Bull and Monkey/graphite, charcoal, acrylic on vellum/by julianna paradisi
Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.
The culture shock experienced by new nurses making the transition from student to professional is well documented. Less well documented is the culture shock seasoned nurses face when changing jobs. Not all nurses are the same. Neither are all nursing jobs.
Working in an unfamiliar setting means being the new guy. You may have been in the top 10 of your nursing class for grades and clinical excellence. Or you may have held a position of leadership in your previous unit. In your new job, you are unknown and unproven.
For nurses changing jobs from high-acuity areas—ICU or bone marrow transplant, say—to an ambulatory clinic, the stress is twofold.
First, there’s a period of grieving the loss of hard-won skills and certifications that are not applicable in the new role.
Then there’s the shock that your skills and experiences did not prepare you for the outpatient setting. Often, the first realization is that high-acuity patients have central lines, so a nurse migrating from such a practice area may not have strong peripheral IV skills.
By contrast, placing peripheral IV’s is something outpatient infusion nurses do all day long; IV placement skills are learned over time through practice. The nurse experienced in high-acuity patient care is suddenly a beginner, often needing the help of coworkers to insert IV’s in patients. The inability to consistently start a peripheral IV is frustrating for the nurse and for coworkers, not to mention the patient.
I’ve been thinking a lot about how it feels to be new at a job, because of the changes at mine (see earlier post, “The ACA and Me: A Dispatch from the Trenches”). Although my job is basically the same job that it was, the oncology piece has greatly expanded, and I’ve worked hard to become familiar with numerous chemotherapy regimens.
Sometimes it feels like “See one, Do one, Teach one” all over again.
For instance, one of my new roles is phone triage. I sit in a small office answering patient phone calls and emails for prescription refill requests, symptom management, and other concerns. I think, to many nurses, sitting at a desk answering phones is a very easy job.
That’s not my experience. While my hands-on patient care in this role is limited to accessing ports, starting IV’s, and drawing labs, I need to summon every ounce of buried nursing knowledge and assessment skill. When this falls short, I search references for drug adverse effect information, because many home medications are unfamiliar to nurses working in clinical settings. This is important—patients may perceive their symptoms as adverse effects of drugs instead of a worsening condition.
Besides this, I verify that preauthorizations have been obtained, chase down busy doctors to sign prescriptions that can’t be sent electronically, assess patients over the phone, hoping I didn’t forget to ask a crucial question.
Meanwhile, the phone keeps ringing, the emails keep coming, and there are constant interruptions.
Then an oncologist pokes his head in the doorway, requesting I provide chemotherapy education for a new patient. This means I have to let go of the ringing phones, and the concerns swirling in my brain. I put on my calm nurse face.
I enter the exam room, and introduce myself to a patient who just found out they have cancer. I see the fear in his or her eyes.
In that moment, nothing else exists.
I love that you draw the connection between art and changing roles as a nurse. Both take time and patience to develop. I think people within and outside the profession tend to overlook that. 🙂 Great read.
I am in the process of finding a new nursing job but feel confident
Past experience will be helpful
Your article reflected so many feelings I experienced working as an RN in a busy practice. The constant transitioning from triage to next patient was a skill we had not learned in school or any of my previous nursing jobs. Thanks for sharing such a powerful insight.
Great post, as always JP!
After years of peds nursing I helped open a children’s hospital call center, this was over 15 years ago. It was very exciting and extremely challenging work. I realised that phone triage is not for the faint of heart. It certainly helped to have years of bedside nursing in my back pocket, as what the patient (or parent) describes from their perspective often takes more questioning and visualization on the nurse’s part to finally determine what is going on.
More than once I had a parent call, describe child in a code situation (not breathing, blue), and when instructed to call 911 was questioned by the parent. We always called back to ensure the parent had done so. Often we got feedback from the ED later about the children which was very helpful in reinforcing our actions as many families did not have insurance coverage for the ride.
This was just one of the challenges of the job.
Thanks for writing this and bringing back memories from an amazing ride I had at that point in my career.
It was good to read this tonight. I have felt very inadequate in my new job on a stroke unit which is strange really as I’ve moved from a stroke unit at a different hospital. I am not allowed to do certain procedures because I am not trained at the new hospital, however, I have been doing these procedures for a number of years. I feel I have one hand tied behind my back. Never mind give it time.
I was a Combat Medic for 4 years before I became and LPN. I had two deployments my last one was route clearance. I was the senior medic for 110 service members. I was on the ground walking with my guys looking for bombs daily. I got tired of not being able to see people get better. I work in an ICU now the only enlisted/LPN on a floor of all RNs. I rarely see soldiers like I did at Walter Reed (for clinicals). I mostly see retired. I had to prove to all my RNs that I deserved to be there plus I was a fresh LPN. Sink or Swim. Most assumed since i was an LPN I had no experience until i shared one day what I did prior to becoming and LPN. My civilian nurses think highly of me and I even orient new officers since we are civilian heavy. Most officers get quite disgruntleted when I know more about the floor than they do. My hardest adjustment was from the line to the hospital not so much student to profession.
I also went through the same transition. Telephone triage is very scary, especially when you are have come from the bedside. I had some triage experience as night shift charge on a very busy BMT unit but this is different. I also had to go back and dig deep into my nursing knowledge and learn many new chemotherapy regimens and teach over the phone as support for the MD office. So your article is spot on!
Very good and interesting article! Thanks!
Julianna, I feel like you are writing my own thoughts! I too am new to a new role, but am an experienced nurse. I think it is harder than being a new nurse. Thank you so much for sharing your experience.
Your perspective is so on target w/ my own experiences. I thought it was just me and wondered why I should feel so incompetent in a much lower acuity environment.
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