I think I'm too slow for Critical Care...

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    i was a nurse for about a year and a half before i came to the icu. i felt fine out there (of course after the initial wanting to throw up every night i had to go to work) and i wanted something more challenging. i've been in the unit for a little over a year, about 9 months off orientation, and i'm finding myself wondering if it was the wrong choice.

    i love it, but i'm having a really hard time with the whole big picture and having to think about meds, patho, etc so fast at times. i tend to freeze even if i know what to do. i always second guess myself even when i know i'm right simply because i'm so self-conscious about everything i do. well, not everything, but the stuff that's out of the ordinary.

    i mean, i've only seen like 2 codes and only had one of them as a patient so i still have minimal experience with that. just because i work there now doesn't mean that i know what to do if something happens ( i mean, besides push the code light and get an airway, while, of course, yelling for help:d). i see all these nurses be so calm and cool about things when they happen and more than anything else i want to be like that.

    i just wonder if it's taking me too long to adjust....my coworkers don't seem to have a high opinion of me, but when i do a skill (a swan, or something) and then i don't see it again for another 3 months, what am i supposed to do? i ask for help when i need it, but i still come out feeling lame.

    also, if you couldn't tell, i'm in a whiny mood! lol
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  3. 16 Comments so far...

  4. 6
    Hello GucciRN22,

    When I read your post, I felt like I was reading something I had written! You and I have similar nursing background and I have also been working on a CV-ICU for about a year now. I know I have had similar feelings as yourself and I have come to the conclusion that these feelings are very normal.

    Learning this type of unit is so complex and is truly a specialty of its own. This means that it will take time and trial and error and redundancy of performing specific skills before one is truly comfortable and confident. My advice is that you hang in there and try to get involved in situations and experiences that you feel the weakest in. If you do this eventually you will gain the knowledge and ability to perform tasks and skills with confidence. When you are having a bad day (..and we ALL do!!) just think about when you first started and how far you have come from there....the growth you have already achieved.

    There are some nurses out there that enjoy letting you know how incredibly smart they are...and sometimes informing you of just how 'unsmart' you are. And sometimes physicians have a way of making you feel as if you are a physician who should be diagnosing.....you are the nurse! To me it seems like the nurse is expected to be all the specialties sometimes.....cardiac, renal, pulmonary...psychology for cryin out loud!! Just try to answer what questions you can and when you don't have the answer (for the physician) then tell them you don't have it.

    Each day at work, I take notes of all the little things that I questions or didn't quite understand. Then when I get home I look things up. I keep a lil notebook with me at work with notes on each body system that includes different illnesses, treatments, ect. I have also bought books specific to the things that I was struggling with. The "Nursing Made Incredibly Easy" series has all types of wonderful books that can be used as resources. I keep two of them in my bag at work and use them often.

    When I started on my unit, everyone said that it takes at LEAST on year to really feel comfortable there, so just keep that in mind. Remember it will take time and people will make you feel very small sometimes, but this is life....just try not to take it too personal and move on. Take the positive from every situation. You CAN do it, you will get better at what you do. And in the end, if you find it isn't for you, then maybe it is time to search one of the many other areas in nursing. Good luck to you!!

    nurseatheart81
    MedChica, ShayRay, athena55, and 3 others like this.
  5. 3
    Start going through a good source book - I like "Pass CCRN" - and slowly start to read/assimilate.

    Good thing is, when you get done with it, you'll be ready to start looking at taking the CCRN!
  6. 0
    Quote from NurseKitten
    Start going through a good source book - I like "Pass CCRN" - and slowly start to read/assimilate.

    Good thing is, when you get done with it, you'll be ready to start looking at taking the CCRN!
    I DO want to take the CCRN exam sometime...I went to a review recently and it was awsome! ;-)
  7. 3
    I would give it some more time and then re-evaluate if this is where you truly want to be. Are you interested in other areas? Examine (truthfully) just why you were attracted to the ICU in the first place and see if those reasons still apply.Critical care is not for everyone and one of the truly wonderful things about nursing is that there are so many areas for us to explore. Our needs and desires change over time and what we think we wanted a year or two ago may not be what we want now.Go with your heart and if, after giving it a good try, your heart says you are miserable in the ICU area or you are attracted to another specialty and you are thinking about changing then go ahead and change.
  8. 1
    Quote from guccirn22
    i was a nurse for about a year and a half before i came to the icu. i felt fine out there (of course after the initial wanting to throw up every night i had to go to work) and i wanted something more challenging. i've been in the unit for a little over a year, about 9 months off orientation, and i'm finding myself wondering if it was the wrong choice.

    i love it.....
    i say if you love it stick with it. i also love my job. i love being a nurse. i work in the cvicu. i still think i'm slow. i run around while other nurses are on the internet or sitting around gossiping. anyways, don't worry about what other nurses think.

    imo, icu nurses are anal, critical, uptight, this way or no way type a personalities...lol. it takes a very strong personality to work with other icu nurses. what's crazy is that for many of them they love to see ppl quit and fail, makes them seem as if no one can do what they do.

    best thing to do is study and ask lots of questions from nurses you trust and doctors. many of them like to teach. nurses in general ask a lot of why questions? i do understand that if you havent done something in a while you will forget..this is what i do. i have printed out policies and procedures and keep them at home. toilet reading or leave it in the kitchen so when you sit to eat you can review. if you catch a bus, plane, train, car road trip whip it out and review.

    but even if you don't do all that you should have access to those resources at work.
    athena55 likes this.
  9. 3
    AS a critical care nurse for over 40 years working primarily CCU in a high acuity transplant center I think that you need to stick with it some more. You NEVER learn everything as the medical world is always changing. Depending on how your unit is set up, when you have the time to walk away from your patients, look around at the other patients and if you see a patient who has interesting things going on try to pay attention and watch as much as you can. Believe it or not, but learning does not have to be from your own patients that you are assigned to. If the docs do walking rounds, make sure you are right there when they talk about your patients so you can listen in.

    It takes time to earn respect both from your coworkers and the MDs, PA, NPs, etc. etc. If you show that you are very interested believe me they will take the time to teach you if you ask.
    celclt, athena55, and sunnycalifRN like this.
  10. 1
    You are in the same boat as me! I have just graduated and work in CCU/CVICU and as soon as one of my pts start having less than a perfect reaction to care I start to freak....though Im told it doesn't show, my Lord I feel it! I start thinking its me, i didn't do something they needed...what did I forget....am I safe to care for this level of illness...I need to google that...but so far, thank you Lord all my pts have made it thru my shift. I havent' had a code yet but don't take ACLS until FEB. Luckily our unit is a total team nursing unit and we all gravitate towards whoever has the sh*t assignment or the very sick pt and we stick together. Thats the only reason Im making it is because I work with such a great group of nurses and those who aren't on the same page as our main personalities never last in the unit. Just keep trucking as I think you have to do this for years before things just come very natural. And I know what you mean about the cool cucumbers that make it look easy but most of them have been doing this for a while so cut yourself some slack and I will try to take my own advice but you are sooo not alone in how you are feeling. Just give it some time and if nothing else, one day at a time!!
    athena55 likes this.
  11. 2
    I too, can relate. I have wanted to be an ICU RN since graduation but chose Telemetry instead. I finally got the chance to train for ICU after 3 years. The first day in ICU I thought "there is SO much I don't know". I was a pretty confident Tele nurse that could handle any situation or know enough to find help when I couldn't.

    Within the first month in ICU, the "sharks" as some of us call them, start reporting to mgmt the shortcomings of the new people. So much for having a year to feel comfortable. I find my self confidence slipping at times. I am also second guessing my care as I am waiting to hear that I made the wrong decision. I actually had one of the Charge RNs take me aside and lash out at me for holding 100mg of Metroprolol on a pt with a BP of 92/53. She said I should have called the doctor in the middle of the night, or talked to the charge RN. She is one of the most unapproachable charge nurses I have ever encountered. Now I call the doctor night or day anytime I want to hold a med.

    I am very uncomfortable in this environment. I love the ICU, I love learning and love the challenge. I do not like the working environment I am in. There are many wonderful RNs that make up for the sharks but I still get uncomfortable before shifts and do check the schedule of who I will be working with.

    The one thing I will take out of this experience: When I am confident and feel like an experienced ICU RN, I will NOT treat new people and new grads in this manner.

    Thanks for letting me vent.
    athena55 and green_serenity like this.
  12. 0
    Quote from wasabiRN
    I too, can relate. I have wanted to be an ICU RN since graduation but chose Telemetry instead. I finally got the chance to train for ICU after 3 years. The first day in ICU I thought "there is SO much I don't know". I was a pretty confident Tele nurse that could handle any situation or know enough to find help when I couldn't.

    Within the first month in ICU, the "sharks" as some of us call them, start reporting to mgmt the shortcomings of the new people. So much for having a year to feel comfortable. I find my self confidence slipping at times. I am also second guessing my care as I am waiting to hear that I made the wrong decision. I actually had one of the Charge RNs take me aside and lash out at me for holding 100mg of Metroprolol on a pt with a BP of 92/53. She said I should have called the doctor in the middle of the night, or talked to the charge RN. She is one of the most unapproachable charge nurses I have ever encountered. Now I call the doctor night or day anytime I want to hold a med.

    I am very uncomfortable in this environment. I love the ICU, I love learning and love the challenge. I do not like the working environment I am in. There are many wonderful RNs that make up for the sharks but I still get uncomfortable before shifts and do check the schedule of who I will be working with.

    The one thing I will take out of this experience: When I am confident and feel like an experienced ICU RN, I will NOT treat new people and new grads in this manner.

    Thanks for letting me vent.
    I so feel you. I went from school (BSN program) to CVICU. So I lived in the world of "not knowing what to do" or how to critically think. I have been a RN for 9 months and I still have my stupid moments...lol. I don't gauge how good of a nurse I am by my coworkers responses. I go by what my patients and their families as well as what management tells me (knowing coworkers run to them anyways telling). I don't mind the telling. Makes me better. I hate being told of mistakes so I naturally try not to make them ONCE I KNOW what they are.

    Now the Lopressor thing....with that pressure I would hold it if it was IV Lopressor (I don't think IV doses would be that high). If oral I know it has to pass thru the GI tract and it's has a gradual effect. I know we provide meds to maintain vitals too so if the pt BP gradually decreased I know I would then call the docs saying, "I gave this med as ordered and now the pt BP is falling below ordered range. What should I do?"

    At my hospital, in our orders, it always state the parameters (Hold if HR <60 or SBP <90). So that results in less calls to the docs. Other things I look at is has this med be held before?? Is is PRN or scheduled? I mean if its scheduled and you hold it did the pt pressures stay about the same or did it gradually rise. After all if the patients BP became hypertensive you can always give it right??

    Don't know why the charge would lash out on you especially if the patient's BP stayed WITHIN ORDERED RANGE. You a learning ICU nurse. It's a teaching moment so WTH? I swear I try to learn as much as I can on my own. Of course I learn who I can go to and not to go to. As for the docs, I don't care about "bothering" them. The way I look at it is this: It is their job and duty to respond to our calls/pages. I remember calling a doc 4 hours in a row about my pt's Urine output <30cc. I knew he wasn't going to give lasix and after the 2nd time he wasn't giving no more fluids. I call because I want to inform him and so i can chart, "physician aware of low urine output"

    I cover myself because the time you don't call and something happens they first thing they will say is that they didn't know and wasn't told (of whatever) and then your butt is on the line.
    Last edit by nursingpower on Dec 22, '09 : Reason: correct spelling errors, clarification of thought.


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