What the Grapevine Said...

Last Wednesday I was almost done with my shift at work and I had nothing left to do. I was waiting for the "leadership" meeting to be over so that I could talk to our nurse manager. I needed to tell her that I'd accepted a relief position in outpatient infusion in the onc department, and that I planned to apply for a real job there once the positions opened up.

The relief job was very minimal hours, that I would keep my ICU job as is, two days a week and just work a few extra hours in the infusion clinic. Getting my foot in the door in oncology was really what I wanted, if they weren't going to have any real jobs there for a while. Hiring has been very slow over the past year despite the outpatient infusion clinic bursting at the seams, having increased it's business by 20 percent in the past year. I knew eventually they'd have to hire more people and expand the clinic, even though in the hospital now there is no space whatsoever for them to expand.

I'd been excited for 24 hours, since I heard that I got the relief job, but even better, that there were quick changes happening in the oncology department and some real positions with guaranteed hours were opening up soon. Like REALLY soon. Our director was on vacation but I needed to tell the nurse manager. Once I did that, I didn't have to keep it a secret anymore.

Not that it's any secret. I've been telling people I'm interested in onc for the past 6 months. I told my boss too, after our last conversation in her office, last fall, when I considered it the last straw. I had gone in to talk to her because I wasn't getting opportunities to precept new nurses and I had been asking for that repeatedly and getting ignored. She told me at that time that most people are content to just do their shifts and go home.

I, on the other hand was always looking for a challenge. She told me I needed to wait, that eventually I would get the experiences I wanted. I've heard that before. Then, her face lit up with a bright idea. She told me I should go to CRNA school.

Actually I can't think of anything more unappealing than being a nurse anesthetist. I hate the OR, and standing for hours over unconscious people was not my thing. I told her actually I'd like to be involved with the cancer center when it opens in a few years and that I was interested in oncology. Her wrinkled nose reply was, "If you can stand to work with cancer patients."

Since she had no desire to help me get the learning experiences I needed in order to help me build on my nursing skills, I decided then that it was time to put my full energy into getting out. I'd been there three years and I didn't have time to waste. Nothing was on the horizon and I heard too many empty promises from her already.

Now I am going on four years in ICU, feeling like I ought to have a bit more opportunity to increase my knowledge and skills, but it isn't happening and no matter how often I find myself asking for things, I never get them.

Sure there have been some opportunities to get out of the unit, very challenging ones, like pushing a cart around the hospital, transporting montiored patients to their rooms from the ER. Or going to the floor and putting NG tubes down patients when the floor nurses were busy.

Or helping with bubble studies, where you hook up a three way stopcock with two flushes to a patient's IV and inject a few bubbles into the patient's circulatory system while the echo tech looked at the image of the bubbles passing through the heart. Or occasionally taking an ambulance ride to take a patient somewhere like the cath lab at the other hospital.

I did all that.

BORING.

But as far as going to conferences or classes, learning new skills like dialysis, being taught more things about how the unit is run or being asked to participate in any meaningful decision-making for the unit, forget it. Those opportunities were reserved for the favorites. Not the best nurses, or the most experienced, but the drinking and gossiping buddies of the manager or director and their yes men.

Those people who could get away with not working very hard, getting the easiest assignments, having time to wander around the hospital and get coffee, help a little where needed and then hide out in the office or somewhere else until they were paged. Great job for the laziest nurses.

I got sick of asking for new learning opportunities, even when I suggested them myself and made up a detailed plan in how I would go about it. If they weren't going to help me, then I, at age 46, was not going to waste one more minute of my time. I scheduled a December meeting with the manager of the oncology department.

I had interviewed for a position in onc in November but didn't get it. Still, it was worth it to get in and talk to them. I know I conveyed that I wasn't ready to leave ICU at the time. I wanted to find out what was going on and what the future looked like in the department, and whether it sounded like there might be a place for me.

The meeting in December was extremely positive and encouraging, she gave me a list of at least a dozen suggestions for people to talk to for networking, ways to increase my knowledge about oncology and cancer survivorship, with the future Cancer Center in the plans. This past spring I met with the director of oncology for the entire system and that meeting also went well. I felt welcome, well-received, and taken seriously. The director suggested a few more things to do, to add to my tool kit.

I've gotten involved in a bimonthly support group for cancer patients and their caregivers and families. I've joined the Survivors' Advisory Council to network and listen to input on plans for the Cancer Center and cancer-related community resources and services. I've gotten involved in more activities for fundraising and raising community awareness of the need for a Cancer Center.

I spoke at Cancer Survivors' Day about my efforts to raise funds through my running. I have spoken twice more to the general hospital community about my running and activities related to this and always put in a plug for the Cancer Center. I've joined Oncology Nursing Society, the professional organization, and taken the online cancer basics course suggested by the director.

A week ago Monday I interviewed for the relief position. The manager of oncology told me she noticed on my application that I took it upon myself to join ONS and take the cancer basics course. She said, "Most people wouldn't do that. It shows me you're serious about this and I'm really impressed. "

The following Tuesday the manager contacted me to tell me she wanted to hire me for the relief position. And then she said, "But, there have been some changes recently and things are happening very quickly. There could be some FTE positions within the next week. Are you interested?"

Wednesday I had to work all day in ICU. That evening before the end of the shift, I walked back to the break room to hit the bathroom before I gave report on my patients. The night shift nurses were coming on for their shift. As I opened the door, I was greeted by one of our nurses, who said, "Congratulations on your new gig!"

I looked at her funny, "What's that?"

"I heard you're moving to onc." Like it was well-known.

I was mildly blown away. Like someone took the thoughts out of my mind before they hit my tongue. But I acted like it was no big deal. "Where'd you hear that?"

She said, "Everyone was talking about it last night, everyone who was here. Why, is that not true?"

I said, "Well, yes it is true that I got a relief position in onc, but I'm not leaving ICU." I smiled. My smile was saying "Not yet."

She smiled back, knowing. "Oh.I heard you got a job there and you were going to be doing speaking for them." Then she said, "Well, congratulations on the relief job. I applied for the job in the OR. So did Lindsay and Laura. Laura got the job, so she'll be leaving."

I told her I knew that and I was happy for Laura. I told her the speaking engagements were all on a volunteer basis but that I was waiting for there to be some jobs with real hours, and then I wanted to leave ICU.

And I was thinking I need to go find our manager NOW.

She said, "Everyone's leaving. I wonder when they're going to notice."

Then Pam walked in, "So I hear you're leaving us too! Congratulations! I hope my day is coming soon."

I told Pam the "real" scoop and then made my way back to the floor to find the manager. She was in her office. I walked up to the door, it was closed and she and the new CNS were in there. I knocked. She said "come in."

"I need to talk to you about something."

The CNS offered to leave. I said, "No, please don't. It's okay, you can be in here for this." I thought in the back of my mind, at least I will have a witness.

I told the manager,"I just heard a rumor that I'm leaving and going to onc." Her eyes got wide. "You did?!"

I said, "That's what I need to talk to you about. I have accepted a relief positon in outpatient infusion. It won't affect my hours here." She looked a bit surprised, but not overly so. The CNS looked surprised.

They both asked me some questions about the position and we talked about how I'd been doing a lot of things with the Foundation and raising awareness about the cancer center, and my recent speaking engagements, one of which both of them attended.

Then I broke the real news. "If an FTE position gets posted, I'm going to apply for it."

She got a strange look on her face, almost like she was disappointed. "Well, congratulations on the relief position. Good luck with everything. I didn't realize you'd been so involved with all of it, I knew last fall I got a call from them for a reference, but I thought you'd decided not to go ahead with it."

The CNS congratulated me and said, "Well from what little I know about you, just listening to your talk last week, I think you'll be great in oncology."

I thanked her. I looked at our manager again. She looked almost sad. Or maybe more like she had a sick feeling in the pit of her stomach.

When I got home I had a message from Laura. Turned out Laura had just told our manager that morning. Two of us are telling her about leaving on the same day. No wonder she looked sick. Two other people just left in the past 6 weeks, and now Lindsay and Pam were working on it, among others looking to leave. I sent an e-mail out to our director since she was still on vacation, to let her know what I said to the manager and to forewarn her about the FTE position, and that I was planning to apply for it.

Monday I got an email from a nurse I used to work with, who has since moved on to the other hospital. She hates our director with a passion. I haven't talked with this nurse in over a year, we don't stay in touch. But in her email she said, "Congratulations, I heard through the grapevine that you're moving to oncology. You'll finally get to see what it's like to work with a sane director and manager."

Holy crap that was fast! They knew at the other hospital. The grapevine got struck by lightning!

I originally hoped to work at least 5 years in ICU. I had hoped that 5 years of ICU experience would leave me with my feet firmly planted under me, even though there is much more to learn that you could never get in 5 years. I felt like 5 years would have given me a broad range of experiences with critical care patients and feel like I was knowledgable and a resource to newer nurses. I can see that the way things are going, another year is not going to give me that growth, because of the way things are run in the unit. I'm not a favorite, I'm not a yes man, and I don't gossip and drink with the girls club.

There is no mentoring or guidance in ICU, I'm not being challenged, and I keep getting the same old crappy assignments. I need some guidance in how to get from here to there, and I've asked for it repeatedly and I get promises and no action.Our educator has her head up her butt, she doesn't need her job and she doesn't put much into it. One of things she suggested was for me to come in and push a cart around with new equipment and teach everyone how to use it. Basically, have me do her job for her, so she she wouldn't have to come in.

I said no thanks.

My boss wishes I would go away. Well I am going. She doesn't know what to do with me because she doesn't know her job. After the last two interactions with her I am done talking to her anyway. She doesn't recognize the value of someone who is self-motivated and ambitious. She's afraid of me, she can't help me, because she doesn't have anyone who can or wants to. She doesn't know how to mobilize her resources, because the "leaders" she's chosen don't know how to lead or harness their experience in an effective way.

I've suffered over the past few years from this, more so than my more experienced co-workers. By last fall I was so depressed I could barely function. It took anti-depressants and making my plan to get out, and following through with that plan to bring me here now. I'ts been a lot of work but I've learned much in the process and I've grown from it. And I've met so many positive, enthusiastic, hopeful, focused people outside of the unit. It's a different world once I step outside of ICU on the five days a week I don't work.

One of the remarkable things I've learned while working with the cancer survivors I've met is that once they realize that life is short, they know things are not guaranteed, and that it's important to make the most of the time you have. Instead of saying they are going to do something, and then sitting on their butts, they take action. They decide what they want to do and then they start doing it, they are in action.

I feel that way too. I don't have time to waste. I don't have time to sit around saying I'm going to make a difference. I need to start making the difference, now.

I started this nursing gig too late in life to let these people suck my energy dry. I want to do something. I can't wait around until the powers that be in ICU decide I have lost whatever flaw I have, to be able to include me as part of the unit, or to take my input seriously.

I feel valued in the organization, and I've had a lot of nice comments from people after my talks. One of the comments was that I am an invaluable resource and source of inspiration to the organization. That one almost had me in tears.

But I go to my home unit and my boss pretends I don't exist, walks right by me on a regular basis with acknowledging my presence. I ask a few minutes of my boss's time and she spends the five minutes playing with her Blackberry without looking at me. Her hand-chosen supervisors act like I've been dipped in invisible ink, like a ghost is taking care of the patients I've been assigned, the ones no one else wanted to take care of.

Strangely enough, I got a card from our nurse manager several weeks ago. Out of the blue one day she told me she had attended a leadership conference where she decided that her new goal was going to be to thank people for what they do and she told me she appreciates that I give good care and that I make a difference.

Like my dad would say, "They're pissing on my head and telling me it's raining".

I can't wait around for them to take me seriously, or for them to decide that they're going to start growing people. It's pathetic what they actually accomplish. The only tangible output I see is them putting up bulletin boards that talk about what they say they're doing, when they're not actually doing it, just putting up bulletin boards about it.

Saying you're doing something and actually doing it are two different things, but they haven't figured that out yet. Of course they have figured out how to play the game. So they wait for someone to recognize them for their achievements because they think it's working. And maybe it will.

In my unit, getting their little award is all they want to do, so the pinnacle of what anyone can accomplish in the unit is getting their CCRN. I did that after two years. Still only one-third of our staff nurses have their CCRN. And they are about to lose one of those. I will set them back on their goal.

Where it all stands now is I am waiting for the FTE position to get posted. I will apply for it and hopefully will be hired into it. If nothing else I have my foot in the door with the relief position.

Yes, I am very very excited to be moving into a unit where they will value my enthusiasm and my drive. I look forward to putting my energy into something that will make a difference because I will have the support I need to make things happen.

The light at the end of the tunnel is not an oncoming train.

And at this point I don't have to keep any secrets, because I've already told them I plan to leave. So if anyone says, "I heard through the grapevine...", my answer can be...

"What the grapevine said!"