for me to try and start? I'm mainly worried about my skills being up to par. I don't have much experience with starting IVs at all. And other things like maintaining certain pumps or drains etc etc. I think that fear is what is keeping me from applying elsewhere.

VANurse2010 · Sep 11, 2015

Hey everyone,
I've come here seeking some advice...here's my story so far!
I graduated with my BSN in May of 2014. From there I started my first job at a short term rehab unit (maybe this was my first mistake?) and I worked there for nine months. I learned a lot at this job, but the management was so unorganized, I was there by myself with 22 patients at a time, and as a new nurse and someone who is prone to anxiety, this was too much for me. I feared for my license every day.
I ended up finding another job in a skilled nursing unit, similar to the type of place I first started, but there is much more staff support and less patients. However, I still have up to 18 patients at a time, and sometimes very sick/demanding patients. I understand that nursing is busy and I love being busy but I have not ever taken a lunch or sat down for more than 10 minutes at this job. I feel I cannot take care of the patients in the way I want to. It is making me hate nursing. And I hate feeling that way.
So many of my coworkers are telling me to go into a hospital, if I can, since I am young and I hope they think I am competent enough to suggest this. More recently, I have been thinking about it but often times think I am not to the skill level I should be at yet. At a skilled nursing, we have a lot of experience with IV's, wound care, some kinds of drains, etc. But I am worried I am not smart enough/ready enough for the more higher acuity patients in a hospital setting.
I feel something has to change before I become burned out and I am only 23 years old. As I said somewhere above, I am prone to anxiety and feel I don't handle stress as well as others...so maybe there is another aspect of nursing I should be in? Any advice would be appreciated!

I think you'll find that many hospitalized patients are not as sick as the chronics you see in a SNF.

emmy27 · Sep 11, 2015

Honestly, if you've got the time management skills to handle 18 patients, even 18 relatively low-acuity patients, I think the transition to med-surg would be a breeze for you. Yes, there will be more skills involved, but skills are the easy part of nursing- see one-do one-teach one is a saying for a reason. How to start an IV/empty a drain/program a pump is a pretty straightforward process that can be taught quickly, and with lots of opportunity to practice, you'll eventually master it.

The really challenging parts of independent practice for new grads are things like time management and organization, and your experience with large patient loads will likely serve you well there.

There will be things you don't know in med-surg, but new grads start there all the time, and you've already taken on patient loads that dwarf what they do. The sooner you switch to hospital-based acute care, the easier it will be for you to be received as a relatively new nurse and get a thorough orientation and understanding from your coworkers. Don't wait until you're years down the road, hiring managers perceive you as "experienced," and your anxiety over changing tracks has crystallized in to an impenetrable barrier.

You can do this!

PS- For what it's worth, I've been a med surg and ER nurse for years and the idea of having 18-22 patients makes me want to crawl under the desk and hide.