Nurses & student nurses!

[Rosehip]

I thought I'd start a new thread, since the previous one seems to have dropped back quite a bit. How is everyone doing? I am a new RN. I graduated in May, started my first job in July. I'm really struggling and my stress is through the roof. I'll be on telemetry/cardiac stepdown, but for the first 6 weeks I'm on a med/surg floor - oncology. To be honest, I absolutely hate it. I dread 9 am meds.

I don't feel competent & am terrified of making a serious error. I did my main student integration (8 weeks, f/t) in an ICU and loved it. I felt part of the team, I really knew the patients, I had the time to understand meds & procedures in depth, etc. Here I feel like I'm just working my way down an assembly line and hope the patients are well enough to survive my care. I only have 5 pts, but it feels like SO much, esp when they have so many Abx & other meds. I have one more week on this floor & then go to tele. I don't know how much better that will be, if at all. I am also not loving the days schedule b/c of my kids. But, at my hospital, new grads are on days for the first 6 months.

Anyway, a few questions:

-What do others do about childcare? The ever-changing schedule is absolutely killing me. Of course, now I'm at the mercy of my preceptor. I don't know how much control I'll have once I'm off orientation on my floor. But getting the schedules on such short notice (~2 weeks before the start of the schedule) makes me insane.
-Will it get better?
-What do you think about starting to apply for ICU positions at other hospitals now? Should I talk to my management? I feel like if I tell them how stressed & unhappy I am, I'll be shooting myself in the foot.

[azjen43]

Hi!

I'm not yet a nurse, (or even a student nurse. I've finished pre-reqs and have been accepted into a program but am waiting for an opening) however I am a seasoned educator with many years of work experience. I just couldn't read your post without offering you some encouragement.

I remember my first year of teaching... half the school year I worried that I was ruining my students' educations, and the other half I was worried I was gonna have a nervous breakdown! But, you know, we all survived. And I still see some of the kids I taught all those years ago ( went to a wedding of one of them recently!) and most of them turned out great. And I went on to have a wonderful fulfilling career.

So my advice (unsolicited, I know!) is to be gentle with yourself. You just graduated in May and have been on your job for less than 2 months. It takes longer than that to get good at most things, and when your job involves people's health and lives, of course it's going to be stressful while you're learning the ropes.

I think it is a good idea to just try to take good care of yourself and simplify whatever you can now, keep focused on sharpening your skills and being kind to your patients, and I'm sure things will get better.

Best of luck to you!

[lorijds]

Spend at least 6 months in your new position (the tele/stepdown unit) before you even start looking for other jobs. No one will want you if you start now. You've only shown them that you can't hang without taking the time to find out if you really can, kwim? For a hospital or unit to feel that they've gotten a fair deal out of the thousands that they spent to train you, you MUST work a minimum of 6 months (though 12 would be better and look better on your resume).

I'd also like to remind you, as I'm sure you heard this before, that it typically takes 6-12 months for you to start to feel really confident in your position. All new grads feel this way. We *all* felt this way. If you would get an ICU job tomorrow, I promise you would feel overwhelmed, scared of making a mistake, and in general frustrated and terrified. Being a precepted student is a million times easier than being a nurse. I'm glad your ICU capstone was such a good experience, but it won't be that easy when you are on your own as an ICU nurse, I guarantee it. You had time before because you were an extra person working with an experienced nurse to guide you.

My advice is to give your tele/stepdown a minimum of 6 months, but really try for a year. You'll hone the assessment, time management and general skills you need in the ICU. Your unit will at least probably break even on their investment in you (which makes you look better in their eyes in terms of references and future rehiring, and makes you look better for other positions). If you still feel like your job isn't right for you, *then* you can request to transfer an ICU within your hospital system or look for another job altogether. You might find, however, that your unit has become a good fit. It *does* get better, but only with time.

I'm on the hiring committee for our unit. I'll be honest, we wouldn't even consider someone who was a new grad and didn't complete their orientation before looking for another job. True, it could be just a bad fit, but unless you could give us a fabulous, amazing reason why you weren't even planning on sticking around in the first job for 6+ months (like an unplanned move due to a spouse's job), we're going to assume that it's because you couldn't handle it, and if you can't handle it there, what's the likelihood you'll handle it on our floor? There are too many other applicants to choose from these days, and we'll pick someone who has a better work history over someone who has only help brief positions any day.

And fyi, most places require a period on days prior to nights, and you're at the mercy of your preceptor's schedule or the scheduler's whims at that time. My medical floor requires at least 2 months; some of the more specialized floors (OR, ICU, ED) require a longer time period. So anywhere you go, you'd be facing that issue.

Hang in there! You haven't even started on your own floor yet; so I definitely think you should give it some time before you start thinking about other positions. I'm impressed that you have found a job that requires such thorough orientation; I'd stick with it, if I were you.

[filiadeluna]

Pre-Nursing here... I start Human A&P next week! I'm pretty excited, but nervous too! I am mostly worried about how I will balance studying with being a Mom and Wife. Any other newbies?

[mks1014]

I'm not in nursing school yet, but may start in January if I don't freak out and say no! I start pharmacology next week. I also work FT. Luckily, I have time to study when I put my 19 month old down to sleep. I have some time at work to study.

I'm still trying to figure out if a career change is the right thing for me. As the time approaches, I think I should just enjoy my flexible career that I do have and enjoy my family instead of going back to school. AHHHH!!!!!




Anyway, Rosehip, so sorry you are stressed out. I agree with others about sticking it out and that only time will give your the confidence! It will also give your more leverage w/ finding a position down the road that may be better suited for you.
After your orientation, how will your schedule be? Do they do self scheduling? Is there anyway to get some sort of permanent schedule once you are on your own? Are you wanting to switch to nights later? Also, do you feel like the 4 days you do have off are quality time with your kids? I sometimes wonder about the schedule...thinking 3 full days would be nice, b/c I'm tired of only seeing my daughter on the weekends and those last few hours in the night. I work FT, so when I get home I have the dinner, bath, bedtime routine part of the day. I enjoy it, but it is not the fun morning time of play that I would rather have with her!

[kate3]

I have been a nurse for 20 years, a NP for 13, and now have a PhD in nursing and teach at the undergraduate/graduate level. Here are my thoughts:

I agree with the advice to give your current position 6-12 months. This is a huge learning curve and transition. I tell my students this all the time. They are so anxious to graduate, be done with school assignments and clinical, and just want to "be a nurse". The reality is far different from clinical, especially if you are not really feeling the love for your new position

The changing schedule is tough. As a staff nurse I was a 12 hour, day/night rotater: 3 weeks of days, 3 weeks of nights. But I also didn't have kids at the time. One of the reasons I wanted to work as a NP was to have a more predictable, daytime schedule. So unfortunately although I can sympathize, I don't have any good advice.

After a year, you will have a solid skill set that you can take anywhere, and you will be very marketable. If ICU is your passion, focus your efforts toward that goal. Take the certification exam for ICU nursing. Go to a critical care conference (if possible). Take CEUs that deal with critical care topics. When you do interview for a new position, you will be ahead of the game.

Best of luck!

[Nillarilla]

I've been an RN for 5 years 2 years on an Internal medical floor and 3 years in hemodialysis. I work a 4 on 5 off rotation of 12 hr shifts. My husband works 4 on 3 off 10 hr days. The only way it works for childcare for us is to have an unlicensed sitter who is a family member who is willing to work with our schedules. She only requires us to pay for the days we use. Whereas when my ds was little I had a licensed daycare spot that we only used parttime but I had to pay for a fulltime spot because of the rotating schedule.
I'm in the process of applying for graduate school for next September. We also want to fit in another baby somewhere. I need a new challenge.

[mks1014]

For the moms who are already RN's, do you mind the 12 hour shifts or do you find yourself wanting a more typical 9-5 type work hour as the kids get older?

[littlehoneybee]

I've been an RN for thirteen years and started out in telemetry. I worked twelve hours shifts three days a week and rotated days/nights. Six weeks days and then two weeks nights. All new grads had to rotate. I worked in a huge teaching hospital and I'll be honest with you and say that telemetry was a very fast paced, high stress unit where I worked. A lot of nurses couldn't handle it and turn over was high. BUT, for those that stayed it was a terrific learning experience. We cared for patients with a wide variety of problems and I learned a lot very quickly. Learn from staff who have been there awhile. They can teach you so much that you never learned in nursing school. I ended up staying on telemetry for five years and was charge nurse for the last two.

My advice is to work there for at least one year. It can take that long to start to really feel comfortable. I also agree with other posters that if you quit early, it's a big red flag to potential employers. Any employer is going to want you to stay at least a year and some make you sign a contract.

As far as the scheduling, it is tough. I didn't have kids when I started, but my friend did and she worked out a deal where she worked the same schedule every week (all days) and then worked additional weekends instead of nights. I know you want to work more nights, so maybe you could work a deal with your manager.

It will get better. You just have to give it some time. You just started working as a "real nurse" which is quite different than nursing school

[feminist~mama]

I'm working 12 hour nights- about 45 minutes from home, so with lunch and travel time- I'm gone from 5:30 pm to 7:45 am 3 days a week. I'm off right now, but will be going back soon with a nursling.

I'm not worried about pumping at work, but I am worried about sleep the next day. We do self-scheduling and before the baby I liked to work my 3 in a row, then go back to a day shift life...

Any tips/hints/helpful advice? The best I can figure is that DP going to stay home with the babe on the days I work- and really stay home. He'll bring the babe to me at nap times and take her away (to the living room) when she's awake... I'm really nervous that I'm not going to be able to sleep/ that everyone is going to be miserable/ etc. She'll be almost 5 months when I go back to work.

To make it all better, DD has decided not to take the bottle anymore. Sigh. So we're working on that- thank goodness I still have a bit of time left before I go back.

[cileag]

I echo the posters above that say to stick with your current job for now. I worked in a transitional care unit for the first year after nursing school and hated it, but after a year, it was dramatically better AND it gave me such good experience in terms of time management---I had 10-12 patients in my step down unit. Ick! Anyway, I moved after a year to in-hospital gyn/gi/gu med/surg and again, hated it for the first couple of months (colostomies! catheters! crazy abdominal pain drug users/seekers!) but again, it got much much better, and really let me get my groove on and I ended up staying for 3 years due to the flexible and awesome management team and great, supportive coworkers.

Now I work in Labor and Delivery and can say resolutely that my earlier work contributed so much. And just for the record, AGAIN when I trained in, I felt awkward, scared, and lacked confidence, but now I'm back to loving it again.

And feministmama, I went back to work at 4 months, 12 hour rotating day and night and to be honest, it WAS rough at the beginning with my night shifts. I didn't prioritize my sleep enough at the beginning and had some really tough shifts at work and then total melt downs at home. We do what you are planning now---I give my babe to my husband at around 1pm and sleep from 1:30-4 or 5, nurse before I go and then head in to work that night and then I nurse when I get home and then hand baby back off to Dad. I ask that he give me a solid 4 hour stretch before bringing her in to nurse, so then usually around 12:30 or 1, we nurse and I then hand her back to Dad and sleep until 3 or 4. On my last day of work for the week, I often get up at that first nursing session, but then my husband will handle any early bedtime issues. And at first, when she was sleeping poorly due to the 4 month sleep regression, I ended up getting MORE sleep working nights than I did dayshift, since I got that 4 hour stretch and then usually another 3. After the first couple of nights, I had no issues sleeping during the day btw.

When I work day shift I try to spread my shifts out as much as possible---being gone for three 12s in a row ends up getting me a cranky, clingy baby by day three. But nights I can't do that--it's too hard on my body.

[carolinagirl1]

I have to agree with the other nurses here that say give it at least 6-12 months. On a floor (as opposed to an ICU), you will learn valuable time management skills, and you will be very proficient and confident in that time.

That said, l admit that I did not start off in floor nursing as a new grad. I went straight to the Neonatal ICU and I couldn't have been happier. I worked on a medical (with post-surgical overflow) floor as a student nurse in a hospital where the student nurses were given more responsibilities than the LPNs. We were expected to do all assessments, meds, treatments, etc just as an RN. We just needed to have the RN sign our documentation. I really did not like it (for the same reasons you don't). For my senior clinical I worked on a telemetry floor and I dreaded going in for clinical and wondered why in the world I decided to leave another field and go into nursing. Then I was offered a job straight out of school in the Neonatal ICU. It was nothing like anything I'd learned in nursing school - totally different, and they didn't expect me to already know anything. I think they were happy to mold new grads into what they wanted. After I worked there for 2 years, I went to a float position where I worked Neonatal ICU and the pediatric floors. I did learn a lot about time management on the floors, but my love for the ICU environment absolutely wins out! It sounds like you experienced that too. I loved having no more than 3 patients and being able to give more to those patients than having 4-5 (or more) patients on a floor, running from room to room. While I did like that the patients on the floor were a little healthier, I didn't feel like I could give them that constant monitoring that I was accustomed to in the ICU.

So, I understand where you are coming from, but 6 months to a year is not a long time to stick it out and it will give you some good experience and it will look better on your resume to keep the same job for at least that long. Then go for it with the ICU job!!

As for the schedule, my new grad nursing schedule was brutal. 6 nights and 6 days per schedule. You could try to schedule nights together and then days together, but the scheduler mixed up your schedule however they wanted. Thank goodness I didn't have kids then. I would've had to have some seriously good childcare/support at home! When I went to the float pool, it was wonderful. I worked in a major regional hospital where I could make my own schedule so I would work M, T, and TH days. Then I had a baby. My husband is the breadwinner so my job became more of a "hobby" since we did not need my income. In my float pool, I could work 4, 8, or 12 hour shifts, so I'd just work a few evenings a month 7p-11p or weekend days, 7-3:30, or maybe even a few 12's a month. We ended up moving an hour away so the travel time got to be too much with the 2nd baby and breastfeeding, etc., so I'm a stay at home mom now, volunteering a couple of days a month in a medical clinic.

I know that doesn't really help you as far as schedule concerns, but it just shows that as a nurse, you have sooo much variety and so many opportunities. PRN schedules (especially at a very busy regional medical center) provide so much flexibility that is great for moms, especially if you don't need the health insurance.

[Faerieshadow]

Subbing... I was accepted into a BSN program starting in January and I want to absorb everything I can while I make that final decision to go for it or not! I obviously don't have a lot of nursing input at the moment so I'm just along for the ride so I can figure out what to expect in the next few months.

[Gator-mom]

Hey all, I'm in my second semester of Nursing school for my BSN this year, and just thought I'd jump in! For Rosehip, I just thought I'd say that we've actually been talking alot about this in school lately. We've been discussing Benner's levels of experience and how in order to become a competent nurse, it can take 2-3 years in each field and every time you switch, you pretty much start back at either novice or advanced beginner again!

I do have a question for nurses out there. I've been feeling like I've been gravitating to work in home health and hospice for a number of reasons, but mainly that I really like it as a CNA. I keep finding myself in end of life care, even though I get assigned with clients who are technically not there when I get them. I keep getting the feeling that this is kind of my niche and I don't mind that, but I'm just wondering if you think it would be a better idea to make sure I get some hospital experience before I actually move into that field? I feel like I will inevitably go there, but I'm afraid that if I do it right away, it will seriously narrow my chances of getting other types of experiences if I so chose to move fields later on.

I'm sort of interested in thoracic ICU and POSSIBLY OB, however I'm worried I have too many biases for that...but just trying to be thinking about all this. I'm taking my first Med-surge class semester and the word on the street is that if we get an 'A' this semester, we will get more of a first pick for our capstone..so I want to have idea of where I actually want to go!

[sugarmoon]

Subbing...

Took A&P I this summer, taking II this fall, and applying to both a MENP and an assoc. RN program for next fall. I really want to do the MENP prog, which leads straight into a DNP grad degree, but there are lots of logisitical barriers to that for me.

[Knittin' in the Shade]

Pre-nursing student here; headed back to college (11 years after getting my BA, yikes!) Taking Chem I and Bio 220 (Nutrition + Well Being) this semester, still have Chem II, Micro and A+P to take. Planning to do a second-degree accelerated BSN/MSN program starting in fall 2012. Really going to work hard for excellent grades in these pre-req's, since I've heard that GPA is the #1 factor in acceptance. My BA GPA was 3.65, so I really want to keep it up there, especially since my first choice school is UPenn. If I don't make it into Penn, it'll be Jefferson; either way I'll be working towards a neonatal NP. (after that, DNP? Who knows if I'll be tired of school by then, lol!)

[goodygumdrops]

Originally Posted by sugarmoon

Subbing...

Took A&P I this summer, taking II this fall, and applying to both a MENP and an assoc. RN program for next fall. I really want to do the MENP prog, which leads straight into a DNP grad degree, but there are lots of logisitical barriers to that for me.

This is what I am interested in doing. What school are you looking at?

[Rosehip]

Thanks everyone for the responses, re: my frustrations. The great news is that I'm done with my 6 week stint on med-surg. I am now on telemetry and it is SO much better. My preceptor is such a better fit, and the whole atmosphere, work flow, etc. is a huge breath of fresh air. I love how it's a bit closer to the ICU atmosphere.

I am going to stick it out for the meantime.

Carolinagirl - My time in the ICU as a student was similar. After a few shifts, my nurse basically left me alone with the patients and I did everything save push IV meds & co-sign for narcotics. I still really want to get into an ICU, but I think that I can stick it out on stepdown. I'm really relieved. I was so incredibly unhappy on the med-surg floor!

I am really looking forward to nights though. Days are just so rough with the kids. Today I didn't see them at all. Yesterday I came home & my 5 year old was sobbing with exhaustion but wanting to see me...

[USAmma]

I'm in the fast track program (super crazy but that's the one I got into!) and will hopefullly graduate in march after 16 months of school. I'm hoping there's a job waiting for me . . things are not so great for new grads in our area right now.

[an_aurora]

I am 2 weeks into my 2nd semester of nursing school! DH is in school too and it's a bit overwhelming. Good news is that our lives are so hectic it's going pretty fast.