Advice needed for a nervous ICU newbie

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    So just got transferred into my hospital's ICU after 5 years on the med surg floor. It's been 2 years since my hospital offered a critical care course. I am so glad I got accepted out of about 20 other applicants, but I can't believe how nerve wracking it is for me right now!

    I've never been the type to dread coming to work or cry or anything like that, even when I was a new grad, but this is my first week of ICU orientation and I can't sleep! I feel like I have a knot in my stomach all the time. Every night I just lay awake and worry about all the things I have to learn. It doesn't help that I've worked nights for years and now I'm orienting on days, but I know I can handle it at least until I get off orientation and go back to nights.

    The good news is that it seems to be a very supportive environment, which I knew already from past experience whenever I've had to transfer a patient to ICU or call rapid response. The orientation is 3 months long and I think that's a good length of time. My first day on the unit was last Tuesday and I really like my preceptor. She's got 30 years experience and is very calm and knowledgeable. We get along great, we've both got a sense of humor and we laughed a lot. A lot of my fears were relieved just being on the unit and seeing what the routine is like. It was familiar in a lot of ways. Assessments, meds, calling docs, documentation, turning, cleaning, more documentation, etc. I already know the computer system and the charting is pretty much the same. I'm also trying to seek out all the learning opportunities that I can. I went with the RR team on a call to the med surg floor, observed a therapeutic hypothermia code, and asked the RT to help me understand a little bit about vent settings. It was a good day, but I'm still really nervous. I'm so glad I've got the experience I do, I can't even imagine trying to do this as a new grad.

    Any advice for me? Will I ever stop feeling like a big ball of nerves? Please tell me about your experiences and what it was like for you just starting in ICU!
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    Been there! Spent 2 years in med surg and PCU and am now 1 year down in a trauma ICU at a university teaching hospital and I love it. I was nervous too. I expected ICU to be this crazy overwhelming place where all the nurses are super crazy smart and I would be the dumb one. It's not really true. Most of the patients are sick, but stable sick. Have confidence is knowing that. After a while, you'll figure out not everyone knows as much as they pretend, although there are def those amazing nurses.

    When I started, I pretty much had the routine down and my preceptor felt spoiled with my already good time management. You just have to train your brain to start thinking like an ICU nurse...critical thinking, anticipating the next step, even ordering boluses and labs (within protocols of course ) it will come with time. I also took home the report sheets and would look up unfamiliar labs, drips, and procedures to try and catch on quickly. I remember vent setting seeming so foreign and vent alarms scaring me half to death. Now I don't even think about what to do if I hear that alarm. You will get there. It sounds like you have a great program! Enjoy it!!

    On a side note, I was really happy I entered ICU when I did. I got my new grad learning curve mistakes out in a place where it had less of an impact. I also think doing it the way I did helps you appreciate the "floor" nurses. Some ICU nurses arent always empathetic, and will even criticize floor nurses for bad reports, not knowing things about the patient, supposedly neglected care, etc when really they were busy hauling butt.
    marshmallownurse likes this.
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    Wow, that sounds exactly like me! I couldn't agree more with you on everything you said, there is a lot of wisdom in your response. That's a good tip on taking home the report sheets. It's better for me to look up specific things than it is to try to learn a general overview of everything beforehand. That's funny, I do expect everyone there to be way smarter than me haha. Like you said, I just need to improve those critical thinking skills!

    About being more appreciative of the floor nurses, my friends in ER said the same thing about how I'll be a little more understanding than the other ICU nurses when they bring me a patient! You're just trying to get the patient stabilized while dealing with 6 or 7 other patients. One thing I hated about being on med surg was you are so busy trying to juggle all those patients, you could go through a whole 12 hour shift without knowing some basic things about them. Docs would ask me how their appetite was or if they worked with PT today and I would have no clue. So when you throw in a crashing patient on top of all that chaos, it makes it that much worse. By the time that patient needed to be transferred, report was usually a little on the crappy side and the patient was most likely a mess. Not to start an ICU vs med surg debate, honestly I've never had a problem with a rude ICU nurse. PCU is another story entirely...

    Anyway, thanks for your reply! About a year from now, I'm sure I'll look back on this post and wonder why I was making such a big deal out of it.
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    I also just started working in ICU (cardiac/neuro) after 1.5 years working in psych. I am struggling. It's been a very difficult adjustment. There is so much to keep track of and to know. It's still quite overwhelming. Just when I think I'm on top of things I'll have forgotten something (often albeit minor, tho could turn out to be more of a big deal) and it really hurts my self esteem. I never thought myself to be an anxious person but working in this environment since March (I am off orientation in 4 days) has made me an anxious hot mess of a person. Im always paranoid (speak of psych! Lol) I'm forgetting something and don't feel comfortable talking to doctors (much different on ICU than behavioral health, of course) and have lots of trouble with time management and prioritization/organization, etc. I have asked for a lot of help and I feel I get "oh you're doing well, it'll come." or "you'll get it". And what I want is explicit redirection to keep me on task when I am doing things out of order or that are wasting time unbeknownst to myself. It's been a very frustrating experience. And I am on the clock to be done with orientation in days. I'll have a "resource person" and I know people will help in a crunch, but I need help with just tasky things too, and time management. I can't say I regret the change from psych yet, but as of now I loath going into work. It consumes me day and night.
    JennyandPups likes this.
  7. 0
    Quote from KayteRN
    I also just started working in ICU (cardiac/neuro) after 1.5 years working in psych. I am struggling. It's been a very difficult adjustment. There is so much to keep track of and to know. It's still quite overwhelming. Just when I think I'm on top of things I'll have forgotten something (often albeit minor, tho could turn out to be more of a big deal) and it really hurts my self esteem. I never thought myself to be an anxious person but working in this environment since March (I am off orientation in 4 days) has made me an anxious hot mess of a person. Im always paranoid (speak of psych! Lol) I'm forgetting something and don't feel comfortable talking to doctors (much different on ICU than behavioral health, of course) and have lots of trouble with time management and prioritization/organization, etc. I have asked for a lot of help and I feel I get "oh you're doing well, it'll come." or "you'll get it". And what I want is explicit redirection to keep me on task when I am doing things out of order or that are wasting time unbeknownst to myself. It's been a very frustrating experience. And I am on the clock to be done with orientation in days. I'll have a "resource person" and I know people will help in a crunch, but I need help with just tasky things too, and time management. I can't say I regret the change from psych yet, but as of now I loath going into work. It consumes me day and night.
    Wow, no wonder you're so nervous. That's a big transition from psych to ICU. Sounds like you're working at a totally different company too, which is a whole new charting system you have to get used to, different policies, docs you don't know, etc. Have you worked any areas other than psych? My suggestion would be for you to work on a med surg or stepdown floor first. I think it would really help you acclimate and get a feel for the medical side of things. There are some people who do well right out of school going to ICU, but not everyone can pull that off. I don't think I could have done it myself. I'm glad I've got 5 years of med tele experience under my belt, plus I already know the facility policies and computer system which makes it easier to focus on learning how to take care of ICU patients. Even with that, you can see how stressed out I am!

    As far as time management, I hate to say it but everyone is right. You can't really be taught that, you have to develop it yourself. Everyone is different though, and I can promise you that you'll still see some experienced nurses who run around all shift like crazy while others could have the same patients and be totally calm. Have you tried writing down things that need to be done so you don't forget? I'm the first one to admit my brains are paper. Also try to pick up any little tips you can from other nurses. Cluster care as much as possible, try to develop a routine.

    Outside of work, try to exercise, eat healthy and get enough sleep. Leave work at work. Geez, I'm gonna have to start following some of my own advice here haha! Good luck.
  8. 0
    How big of a hospital is this? There are small hospital ICUs where patients maybe monitored but are walking around the unit, talking, maybe have a PICC line ... and then there are large hospital ICUs where you'd never see a patient like that, every one in that ICU has at least one foot in the grave and are usually sliding in further!

    Hang in there and good luck!
  9. 3
    I've been an ICU nurse for 14 years, and the biggest advice I can give both you KayteRN and Sweet~Revenge, is to relax and breathe. All of the feelings you both are expressing are 100% normal.

    @ Kayte...if your having time management problems, make lists. Cross off your list when that task is done. Add to the list as problems/issues develope during your shift. It will help you organize your thoughts, and be able to prioritize by being able to see it with your eyes. I prioritize by most dangerous/detremental to least. If the pt's levophed has 30min left before it runs out, that takes higher priority than trying to unclog one of the ports in the PICC line. Another thing, be flexible. That list changes constantly in my head throughout the day as issues surface. If your having trouble sticking to your routine, write it down. I work with several girls who actually write down their whole day in 1hr increments on a piece of tape and attach it to their desk, and write in the 9am spot for meds, 10am bath, 11am chart etc etc. If your forgetting to grab flushes and alcohol for med time, keep a stash in the room or in your pocket so you'll always have them, and not wasting time running back to the med room. If you don't know where to start as far as routine, ask the people you work with or your preceptor what times they do things, and write it down and adopt it as your own. Over time, you'll be able to modify this to match your own work style, and before you know it, you'll be what I call "On It".

    When calling the doctor, 1st, remember that 90% of them are very nice human beings, and appreciate being called when there are issues developing with their patient. It is ultimately their responsibilty to care for the patient, and part of their job to get paged at all hours of the day and night. They know this, so don't be intimidated to call when your pt needs something. A couple of things I suggest you have in front of you before you call, is the pt's most current labs and med list, as well as the chart. You'll earn the doctor's respect when you are prepared and not wasting their time on the phone because you have to log into the computer system to look up that mornings calcium level.

    I also suggest getting a book "Fast Facts for Critical Care". I love my little navy book, as it's packed full of useful information on critical care drug drip calculations, how to set up a CVP, how to shoot Cardiac Outputs, ACLS algorythms, just anything you could ever need to look up while at work. And it's all there at the tip of your fingers.

    I hope this helps ease some of your fears/anxieties. I wasn't a confident "on it" ICU nurse when I started, it takes time. Learn from your mistakes, but don't loose sleep over them. At the end of the day, the pt is fine and so are you.

    Zen
    Last edit by Zenrn73 on Jun 24, '12
    JennyandPups, RNQQ, and KayteRN like this.
  10. 0
    I went right into the ICU as a new grad. I have never replicated the fear and paranoia I had those first few months when I thought everything I did was going to kill my patient. I worked as an ICU nurse for 5 years before finishing my acure care NP and loved every second of it. Take small steps. Learn one new thing everyday. If you can, work night shift (it gives you more free time to look up your patient, including patho, treatment, signs/symptoms), and realize you are in a great place to make a difference in someone's life. The best advice I ever got was from my preceptor in nursing school who said to me, it always could be worse, it could be you in the bed. That calms me down everytime I feel out of control. Good luck and keep us posted!!!


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