New to CCU, quick question

pricklypear · Mar 29, 2006

Sorry you haven't had any replies so far to your question!! I may not be the best one to answer your question as I didn't start out in ICU as a new grad, but I'll offer my opinion!

I think it's totally normal to feel somewhat behind as a new grad, no matter where you start. There is so much to learn. But, I would think that 3 months into your orientation, you should be feeling a little more confident. If you feel comfortable talking to your preceptors, or your manager, you might want to approach them with your concerns. You may feel "a step behind" the other orientees, but the people training you might have a different perception of your performance.

I wish you the best of luck! If CCU doesn't work out for you at this time, try telemetry, or a step down/interventional unit. When you're working with tele patients, you're learning the kind of assessment skills you will use in ICU. Feeling comfortable with rhythms, cardiac procedures, and all the various cardiac conditions will be a good base for transitioning later. I worked for 3 years in tele before going to ICU, and I felt very well prepared. I still had tons to learn, but I had a good base of skills and knowledge on which to build.

Hopefully, you will get some more replies. I know there are tons of people around here who started as new grads in ICU - they should have a lot of good advice for you, and may be able to ease your mind.

Editorial Team / Admin · Mar 29, 2006

hello, tianicole and welcome to allnurses.com

check out the sticky at the top of the page in this forum. great links to some of the things you will be seeing in this unit.

good luck and stay here for great advice and support.

enjoy the site.

dorimar, BSN, RN · Mar 29, 2006

Hang in there Tianicole. It will come. Keep looking things up, reading, and asking questions. The fact that you want to learn tells me you'll do fine.

TiaNicole · Mar 30, 2006

:mad:

thank you to everyone for your advice

NurseEcho · Mar 30, 2006

TiaNicole, I started out as essentially a new grad in CCU in November 2005. The first couple of months were completely overwhelming. The best thing for me, I think, was coming off orientation. I didn't even know it was going to happen; I just walked in one night after 10 weeks on orientation and there was my name on the board without a preceptor.

In a way, it was freeing -- without someone looking over my shoulder every few minutes, I felt more comfortable in doing things on my own schedule and developing my own style. Not that I didn't need plenty of backup -- and all the experienced RN's were happy to jump in when I had questions.

I'm now in my fifth month in CCU, and while I would say I'm far from being an expert, I can usually manage my assignments. If I run into trouble, I'm not shy about tracking down someone who can help.

I've been told that if you feel completely comfortable in critical care (as a new grad) in fewer than 12-18 months, you are probably being overconfident. It is a *hard* unit to work on. I hope you are being offered some other training as well -- spending time in CVOR and the cath lab, classes on rhythm interpretation, IABPs, cardiac pharmacology, ACLS, fhemodynamics, fluid and electrolytes, to name a few -- you probably touched on all of these in nursing school, but they are essential to your practice in CCU and you really need to understand them well.

Please do discuss any needs you have with your preceptor and/or manager. See what resources are available to you. They did not hire you to watch you fail, but you need to communicate your needs to ensure that you succeed. Make a list of the things you feel you need to address further, and see that it is addressed in both your training and your patient assignments.

I wish you all the best -- I too am continuing every shift to learn more and work on my weaknesses. But do hang in there -- with perseverence, a good attitude, and the right training, you can become a great CCU nurse.

nicolentony · Mar 30, 2006

Hang in there! You will make it. Everyone has a hard time in the beginning. The people that don't feel confident are in my opinion the best nurses. The overconfident ones are the nurses who think that they know it all and don't ask important questions. Just remember to ask questions! Never claim to know it all and that will earn the respect of all those that you work with.

It will get easier as time goes on and you'll someday look back at yourself and smile because a new grad will be reminding you of yourself at that stage.

Spastic Airway · Apr 1, 2006

Hello, I have worked in Critical Care for about 12 years.... the Last 4 as a Director of Critical Care. I have had much experience hiring and evaluating new RN's, both new graduates and just new to the job. Also I have had the chance to be a preceptor and to evaluate the preceptors that I have assigned to the orientee. Most new nurses feel incompetent at times, this is totally natural. If you have the right person orienting you, it will be ten times better. Do not feel like it is wrong to ask for another person, it will help you in the long run. Experience will teach you many things, orientation will not cover everything..... The one piece of advice I would give to anyone new or veterans of many units. I feel like nurses are on a scale 1-10, the first 30 percent do not have the critical thinking skills to lean on or the Anatomy and Physiology education to be great ICU nurses. They can function safely most of the time, but they look at the schedule to see who is going to be there to help them if something goes wrong. The next 40 percent have better critical thinking skills and are better with more intensive patients, but they do not put in the extra work it takes to develop advanced assessment skills. The last 30 percent are more motivated to keep learning (not just by going to school), they pick up books are read to learn about treatment options, pacemakers, etc. They will be the one that the first 30 percent are looking for on the schedule. I think the term used now is the adult learner. This person will be the best preceptor (if the personality fits), they will be the one that teaches the pathophysiology of the disease process, along with the nursing task. Also the manager of the unit is essential to the success of the new nurse, if during your orientation the manager did not ask you many times how you feel the oreintation is going, look out. I wish you the best of luck, be in the last 30 percent please the patients deserve it. I will feel the same as you are now all over again shortly, I start CRNA school in Jan, 2007. :eek:

rayman · Apr 1, 2006

There is a lot of wisdom in spastics post. I would definitely heed that advice. I started out in a busy cvicu as a new nurse about 13 years ago. It was the best place I have ever worked with a nursing staff unparalleled by any I have ever seen and one of the most forward thinking managers around. She did the things spaz spoke of and retention and job satisfaction were unrivaled. It should take you about a year to feel pretty comfortable and to start putting it all together. I was a quick study and everyone thought I was ahead of my time, but looking back in the 20/20 rearview mirror I know I wasn't connecting the dots as well as I thought I was at the time despite functioning at a high level...kinda scary to look back! Hang in there, study, find not just a preceptor but a mentor.

WOLFE, BSN, RN · Apr 1, 2006

Hello,

Hang in there...Things will come to you as you become more experienced. All patient situations will enable you to exand on the knowledge and "getting things faster."...I was not comfortable for at least 6 months...become a little more comfortable each and everday day...it will come in time...and ask lots and lots of questions...to everyone...fellow rn's, lpn's, np's and drs.