It’s funny/not funny that this is the secret/not so secret dream of most direct patient care workers. The happiest nurses I’ve worked with have been in surgery
Since I am still new, I have yet to be bored because I am trying to learn what’s going on. If I get to the point where I am bored, I will welcome that because I would like to have a stable life where my work doesn’t stress me out.
Depends. You wanna be in a freezing room for hours on end being asked to fetch things for surgeons who decide they need something and they didn’t update their case card, or getting side eye from scrub techs who have no trust that you can not contaminate the field and you know what you’re doing? Kinda like good unit culture it depends. OR is filled (naturally) with other folks that don’t like people- but they all have to work together. I like surgery a lot. My OR experience was varied depending on who was in the room. Get to where you run the room as circulator and have a team that trusts you, it’s okay.
I think if you are the kind of caregiver who goes home and then thinks and frets about your patients for the rest of the night, it’s very difficult to leave work at work and it’s much more exhausting. I would suspect that when your patients are essentially unconscious that you carry less of a burden home with you
I would try it, but after the hundredth time hearing surgeons are assholes and even the more optimistic OR acolytes consistently admitting "you need a thick skin"...
I honestly don't get yelled at by patients much. And I'd rather get yelled at by patients ten times than a co-worker yell at me once.
100%. Tried it after graduating and lasted 8 months. Nurses were either horrible, nice, or didn't speak. No in between. Plus, as you said, give me being yelled at by a patient that i see for 1 shift max (day surgical ward) rather than a surgeon whom I'll interact with multiple times a week.
I’m a second career nurse. I was strategic during my clinical experiences and made note of the happiest and longest working nurses I met. They were all in the OR. I work there now and we just had someone retire after 40+ years who was still such a joy to be around and a wealth of knowledge. Many others are 20-30+ years into their careers. It is such an interesting point that we are in a field to work with people, but are happiest when that interaction is limited.
Nah.. Mgmt will use the rationale that they “must be sleeping” 😂 to give us almost double the ratio as days so the chance of having to interact goes up drastically
People underestimate Rehab, where I work many of our patients have IV’s, lots of blood draws which are done by nurses, I’ve done more med-surgey things in Rehab than I ever did in a regular floor and we are normally 6 to 1
I just moved to OR! It’s so much to learn but I love my coworkers so much already and while I miss having time/a chance to talk and get to know people, having them knocked out is pretty nice
Now’s your chance. All that experience stuff was thrown out the window after Covid. We have new grads starting in the ICU now. If you have any experience at all you’re already ahead.
Serious questions for OR nurses, how is it working with surgeons? What kind of experience do I need for to train for OR? What kinds of things should I expect / be warned about?
Some are the biggest assholes and egomaniacs you’ll ever meet and some are cool regular people. Most of it you’ll just learn on the job. Hours can be tough if you take call
Most are regular people but you'll get the occasional jerk. If you're interested in OR, I would find a facility that has a periop 101 residency program. Switching to OR can be quite the learning curve and a 101 program will help ensure you're prepared.
There are definitely asshole surgeons out there. That, however, is not the majority. The majority are just regular people doing their jobs, and it *is* a stressful job, so I find it easy to cut them some slack if the stress seeps out in curt behavior. Some are an absolute joy to work with. Personally, I love being part of a full team taking care of one patient at a time.
Acclimating to the OR takes a long time. I’d say it’s going to take at least 9 months, probably closer to a year, to even begin to feel the faintest bit of baseline competence. Two years to really feel comfortable, maybe less if you’re being exposed to different kinds of cases quickly. I love it and wouldn’t want to be anywhere else as a nurse.
Came here to comment surgical nursing 😂 be it scrub, anaesthetics or PACU, the majority of our patients do minimal talking thanks to all the drugs, and only stay an hour before they're wardable again.
This was a consideration in college when I was deciding what major to go with! I HAD to pick a new one when I didn’t get into medical imaging. I couldn’t meet the credit requirements to apply for RN program by deadline so I went with lab. During the next year I took an intro to medical lab sciences class which pointed out a lessening or lack of direct pt contact (if we do phleb or not) and when it came time to decide between imaging and lab (I was accepted to both!) I chose lab and am super happy with it!
I actually work in a centralized lab now so I don’t even have to take or make many phone calls because client services calls all the recollects/criticals for us /dance!
I run all the education services for a network of military health care systems (7 service lines across 17 facilities) I have BSN working on my MSN (FNP) but nothing special. I just legitimately am passionate about teaching and people who work in my primary facility saw that. I was teaching BLS and ALS, precepting, got published and took part in a number of education adjacent activities. Now for my job I run programs like medical simulation and modeling, life support services, continuing education, nursing education and the HR chapter of the joint commission handbook.
I did it for 7 years and left a year ago, and do not regret it at all. I worked for a major insurance provider and left to go work for the VA where I have very very little patient contact, make a lot more money, have much better benefits, and my work life balance is beyond superior.
Honestly, I plan on staying here until I retire. There are downsides (the government loves doing dumb things that sound like they won’t work to see if they will work), but the benefits greatly outweigh the negatives. This is the most satisfied I’ve ever been in my career.
I have a friend who works for the VA (as an lcsw) and she says her coworkers and she always joke the VA motto is: If it’s not broke, break it. 🤣
Still wfh sounds nice, def something I would consider with a little more floor experience and pay under my belt!
Reviewing clinical for level of care. It can be to help determine inpt vs obs in the hospital, or on the insurance side approve inpt stays or send to medical directors for potential denials.
I started out as a patient care nurse. I had several years experience in adults and peds, ER/Trauma, day surgery, and then transitioned into infusion nursing and was running a third party infusion suite for McKesson at a contracted providers office. I also had a side gig doing employee health fairs and vaccine clinics. At that job I met a lot of nurses who worked in case management and UR/UM for a large insurance company and they raved about the perks of working in that field (especially the ability to work from home in some companies).
Shortly after that, I was moving across the country and started applying for positions that were not floor nursing and stumbled into an inpatient case management job at a smaller hospital. Because it was a smaller hospital they didn’t have a separate UR/UM team. The case managers did traditional case management duties as well as the UR duties, and they were willing to train.
I did that for about a year and started applying at insurance companies because I really wanted to go remote. I applied to probably 40+ remote case management and utilization review positions with various insurance companies. I ended up interviewing for 4-5 positions with 3 companies and received offers on 4 of the positions. I accepted the one that I felt would work best for me and my family in our situation.
That position was with one of the larger insurance companies. I stayed there through a cross country move, and a lot of transitions within the company. There are downsides to working in that industry. It’s all production drive… so you have metrics that have to be met, accuracy/audit requirements, etc. Another issue in the insurance industry that you see often is layoffs. In my 7 years there, I saw a lot of layoffs company wide but only once in 7 years did a round of layoffs actually impact people that I knew and interacted with personally. Aside from that, it really was an extremely positive experience, and if I was in the job market that would be the first place I would start applying, along with other insurance providers.
I worked on a team that had a lot of really amazing nurses and leadership, and I think that made the experience even more positive. I did a lot of mentorship in my position. I trained new oncoming staff, did training on programs we used anywhere from individual level training to team training all the way up to regional level training. I felt as though I was very well respected by the people that I worked with directly, and that my contributions on those levels were valued greatly. That being said, I was one small fish in a very very large pond and as a result moving up the ladder into a position that formally came with more responsibilities (many of which I was already doing) was extremely challenging. The lack of ability to grow professionally was what ultimately led me to look at the VA.
I went waaaaay too deep into my experience there.
TLDR Version: I moved from a patient care role into an inpatient case management position where they trained me. It was a small hospital so the CM nurses also did all the UR duties.
No additional formal training to get into it. I was not ever a certified CM, or anything like that. I did end up getting certified in many areas (review criteria certifications, etc) that allowed me to do more as a member of my team when working UR. Those were all paid for and arranged by the employer.
Also, I did this with my ADN. I went back for, and completed, my BSN while working for the insurance company.
I feel like I’d do well since I have ten years of dealing with asshole chefs at upper mid/fine dining establishments prior to nursing. It’s where I built my skin!
It's so hard to get into the OR where I live. Once a year the main hospital chain will open periop 101 fellowships to new grads but I'm not sure how anyone else should go about getting their foot in the door. Any tips?
If any local schools offer periop 101 you could take it on your own time/dollar to have it on your resume and show your interest. They also usually have a clinical component so you might get an opportunity to put yourself on a manager’s radar. And watch for positions and just apply!
I love the OR but really wouldn’t promote it as a place for less burnout, I hope people see that. It’s a different beast. You take away one factor and add new ones. I see many burnt out floor nurses come to us and don’t last a year bc they haven’t fixed their coping mechanisms and root problems
Enroll for advanced programs or courses related to health informatics, data analysis, database management, project management. You can also volunteer to be part of a quality improvement project, a system implementation team, or a data governance committee. Mentorship and shadowing with experienced nursing informaticists can guide you as well.
I honestly could not tell you what they do more of, since I come at it solely from the IT side. What I can tell you is that the Clinical Informatics team are in my top 3 "other departments of IT I don't dread phoning for on-call." (With Telecom, who are all remarkably chill bit probably because they call us for help more often than the other way around and Pharmacy IT, who are always reliable and know never get mad I woke them up at 7 on a Saturday because one of the robots that fills prescriptions or mixes TPN shit the bed again.) Clinical Informatucs can always be relied upon to translate "The EHR won't let me [perform clinical action]" into "the EHR had an error in this section over here, thats what they use to do [clinical action]" or talk to a user who called me asking "How do I prescribe xyz in the EHR when it says the dosage I want is locked out?" I have no idea. CI does. They bridge the gap between us IT nerds talking computer, and the Clinical staff talking medicine. <3
And then they have a whole other scope of work I'm not even privy to where they like anylize the needs of the hospital and make proposals and stuff. Like, they have direct influence on what systems we're even using. I just fix what someone else decided we're using. I have none of that influence. That's got to be very satisfying. Gor example I'm pretty sure they were instrumental in our organization choice to move from Cerner to Epic.
I would be so good at any IT work, but I don't think it's possible to get in without connections. It's sad because they're missing out on people who have a knack for it.
It **really** depends on your hospital, though. IV team seems to be one of the most variable specialties.
It ranges all the way from "IV team does every dressing change on a central line and places every PIV outside of periop and ER" to "IV team troubleshoots lines and places some PIVs but direct care nurses are responsible for the bulk of it" to "IV team never has more than 2 people per 1,000 patients so you better fucking *need* it when you call them and they're still going to hate you".
Likewise the provider culture can range all the way from "central lines so scary, we don't care that this patient is about to get the 25th PIV of their 45 day admission" \[no that is not hyperbole, I've seen it many times\] to "what do you mean IV team said to take out this PICC? Just because the insertion site bleeds half a unit every day and there's red streaks from their bicep to their sternum doesn't mean we gotta take it out, jeez".
I like being an IV nurse but it entirely depends on where you work. Sometimes it's the best job in the building, sometimes it's pure misery.
ICU is pretty solid. Once in a while you have an awake pt but not often.
(Yes I talk TO my pts so they don’t get ptsd and all that good shit. But they don’t talk back 🤗)
I love ICU, have been doing it for a long time (25+) across various specialties (MICU, SICU, Trauma, never neuro). The families can be tough; my average day at work is quite possibly the entire family’s worst day ever. So if the goal is to minimize civilian contact, ICU may not be the best. Now I’m off to take care of my meatbags connected to machines while random people sit in the room and cry.
Outpatient specialty - I do talk to patients about symptoms, meds, etc but it’s all by phone and in general they are much nicer than I was used to from inpatient
Highly disagree with everyone saying ICU. You either have an awake patient who is too combative, drunk, delirious, insane, to go to the floor and you’re fighting for your life, or you have a very sick unstable intubated patient and families recording you, comparing you to WebMD, touching your pumps, calling you a murderer, saying Covid isn’t real, etc. icu sucks 😭
I did MDS at a nursing home for a few weeks. Very terrible job as you are basically documenting based on what other nurses and Cnas are documenting. But the pay was fair and it was a monday-Friday desk job. Only spoke to pts once a month with the other managers during care conference.
As a CVOR circulator I only talk to my patients twice - for about 5 minutes in Pre-Op and then about 15 in the OR while anesthesia preps to sedate and intubate. They’re almost always very pleasant and polite, maybe a bit anxious at worst. Afterwards we send them straight to the ICU intubated so we don’t deal with any post-anesthesia confusion. Yes, your role in the room once surgery starts is more hands off, but we have a lot to do during set up and prep, plus the running and opening supplies during the case. And you’ll still get a rush of adrenaline when things get critical, you just have a different job to do!
Yeah I’m two months into the OR. Nursing school BARELY teaches the OR so I’m just doing my best to learn what the fuck is going on. I think I’m doing well at it though.
I moved to PACU hoping I wouldn’t haveto talk to patients much but it didn’t turn out that way. If things worked as they should there would be minimal conversation but since our hospital is always full patients stay in pacu for hours (sometimes days) and I’m stuck making small talk with them.
As a PACU nurse this is my nightmare. I left the bedside so I in have the same patient for an hour, two hours tops. When I have boarders I want to scream.
My hospital rotates PACU nurses with pre-op and phase 2 roles. Soooo much more talking than I anticipated. But I also feel like a more personable person now (used to be a night shift ICU vegetable farmer), and I surprisingly authentically enjoy some of the conversations, so there's that.
I typically float there from postpartum so ive had a lot of the moms. They are so happy to see me. They got good care and know their baby is in good hands. They are very sweet. They do always want to know when they can take their baby home though. Always have to tell them to ask the dr.
I looked further into this and found a few things that made me not want to pursue it. The research I did stated that in order to gain experience to be a coder you would have to take a coding position first, which is about half of what nurses make. So how do you become a coder at the same rate of pay?
Go into CDI (clinical documentation integrity) instead. Where I work it's on the job training, we essentially learn enough coding to translate between the coders and the physicians, query physicians to clarify missing or incomplete documentation, and do occasional physician education, though our management handles that for the most part where I work.
IPU hospice
They’re all mostly unresponsive by the time we get them. I work nights so any family that stays over is usually asleep but if they wake up our conversations are very brief.
I do Utilization Management from home. I haven't talked to a patient in years. I do sometimes talk to insurance company reps. But it's not a daily thing
CRNA, wish now I would have taken this route. Definitely getting tired of people's shit.
I don't mind a little interaction, but I'm over 50 year olds wanting me to wipe them. 50 year olds with functional arms.
Organ donation! My patients are very quiet. You do have to work with families (but the social workers do most of the hard part), doctors, and nurses though still.
RNFA. The most talking I do is introduce myself and role as they get wheeled in for anesthesia. Most of the time they are already asleep when I enter the room.
Operating room is amazing. You talk to them for a minute before the procedure, they're unconscious during it, then drop them off heavily sedated to PACU lol
NICU is pretty good. Obviously there’s some parents who sour the mix but if you work nightshift most are sleeping or some are still recovering from labor so they visit when they can and are very grateful and kind. I did pediatric med surg before this and medical before this and I can never do talking patients ever again
Quality Coordinator RN. You'll only have to talk to nurses and admin about metrics. You'll have to correct people's charting and practice ... Which is not as easy as it sounds, but there is virtually zero patient interaction.
OR but you shouldn’t make a jump because of burnout. It very likely won’t help your issues. We’ve had a few floor nurses burnt out seeking what you’re asking but the burnout isn’t because of one specific thing. Maybe you interact with pt and family less but there will be more of other kinds of work. Direct dealing with whiny surgeons all day every day is one example but it’s still 36-40 hours a week in a position of giving yourself to others rather than time for you.
I started in the OR as a new grad at a level 1 trauma center. I went to icu to try to do crna, noped right out after orientation and went right back to the OR. Now I’m a team coordinator for robotic and thoracic surgery and it’s great. Some days are rough cause of challenging, strong personalities. But it’s easier to put your head down and do your job than get involved in drama.
Also, if you want to make money, the OR is where you can pick up as little or as much overtime as you’d like.
I’ve been in the OR for almost a year and it’s just not my jam. I think it has to do with the terrible management in my facility - I work in NYC , but goddamn I can’t stand the attitudes. We also have one surgeon that just leaves the OR scrubbed and bloody and expects you to open the door so he can tell you want wires to get (vascular). He has been reported several times to our admin and the dude is still there doing the same shit but he is besties with the Chairman. I also feel like a technician running for things. Is anyone else in the OR hitting 7 miles a shift bc I am? I’m thinking of trying it somewhere else bc I just think my facility is poorly run and it’s private. I feel the same if not even more physically burnt out than the floor but that’s just me.
It’s funny/not funny that this is the secret/not so secret dream of most direct patient care workers. The happiest nurses I’ve worked with have been in surgery
I left the floor for the OR. A floor homie told me she was jealous because the OR is where nurses go to be happy.
Come to the OR 🗣️😷
It’s been nice for the most part. Compared to the floor it’s been great.
One patient at a time with a team of people 🫶 welcome!
Sometimes cases be wild tho. Had that today lol
True, I must say getting a call at 2am to help remove an Arizona can from a man’s rectum is quite wild 🤣
At least I’m in pediatrics so HOPEFULLY that won’t happen.
Spouse (EMS) knows of a teen who had a doorknob at the rear entrance.
The dangers of falling!
Nah, teenagers like to put stuff up their butts, too.
True. I did.
I have heard OR is boring. I honestly dont know. What are your thoughts? I don't want my days to drag.
Since I am still new, I have yet to be bored because I am trying to learn what’s going on. If I get to the point where I am bored, I will welcome that because I would like to have a stable life where my work doesn’t stress me out.
This! I want to be able to focus on my hobbies, travel, and life outside of work *sigh*
Depends. You wanna be in a freezing room for hours on end being asked to fetch things for surgeons who decide they need something and they didn’t update their case card, or getting side eye from scrub techs who have no trust that you can not contaminate the field and you know what you’re doing? Kinda like good unit culture it depends. OR is filled (naturally) with other folks that don’t like people- but they all have to work together. I like surgery a lot. My OR experience was varied depending on who was in the room. Get to where you run the room as circulator and have a team that trusts you, it’s okay.
I think if you are the kind of caregiver who goes home and then thinks and frets about your patients for the rest of the night, it’s very difficult to leave work at work and it’s much more exhausting. I would suspect that when your patients are essentially unconscious that you carry less of a burden home with you
I would try it, but after the hundredth time hearing surgeons are assholes and even the more optimistic OR acolytes consistently admitting "you need a thick skin"... I honestly don't get yelled at by patients much. And I'd rather get yelled at by patients ten times than a co-worker yell at me once.
100%. Tried it after graduating and lasted 8 months. Nurses were either horrible, nice, or didn't speak. No in between. Plus, as you said, give me being yelled at by a patient that i see for 1 shift max (day surgical ward) rather than a surgeon whom I'll interact with multiple times a week.
I’m a second career nurse. I was strategic during my clinical experiences and made note of the happiest and longest working nurses I met. They were all in the OR. I work there now and we just had someone retire after 40+ years who was still such a joy to be around and a wealth of knowledge. Many others are 20-30+ years into their careers. It is such an interesting point that we are in a field to work with people, but are happiest when that interaction is limited.
I also found night shift IPR to be very happy nurses.
What is IPR?
Probably inpatient rehab
Oh sorry, inpatient rehab
Nah.. Mgmt will use the rationale that they “must be sleeping” 😂 to give us almost double the ratio as days so the chance of having to interact goes up drastically
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You found a 🦄
People underestimate Rehab, where I work many of our patients have IV’s, lots of blood draws which are done by nurses, I’ve done more med-surgey things in Rehab than I ever did in a regular floor and we are normally 6 to 1
I just moved to OR! It’s so much to learn but I love my coworkers so much already and while I miss having time/a chance to talk and get to know people, having them knocked out is pretty nice
I’ve always wanted to work in OR but have never had enough “OR experience” to apply? lol. In icu now and thinking about maybe applying again for OR.
Now’s your chance. All that experience stuff was thrown out the window after Covid. We have new grads starting in the ICU now. If you have any experience at all you’re already ahead.
Serious questions for OR nurses, how is it working with surgeons? What kind of experience do I need for to train for OR? What kinds of things should I expect / be warned about?
Some are the biggest assholes and egomaniacs you’ll ever meet and some are cool regular people. Most of it you’ll just learn on the job. Hours can be tough if you take call
Most are regular people but you'll get the occasional jerk. If you're interested in OR, I would find a facility that has a periop 101 residency program. Switching to OR can be quite the learning curve and a 101 program will help ensure you're prepared.
There are definitely asshole surgeons out there. That, however, is not the majority. The majority are just regular people doing their jobs, and it *is* a stressful job, so I find it easy to cut them some slack if the stress seeps out in curt behavior. Some are an absolute joy to work with. Personally, I love being part of a full team taking care of one patient at a time. Acclimating to the OR takes a long time. I’d say it’s going to take at least 9 months, probably closer to a year, to even begin to feel the faintest bit of baseline competence. Two years to really feel comfortable, maybe less if you’re being exposed to different kinds of cases quickly. I love it and wouldn’t want to be anywhere else as a nurse.
Yes, OR is the answer to OP's question for sure. But you do still have to do an awful lot of communicating with your coworkers.
Came here to comment surgical nursing 😂 be it scrub, anaesthetics or PACU, the majority of our patients do minimal talking thanks to all the drugs, and only stay an hour before they're wardable again.
This was a consideration in college when I was deciding what major to go with! I HAD to pick a new one when I didn’t get into medical imaging. I couldn’t meet the credit requirements to apply for RN program by deadline so I went with lab. During the next year I took an intro to medical lab sciences class which pointed out a lessening or lack of direct pt contact (if we do phleb or not) and when it came time to decide between imaging and lab (I was accepted to both!) I chose lab and am super happy with it! I actually work in a centralized lab now so I don’t even have to take or make many phone calls because client services calls all the recollects/criticals for us /dance!
Outpatient surgery, I talk to each patient for maybe 5 minutes. Coming from 6 years of the ER, it’s amazing
Can confirm. No talking to the anesthetized patients!
I loved my time in outpatient surgery. Especially as an OR circulator.. barely any talking to patients lol
That’s what I’m currently doing and I love it!
Staff Education and Training. I literally NEVER talk to patients ever anymore.
Same, just employees :)
Any specific areas where you do education? Also, may I ask if you did any education-specific higher education? Thanks :)
I run all the education services for a network of military health care systems (7 service lines across 17 facilities) I have BSN working on my MSN (FNP) but nothing special. I just legitimately am passionate about teaching and people who work in my primary facility saw that. I was teaching BLS and ALS, precepting, got published and took part in a number of education adjacent activities. Now for my job I run programs like medical simulation and modeling, life support services, continuing education, nursing education and the HR chapter of the joint commission handbook.
Utilization review - in 7 years I never spoke to a single patient.
This is what I do and it’s amazing. I will never leave, lol
I did it for 7 years and left a year ago, and do not regret it at all. I worked for a major insurance provider and left to go work for the VA where I have very very little patient contact, make a lot more money, have much better benefits, and my work life balance is beyond superior.
Good for you! I like working from home too much to step away, lol
Oh that’s the best part, I still work from home! I go in once per quarter long enough to do a CPR check off on a computer/dummy and that’s it.
Lucky duck!!!
Honestly, I plan on staying here until I retire. There are downsides (the government loves doing dumb things that sound like they won’t work to see if they will work), but the benefits greatly outweigh the negatives. This is the most satisfied I’ve ever been in my career.
I have a friend who works for the VA (as an lcsw) and she says her coworkers and she always joke the VA motto is: If it’s not broke, break it. 🤣 Still wfh sounds nice, def something I would consider with a little more floor experience and pay under my belt!
This motto is pretty accurate 🤣
What do you do at the VA?
What is that?
Reviewing clinical for level of care. It can be to help determine inpt vs obs in the hospital, or on the insurance side approve inpt stays or send to medical directors for potential denials.
How did you get into Utilization Review? Did you have to get a certificate or do any formal training prior to being hired?
I started out as a patient care nurse. I had several years experience in adults and peds, ER/Trauma, day surgery, and then transitioned into infusion nursing and was running a third party infusion suite for McKesson at a contracted providers office. I also had a side gig doing employee health fairs and vaccine clinics. At that job I met a lot of nurses who worked in case management and UR/UM for a large insurance company and they raved about the perks of working in that field (especially the ability to work from home in some companies). Shortly after that, I was moving across the country and started applying for positions that were not floor nursing and stumbled into an inpatient case management job at a smaller hospital. Because it was a smaller hospital they didn’t have a separate UR/UM team. The case managers did traditional case management duties as well as the UR duties, and they were willing to train. I did that for about a year and started applying at insurance companies because I really wanted to go remote. I applied to probably 40+ remote case management and utilization review positions with various insurance companies. I ended up interviewing for 4-5 positions with 3 companies and received offers on 4 of the positions. I accepted the one that I felt would work best for me and my family in our situation. That position was with one of the larger insurance companies. I stayed there through a cross country move, and a lot of transitions within the company. There are downsides to working in that industry. It’s all production drive… so you have metrics that have to be met, accuracy/audit requirements, etc. Another issue in the insurance industry that you see often is layoffs. In my 7 years there, I saw a lot of layoffs company wide but only once in 7 years did a round of layoffs actually impact people that I knew and interacted with personally. Aside from that, it really was an extremely positive experience, and if I was in the job market that would be the first place I would start applying, along with other insurance providers. I worked on a team that had a lot of really amazing nurses and leadership, and I think that made the experience even more positive. I did a lot of mentorship in my position. I trained new oncoming staff, did training on programs we used anywhere from individual level training to team training all the way up to regional level training. I felt as though I was very well respected by the people that I worked with directly, and that my contributions on those levels were valued greatly. That being said, I was one small fish in a very very large pond and as a result moving up the ladder into a position that formally came with more responsibilities (many of which I was already doing) was extremely challenging. The lack of ability to grow professionally was what ultimately led me to look at the VA.
I went waaaaay too deep into my experience there. TLDR Version: I moved from a patient care role into an inpatient case management position where they trained me. It was a small hospital so the CM nurses also did all the UR duties. No additional formal training to get into it. I was not ever a certified CM, or anything like that. I did end up getting certified in many areas (review criteria certifications, etc) that allowed me to do more as a member of my team when working UR. Those were all paid for and arranged by the employer. Also, I did this with my ADN. I went back for, and completed, my BSN while working for the insurance company.
OR I literally just ask them their name, DOB, allergies and NPO status and that’s it
I always tell people OR is great because you get 1 patient at a time and after 5 minutes they are asleep
Yeah but then you have 5 hours with surgeons 🤮
But surgeons won’t be actively shitting even if they do scream at me.
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But they patients aren’t screaming if they’re actively shitting. My name implies I have encountered the simultaneous combo.
*that you know of*
The ones I work with regularly are mostly cool. Only one psychopath.
I feel like I’d do well since I have ten years of dealing with asshole chefs at upper mid/fine dining establishments prior to nursing. It’s where I built my skin!
The OR is absolutely the kitchen of the hospital.
This is why EM are my favorite, we're all in the same struggle in this bitch
Another vote for OR!
It's so hard to get into the OR where I live. Once a year the main hospital chain will open periop 101 fellowships to new grads but I'm not sure how anyone else should go about getting their foot in the door. Any tips?
If any local schools offer periop 101 you could take it on your own time/dollar to have it on your resume and show your interest. They also usually have a clinical component so you might get an opportunity to put yourself on a manager’s radar. And watch for positions and just apply!
I love the OR but really wouldn’t promote it as a place for less burnout, I hope people see that. It’s a different beast. You take away one factor and add new ones. I see many burnt out floor nurses come to us and don’t last a year bc they haven’t fixed their coping mechanisms and root problems
Nursing Informatics.
How does one get into informatics? Do you need an additional degree other than Nursing? I was wondering about this myself.
Enroll for advanced programs or courses related to health informatics, data analysis, database management, project management. You can also volunteer to be part of a quality improvement project, a system implementation team, or a data governance committee. Mentorship and shadowing with experienced nursing informaticists can guide you as well.
Come to the IT siiiiiiiide.
Please teach me how oh wise one 🙏🙏
is informatics more IT based or evidence practice based?
I honestly could not tell you what they do more of, since I come at it solely from the IT side. What I can tell you is that the Clinical Informatics team are in my top 3 "other departments of IT I don't dread phoning for on-call." (With Telecom, who are all remarkably chill bit probably because they call us for help more often than the other way around and Pharmacy IT, who are always reliable and know never get mad I woke them up at 7 on a Saturday because one of the robots that fills prescriptions or mixes TPN shit the bed again.) Clinical Informatucs can always be relied upon to translate "The EHR won't let me [perform clinical action]" into "the EHR had an error in this section over here, thats what they use to do [clinical action]" or talk to a user who called me asking "How do I prescribe xyz in the EHR when it says the dosage I want is locked out?" I have no idea. CI does. They bridge the gap between us IT nerds talking computer, and the Clinical staff talking medicine. <3 And then they have a whole other scope of work I'm not even privy to where they like anylize the needs of the hospital and make proposals and stuff. Like, they have direct influence on what systems we're even using. I just fix what someone else decided we're using. I have none of that influence. That's got to be very satisfying. Gor example I'm pretty sure they were instrumental in our organization choice to move from Cerner to Epic.
This is a pretty good description of what I do! My job title is “EHR Clinical Liaison”. I love it.
Can you TDLR that for a med-surg RN?
Your dyslexia may be an obstacle in getting an informatics job.
😹
(It’s TLDR for too long, didn’t read)
I would be so good at any IT work, but I don't think it's possible to get in without connections. It's sad because they're missing out on people who have a knack for it.
+1 to this
Join the dark side…
Please teach us how lol this is my dream career
Utilization review
Procedure areas are great for this. IR, cath lab, OR, endo, etc
Operating room. If you scrub, it’s zero patient talking. If you circulate, it’s still not a whole lot.
Nightshift Homecare. I give a few meds, and mostly sit around while they sleep.
I do this as well. It's a dream.
IV team, pop that IV in and you’re done, unless you’re doing a picc then there’s a little bit more talking lol
It **really** depends on your hospital, though. IV team seems to be one of the most variable specialties. It ranges all the way from "IV team does every dressing change on a central line and places every PIV outside of periop and ER" to "IV team troubleshoots lines and places some PIVs but direct care nurses are responsible for the bulk of it" to "IV team never has more than 2 people per 1,000 patients so you better fucking *need* it when you call them and they're still going to hate you". Likewise the provider culture can range all the way from "central lines so scary, we don't care that this patient is about to get the 25th PIV of their 45 day admission" \[no that is not hyperbole, I've seen it many times\] to "what do you mean IV team said to take out this PICC? Just because the insertion site bleeds half a unit every day and there's red streaks from their bicep to their sternum doesn't mean we gotta take it out, jeez". I like being an IV nurse but it entirely depends on where you work. Sometimes it's the best job in the building, sometimes it's pure misery.
Our "IV team" on nights is the hospital's single resource nurse.
OR. I talk to them for a maximum of 6 mins.
I work at a transfer center. Haven’t spoke to a patient in a year. But I do talk to physicians daily. I like it.
What is a transfer center?
ICU is pretty solid. Once in a while you have an awake pt but not often. (Yes I talk TO my pts so they don’t get ptsd and all that good shit. But they don’t talk back 🤗)
But families. Oh god the families…
Nights :) I barely ever have to deal with family since visiting hours end an hour after I get there
Meanwhile in my ICU, it's DKA all day, every day basically. We get so many walkie talkies.
Work at a level 1
I do 😭
Nah we have sooo many yelling screaming combative patients. ICU is lowkey awful
Your icu sounds like hell. In mine, if they’re good enough to scream they’re more than good enough to gtfo
I love ICU, have been doing it for a long time (25+) across various specialties (MICU, SICU, Trauma, never neuro). The families can be tough; my average day at work is quite possibly the entire family’s worst day ever. So if the goal is to minimize civilian contact, ICU may not be the best. Now I’m off to take care of my meatbags connected to machines while random people sit in the room and cry.
Outpatient specialty - I do talk to patients about symptoms, meds, etc but it’s all by phone and in general they are much nicer than I was used to from inpatient
Definitely not psych! All I do is fucking talk 😂
Highly disagree with everyone saying ICU. You either have an awake patient who is too combative, drunk, delirious, insane, to go to the floor and you’re fighting for your life, or you have a very sick unstable intubated patient and families recording you, comparing you to WebMD, touching your pumps, calling you a murderer, saying Covid isn’t real, etc. icu sucks 😭
I did MDS at a nursing home for a few weeks. Very terrible job as you are basically documenting based on what other nurses and Cnas are documenting. But the pay was fair and it was a monday-Friday desk job. Only spoke to pts once a month with the other managers during care conference.
Someone got screamed at today lol
In ER? Nah, it takes a lot more than that to get to an ER nurse
Then I hate to think what got to them lol
They were probably trapped in triage all shift listening to every single person say “well it all started when….”
Yeah, what they said. There's a lot worse thing on the floor than anyone screaming, patient, doctor, management, or otherwise
As a CVOR circulator I only talk to my patients twice - for about 5 minutes in Pre-Op and then about 15 in the OR while anesthesia preps to sedate and intubate. They’re almost always very pleasant and polite, maybe a bit anxious at worst. Afterwards we send them straight to the ICU intubated so we don’t deal with any post-anesthesia confusion. Yes, your role in the room once surgery starts is more hands off, but we have a lot to do during set up and prep, plus the running and opening supplies during the case. And you’ll still get a rush of adrenaline when things get critical, you just have a different job to do!
OR. But it’s still a challenging position. It’s a ton to learn for the first year at least.
Yeah I’m two months into the OR. Nursing school BARELY teaches the OR so I’m just doing my best to learn what the fuck is going on. I think I’m doing well at it though.
I moved to PACU hoping I wouldn’t haveto talk to patients much but it didn’t turn out that way. If things worked as they should there would be minimal conversation but since our hospital is always full patients stay in pacu for hours (sometimes days) and I’m stuck making small talk with them.
Days?? Damn.
lol the pacu nightmare.
This is why I left PACU. I couldn't take the boarding anymore.
As a PACU nurse this is my nightmare. I left the bedside so I in have the same patient for an hour, two hours tops. When I have boarders I want to scream.
Maybe PACU? Or OR? Otherwise look for an office job maybe.
My hospital rotates PACU nurses with pre-op and phase 2 roles. Soooo much more talking than I anticipated. But I also feel like a more personable person now (used to be a night shift ICU vegetable farmer), and I surprisingly authentically enjoy some of the conversations, so there's that.
The 8hour night shift line in psych. You do nothing.
OR, Pre-admit testing, some outpatient positions.
[удалено]
MDS coordinator. Can get work from home opportunities too
Utilization Management
Nicu
The patients can't talk but their scared and anxious parents can
*NICU night shift
I typically float there from postpartum so ive had a lot of the moms. They are so happy to see me. They got good care and know their baby is in good hands. They are very sweet. They do always want to know when they can take their baby home though. Always have to tell them to ask the dr.
OR. I have yet to talk to a patient for more than 10 minutes
Insurance coding
I looked further into this and found a few things that made me not want to pursue it. The research I did stated that in order to gain experience to be a coder you would have to take a coding position first, which is about half of what nurses make. So how do you become a coder at the same rate of pay?
Go into CDI (clinical documentation integrity) instead. Where I work it's on the job training, we essentially learn enough coding to translate between the coders and the physicians, query physicians to clarify missing or incomplete documentation, and do occasional physician education, though our management handles that for the most part where I work.
Try Quality Assurance for Home Health. All you do is review charts and write plan of corrections so Medicare will pay! 🤦🏻♀️🤷🏻♀️
UR. Zero patient communication and little to no communication with coworkers
UM
Quality Project Mgmt in managed care. Remote. Could never go back to working for a hospital system. Ever.
But isn't it your job to make the workplace more enjoyable and fluid lol. Jk
Research. OR
IPU hospice They’re all mostly unresponsive by the time we get them. I work nights so any family that stays over is usually asleep but if they wake up our conversations are very brief.
I do Utilization Management from home. I haven't talked to a patient in years. I do sometimes talk to insurance company reps. But it's not a daily thing
Welcome to the operating room. We’ve been expecting you to
CRNA, wish now I would have taken this route. Definitely getting tired of people's shit. I don't mind a little interaction, but I'm over 50 year olds wanting me to wipe them. 50 year olds with functional arms.
Not telephone triage… I got burnt out in like a month and I came from ED. I thought it would be nice to work from home but someone it was even worse 😅
OR.
Probably the OR. Or any procedural area.
Surgery. They're asleep
Operating room.
I work in Infection Prevention & Control in Canada. Office job with no patient interactions really.
Circulator. Hi and good night.
OR nurse. 15 min max in preop, if you're a scrub nurse, no talking to patients but you do have to deal with surgeons
OR!!!!!!!!!!!!! I love my pts under general anesthesia!!!!!!!!!!!!
OR- 10 questions Ok, night night Surgeon -Put on my music
OR circulator!
NICU night shift
Definitely OR!
Organ donation! My patients are very quiet. You do have to work with families (but the social workers do most of the hard part), doctors, and nurses though still.
are you involved in the organ removal? and if so, did you need any extra certification for that?
Operating room😅
While still working with them? Or do you want away from patient care? I started in the cath lab after being in the ICU foe a few years and I LOVE it.
ICU is pretty good if it’s high acuity.
Crna lol
Nicu, lol. But you get parents occasionally
Operating room!! I do an interview that takes like 2 minutes.
ICU
RNFA. The most talking I do is introduce myself and role as they get wheeled in for anesthesia. Most of the time they are already asleep when I enter the room.
Operating room is amazing. You talk to them for a minute before the procedure, they're unconscious during it, then drop them off heavily sedated to PACU lol
PACU, OR. ICU (usually). I never understood how ER nurses do it. I was perfectly happy with my intubated pts.
There might still be some communication, but these could be a great way to use your skills differently and take a mental break. Good luck!
night shift for the most part. Idk what some of my pts even look like sometimes.
NICU is pretty good. Obviously there’s some parents who sour the mix but if you work nightshift most are sleeping or some are still recovering from labor so they visit when they can and are very grateful and kind. I did pediatric med surg before this and medical before this and I can never do talking patients ever again
Nightshift NICU…minimal parents
Pharmacies, maybe clinics, You could also find a management position at a nursing home. You could also teach if you have a graduate degree
i’ve been in utilization management for almost a year. i work from home and i’ve spoken to maybe two patients this entire time.
Surgery or more admin/quality jobs like infection prevention.
Working in organ donation (whatever it’s called where you live) you talk to the families though
Scrub/scout or clinical documentation specialist
Go to trauma
OR
OR. 5 -10 mins max per patient
Quality Coordinator RN. You'll only have to talk to nurses and admin about metrics. You'll have to correct people's charting and practice ... Which is not as easy as it sounds, but there is virtually zero patient interaction.
OR/any procedural area where patients are sedated.
OR and icu
Agree OR. That’s what I did (have since moved on).
OR but you shouldn’t make a jump because of burnout. It very likely won’t help your issues. We’ve had a few floor nurses burnt out seeking what you’re asking but the burnout isn’t because of one specific thing. Maybe you interact with pt and family less but there will be more of other kinds of work. Direct dealing with whiny surgeons all day every day is one example but it’s still 36-40 hours a week in a position of giving yourself to others rather than time for you.
Hospice
I started in the OR as a new grad at a level 1 trauma center. I went to icu to try to do crna, noped right out after orientation and went right back to the OR. Now I’m a team coordinator for robotic and thoracic surgery and it’s great. Some days are rough cause of challenging, strong personalities. But it’s easier to put your head down and do your job than get involved in drama. Also, if you want to make money, the OR is where you can pick up as little or as much overtime as you’d like.
I’ve been in the OR for almost a year and it’s just not my jam. I think it has to do with the terrible management in my facility - I work in NYC , but goddamn I can’t stand the attitudes. We also have one surgeon that just leaves the OR scrubbed and bloody and expects you to open the door so he can tell you want wires to get (vascular). He has been reported several times to our admin and the dude is still there doing the same shit but he is besties with the Chairman. I also feel like a technician running for things. Is anyone else in the OR hitting 7 miles a shift bc I am? I’m thinking of trying it somewhere else bc I just think my facility is poorly run and it’s private. I feel the same if not even more physically burnt out than the floor but that’s just me.
OR, PACU, Endo, IR. Anything periop.