War of Attrition

When I first started my externship this past January, there were two GNs starting their internships on our unit. They were both externs during nursing school-- one on our unit, the other on a generic med-surg unit.

The GN that had externed on our unit made it out of her internship, but only a few weeks past that. It was quickly evident she wasn't ICU material, although she claimed it was because nobody would help her, and we all let her drown. Of course when you stand around flapping your jaws, people tend to assume you're caught up, and don't need help. But whatever. Whatever it takes to soothe that keen edge of personal responsibility.

The other GN did much, much better. She is turning into a solid nurse, especially for having as little experience as she does. She's 8 months in--always comes to work when she's on the schedule, and shows up swinging with both arms. She's doing really well.

Or so we thought.

Yesterday I found out she changed her status to PRN. When I asked where her new job was, she just gave me a blank look. Confused, I asked why she was going PRN if not for a new job. She just about broke down when she told me.

Since she started working she's been having major anxiety attacks at home. She's gaining weight, her hair is falling out. She's been having crazy dreams about patients and about work. One night she dreamed she'd left a patient in her car, and even though she knew better, she went downstairs to check her car, just to settle her mind. She'd been able to hold it together at work, but her personal life was a wreck, and she was a shell of a human at home.

I'd had no idea. None of us did. Didn't ask for help, didn't confide in anyone. She was trying to soldier on, on her own.

Now have no doubt, our ICU is relatively small. We're only 16 beds, and we get bypassed for most major traumas. But we are pretty busy and we do see our fair share of critically ill patients, and the pace can be pretty heavy.

I feel bad for her, I really do. I think she's selling herself short thinking she's not ICU material. This hits home for another reason too.

These days I sit and contemplate: Do I stay where I am or move to a major hospital in the area?

I like the unit I'm on. It's a brand new hospital built only 4 years ago. I know the people both on the unit and around the hospital. I know how things are done. I will get some solid experience, especially DKA's, post-cath, post CABG, STEMIs, strokes, renal failure, COPD. Pretty well rounded actually. It's only 7 minutes from my house by car. The down side, it's not a hugely impressive name on my resume. I won't see major traumas, and I may not see as *much* cool stuff.

The big-name hospitals are all at least 30 minute commutes, but they are all awesome organizations. I will no doubt get an amazing amount of experience. But with current job markets, I may not even get onto a dream unit.

And now, given my co-worker's plight, the self doubt starts to creep in. Could I really hack it on a truly busy unit? Am I up to the truly critical nature of the patients at a teaching hospital?

My current unit is safe. The big hospitals are the great unknown.

I'm scared to death regardless. Maybe like a patient extubated too soon, I just won't fly...

I don't know if I can take another graduation and then colossal failure.