Ready for Change

Recently I have been going "full steam ahead" with my job search for a new job (I started looking over a month ago but have been actively applying for about a week or two now). I am completely over med-surg- yes most of my colleagues are great but I dread going to work just about every shift, am tired of the high patient load, annoying family members, and having to document for a couple of hours after running around all day. Things are even worst now with the mass exodus of nurses from my unit lately who left for other areas because they themselves have probably had enough or wanted change. I certainly feel bad for wanting to leave as my timing is pretty bad but I am not happy and I am starting to doubt whether I made the right decision to leave my previous career (OK I know long-term I made the right choice but I really have to remind myself sometimes). At this time I am still working the two jobs but I would ultimately like to obtain full-time employment in a non med-surg position and retain my per-diem job.

Starting over, again

One thing that I hate about starting a new job is starting over again, which means "new nurse" anxiety, decreased seniority, figuring out new people, etc. Sure a part of me is excited about the prospect of doing something "new" but it also nerve racking too. Also since I have a family, adjusting to a new job means my entire family has to adjust as well, since my decisions with work always affects my husband and children. 

What if I don't like it?

Seriously what if I get another job and dislike it as much as my current job or maybe more? Do I start job hopping all over the place. I am all about being happy but it isn't practical (nor is it advisable) to change jobs so often. If I get another job I didn't care for I would have to stick it out since I have to consider my retirement as well.

4 to 5 day work week

Most outpatient/non-med surg jobs (besides the ER) are 4 or 5 day work weeks; with a per-diem job, it will probably be 5 or 6 days some weeks. While I can tolerate a 4-day work week (that is what I was essentially doing when I started my second job) I really would like to avoid 5 days if at all possible. I love having at least one day off during the week to take care of business and having a "9 to 5" means not participating in anything my kids have during the week. Also since I am still the primary homemaker, having more days off gives me more time to actually be a homemaker as I refuse to do these things after working so many hours in a day.

May stick with 3 twelves

My ideal would be 3 twelves in a non- med/surg position that is day shift (yes it is taxing on the body but I am off 4 days a week) . Are these available? I haven't seen them really but would really like something like that I think. We will see in the next coming months.   

New RN- One Year Update

It has been over a year since I began working as a RN and I all I can say is, what a ride! I still feel those pangs of anxiety (or dread) before most shifts and I am still not confident in all my skills and knowledge, although I would say with the passage of time there are obviously some improvements. By all accounts I should be feeling super confident at this point in my career but alas I don't, at least not fully. Lately I have been reflecting on my experience these past 14 months and am currently in the process of improving my situation somehow.

Why am I still a nervous wreck?

Honestly I don't know but I am pretty sure it has a lot to do with the fact that I am responsible for people's lives? I also feel that the constant "rushing" (particularly in med-surg where a 1:7 to 8 ratio plus an admission or two has become the norm) is completely contrary to my meticulous nature. To make matters worse I never leave on time when I work in the hospital, ever (I can only recall one instance where I left on time and I was actually floated to another unit). I am also still part-time so technically I am "less experienced" than my full-time counterparts and feel I have to do a little more to "catch up to speed."

What about ambulatory care?

Ambulatory care was going well, or at least so I thought. I am still per-diem but I was working close to 20 hours per week so I essentially didn't need to work full-time in the hospital and I had the extra money without the extra stress. Unfortunately my hours have been more inconsistent and sporadic lately, which in turn makes skill development even more difficult than they are in the hospital. Full-time prospects, at least at my current location, no longer seem to be a possibility any more which is not only disappointing but has left pondering what my next options are (I still would like to retain my per-diem gig but need to obtain full-time hours at a "main" job).

What are my goals/plans for this year?

For one, I want to work on my time management. This is something that I struggle with even one year later (I am organized for the most part but there is not enough hours to do what needs to be done and actually document it). I need to control my anxiety too but it hasn't decreased much in a year (I would like to avoid resorting to anti-anxiety meds but if things don't get better in year 2 I will consider it). At this time I am currently looking to leave med-surg nursing as I do not feel it is the best fit for me but I am once again limited by the fact that I cannot do overnight shifts.  

MSN any time soon?

Probably not. My brain is still fried from nursing school almost 2 years later and I am not in the right frame of mind at this time to return to school anyway. My main focus right now is making more money, finding my niche (or at least an area of nursing I can tolerate and grow in), and hone my skills. I am tired of feeling like I am all over the place. 

Ambulatory Care Nursing

After several months of applying to various positions at different facilities, I was offered a per diem RN position in an ambulatory care setting! Yeah I know I've only been a RN for like 5.2 seconds but remember I am only employed part-time, leaving room for me to work elsewhere to supplement both my income and experience. It wasn't easy since I lack ambulatory care experience and I am still a relatively new nurse still developing my practice but I was honest about my experience and knowledge, and apparently sold myself at the interview. Interestingly enough my very first interview for an RN job was at a large outpatient clinic but I was hesitant to begin my nursing career there since I felt it was imperative to have at least some acute care experience before going the outpatient/ambulatory route. Now, roughly a year later (I interviewed for the job right before taking NCLEX last year) I find myself trying to transition to ambulatory care, perhaps a little sooner than I initially anticipated. Since the position is per diem, I will be maintaining my current med/surg position while I work in outpatient practice which is cool since I will have a mix of experience (not to mention I keep my current position for at least a year) which I feel looks better to potential employers. I was told the position could potentially lead to full-time in the future but even if it doesn't, this opportunity will at the very least allow me to explore working in an ambulatory care setting with less commitment and more flexibility (the employer could say the same!). I start orientation next month.

Is Ambulatory Care for Me?

Quite frankly, I don't know. In my pediatric clinical in school, I worked in a peds clinic and although some areas appealed to me (like triage/walk-in, patient education), some aspects of working in the clinic seemed a little boring to me (I also have experience volunteering at a health fair which I loved but don't know if that counts for ambulatory experience). Ambulatory care however is so varied and it's hard to use my one time experience to determine whether or not I would enjoy working in a clinic setting for adults. What I do know is that the days and hours I will potentially work would be less than the 13+ hour days I work at the hospital, will never work Sundays there  (since the clinic is not open on Sundays), and the clinic is part of a large hospital system that could potentially expose me to other acute or ambulatory care opportunities in the future if that's where my spirit leads me. I am also realizing that management of chronic conditions seem more appealing to me now than the unpredictability of acute conditions in the hospital (I guess working in critical care is no longer an ideal option for me?). I am cautiously optimistic about my new position but optimistic nonetheless.

On my Own

I have been on my own now for over 5 months now it's going OK, I guess. Overall things are a little better but progress is slower than I'd like it to be. I still leave late most shifts (I usually leave about 45 minutes to an hour after my shift) and there are times when I feel overwhelmed (my meticulous nature has a hard time adjusting to being pulled in multiple directions constantly). I still feel dumb now and then and make mistakes (nothing life threatening thank God) but there are also moments where I feel like I am helpful and actually know something. My critically thinking still needs tweaking but there is evidence of improvement. I still don't love or even like med/surg nursing and I am sure I will not be doing it in my 40s (which starts next year by the way) but I would be lying if I said I wasn't learning a lot. All and all this is how I would break down my nearly 9 months of experience as a registered nurse:

The Good:
Most of my coworkers seem to be cool and decent people, especially those that work day shift which makes going to work more bearable. This is not to say that "nurses eating their young"  doesn't exist, it's just that my interactions with coworkers, both fellow RNs and support staff has been more positive than negative.

Med/surg nursing, despite it's very fast-paced and varied nature (think 1:7 most shifts, excluding admissions/transfers), is still a good place to start a nursing career even if just for a short time

My schedule is the $%#*! Having 5 days off (or 4 days when I pick up an extra shift) allows me to do a lot at home and be more involved with my kids which was much harder when I worked 5 days and when I was in school. I can easily schedule appointments, run errands during business hours, etc. during my off days.

I am getting my initial experience working in a hospital, which is what I wanted and probably needed.

Even though I work part-time, it's still a day position which is not easy to get as a new RN.

As long as I get to work on time (which is all the time, to date) I get free, easy parking. If I worked in the city, this would probably be a luxury.

The Bad:
I work part-time, which not only means less money but also less experience than full-timers.

I am still anxious and overwhelmed before and during my shifts. I even notice an increase in my anxiety level the day before my shift. I often wonder will it ever get better.

My hourly pay is less than most hospitals in the the city/Long Island, I am not in a unionized hospital, and I am not sure if I see myself setting "roots" where I am now.

I almost never leave on time because I am doing the documentation I had no time to do during my shift. Giving hand off report also can take forever since you usually are giving hand off to multiple nurses.

When I work I am literally out of the house for like 15 hours/day since I leave the house around 6 am and don't get home until close to 9 pm.

I need close to a day to "recover" from my long shift since it is taxing on my body. I can also forget about doing anything else on my work day other than eating (barely), sleeping, and showering.

Some providers can be @#$holes. Most are not but the ones that are usually let their superiority complexes get in the way of what is best for the patient. Humility goes a long way!


The Ugly:
The nurse seems to get blamed for and is expected to do everything, even things beyond their control (like the time a patient goes to a procedure or if a patient refuses treatment or when a provider fails to update patient/family member on patient's health status and you have to track them down like a detective). Nurses have to deal with the brunt of frustration from patients, family members, providers and even other staff members.

Running a hospital like it's a hotel or restaurant makes an already difficult job even harder (I still don't get the whole "VIP" thing since I was under the impression that all patients should be given the same level of quality care but I digress)

Family members can be a lot. Seriously. I get their concern and the need for involvement (as it should be) but when they start telling you how to do your job or they get so much in the way that you can't, well, do your job, it actually can impede patient progress and takes away precious time from all the other #$&* you have to do for your 6 (or possible more) patients.

Recently, I have been offered a per diem RN job to supplement my income and to hopefully expose me to a new environment as well a different set of skills. Will this new job lead to my nursing niche? Only time will tell.

I Don't Like Being a RN

I have completed 5 weeks of my 12 week RN orientation and I can honestly say, I don't like being a nurse, at least not yet. My previous career was mentally stressful but as a hospital RN I am both mentally and physically exhausted at the end of my shift. I feel completely inadequate and dumb and second guess myself every single time. I was a strong student in my clinical rotations but that experience did not fully prepare for being a RN on a nursing unit. Even my experience as a unit clerk, while extremely helpful, did not prepare me adequately for working on a unit in a RN role. Nurses I have spoken to have said that at some point (anywhere between 6 months to a year) I should feel more comfortable and confident but nursing is not the bed of roses that people may think it is. There is a steep learning curve and a lot of "politics" behind the scene that is every bit as much a part of nursing as patient care is. Nurses work hard for their money and don't always get the respect or acknowledgement they deserve.

First off let me say that I enjoy patient care. Sure there are things that I don't particularly care for (wound care and over-bearing family members to name a few) but for the most part I seem to be comfortable dealing with patients as long as I know what the hell I am doing and many seem to be forgiving about the fact that I am still a new RN. I like my patients to feel comfortable and do what I can to make their hospital stay less dreadful, when practical. Despite the long and exhausting hours, I love only working/training just three days a week (which will be two days once I am on my own) and having days off during the week is truly the bomb! Even though my hourly salary is lower than other hospitals it is doubled the amount I was making as a clerk and about a third more than my previous career, not to mention my commute is tolerable. My issue is having so much to do in so little time, high liability and the fact that I feel constantly rushed even though I am still not comfortable with things (my preceptor is very efficient which is great but her focus seems to be more about getting out on time than me understanding $%#&). Working at a constantly fast past doesn't always allow me to process information properly. Documentation, while necessary, is still a @#$%& and takes away from actual patient care.The team work between ancillary staff, nurses, and even providers is occasionally lacking, which is frustrating when I need to get things done. Not sure if that is unit specific or if this is a theme in many nursing units or if all hospitals have this in some capacity but it's annoying to deal with "drama" when I am more than willing to be a team player and others not so much. All of this and I don't even have a full patient load yet! Now I see why some new grads end up having anxiety, depression, or burnout early in the game or why turnover rate tends to be high. For those new grads who work the overnight shifts, this issue is probably exacerbated with having to adjust their body to a different schedule in addition to everything else. 

My hopes were to post about this wonderful orientation experience I was having and how grateful I am for changing careers but alas that is not the case. Hopefully as my comfort level increases and my time management improves I can have more positive things to say. As far as me leaving nursing? Not gonna happen. I will be a RN in some capacity until I retire which won't be for another 25-27 years. No more career changing for me! The good news is nursing is so broad that even if I find that after a year or two I simply can't get with the whole med-surg/bedside nursing I can take my experience and go elsewhere if need be.