New Grad in ICU struggling

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    Hi everyone, new to the site and the nursing world.
    Story in a nutshell: Graduated in May 2009 with a BSN and finally got a job in Florida as a new grad in a critical care program that rotates you through the different units. Basically, the first few months are mostly classroom doing the AANA ECCO program, and you build up to your 3 12 hour shifts per week. My first "rotation" is six months long, so I came of orientation at the end of May and worked through the 4th of July solo, got good reviews from my preceptor and coworkers, etc.
    After that I was rotated to the Cardiac/Thoracic Intensive Care unit, given 8 shifts, and then "facilitated"-basically being tested to see if you can handle the patient load alone. The managements main complaint was that i did not have the concentrations and max dosing levels of some vasoactive drugs memorized, and that I take longer on some tasks. They said that they thought it would take another 4 weeks for me to be able to work alone (bringing my orientation on this unit to 8 weeks) Therefore, the unit did not want me, and I have just had a meeting with my rotation director where they are questioning whether I'm fit for critical care or not.
    My question is, does 8 shifts seem a little short to anyone else? Granted, i was oriented in the neuro unit, but shouldnt there be a bit more leeway coming into the new unit, especially as a new graduate having not experienced 90 percent of what goes on there? I was told that since other rotators are able to pass, i should too, and that they dont have the budget for someone who needs a longer orientation. Am I truly not fit for critical care nursing? Thanks for any advice
    rkoomler likes this.
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  3. 14 Comments so far...

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    interesting as well as understandable, that it’s the ct service rotation giving you the most scrutiny; this gives me a bit of insight as to what may be going on here. i would venture to guess that there is a service obligation at the end of this program.

    the theory behind these new grad icu indoctrination programs is to address the simultaneous issues of icu staffing and labor cost by harvesting “cream of the crop” graduates and rapidly gleaning them into a performing staff member. success is more a matter of individual learning ability, than it is of “ability” in general.

    the good news for you is that you met the standard for entry, which in this case would no doubt be both your school and interview performance. the first requirement of an icu nurse is effective communication, so this question has been answered. this is followed closely by “critical thinking” and “organizational skills.”

    the problem for new nurses is not any one of these items singularly, but meshing them all together. learning how to “prioritize” and “simplify” seemingly insurmountable complexity effectively and efficiently, is a key to success and avoiding burn-out.

    for example, a novice nurse sees an intubated patient on vasopressors as a complex case, whereas a seasoned nurse sees such a case differently. a freshly extubated stable post op ortho case with a multi-substance abuse history on the other hand, now there’s a nightmare.

    the answer to your question is strictly in your hands.
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    thanks for your reply, you seem like you have a lot of experience. I was told today that they were afraid i didn't know where to find the resources for things such as drip dosing- i replied that not only is it in the card in my pocket, but its kept on various places on the unit, etc, and they obviously have not seen the paper trail i leave in the room of printed out drips and iv compatibility sheets! (I wanted to say are you crazy? why would i ever do something i wasn't sure of? but didnt) I could understand if they had an issue with my critical thinking or something, but that accusation was an absolute blindside- and that makes it harder since I have no idea how to remedy it since i have no idea where they got that idea.
    There other issue was i take longer on tasks- well yes, i've been there 8 shifts! My first night i did busywork like emptying the foley, changing out suction, restocking the server, etc earlier in the night to make my morning easier, since at 5 am its meds/bath/dressings/mixed venous and abg's/calibrat the swan/lab replaements/out of bed to chair, and i finished on time, though was reprimanded that "suction cannisters arent changed before 5 am....and the foley is dumped at 6 (i had dumped it at 530, no lie). I even asked if i could start baths/dressings earlier so that i could have more time as i'm a novice to some of it, and i was shot down.
    All in all, thats a lot of crap to do in an hour and a half when you "should" be done at 630. its not like getting two patients out of bed each with three chest tubes, a swan, foley, and external pacemaker is going to be a quick task. I realize that the patients need there sleep, but whats the harm in me starting a little early so i can complete my tasks on time?
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    If this is truly the case, then you are still in nursing school with someone enjoying themselves “nickel and diming” you to death.

    As a former Air Traffic Controller, Commercial Pilot, and Mechanic, my ability to negotiate multiple complex tasks is well documented, but I myself (17 years consecutive ICU), would not be able to jump those hoops as you described.

    I suspect that neither can anyone else.
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    Our ED's orientation for new graduates is 6 months, and 3 months for experienced RN's. So yes I agree. I dont think 8 shifts is a sufficient orientation.
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    I've been a nurse for 7 years (five in ER) and I just switched to ICU and they are giving me 8-12 weeks of orientation. I am also doing ECCO modules. It takes a seasoned nurse time to learn all of the drips and the bells and whistles of ICU. Be patient with yourself and give yourself some credit for having the guts to start out somewhere like ICU.
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    Hi, I am working in CCU, I took the critical care class then had 8 weeks on the unit orientation. Only one week on nights. Previously I have been working in medical surgical tele unit. Very busy.
    I had good feedback from my preceptors. I understand everything what is going on, I know what and why. I learn fast how to operate all the complicated machinery but seems like I forget to do some things that I know need to be done. Like changing inner cannula of the trached patient. However patient has had it for a while and none of the experienced nurses changed it prior to me, nor respiratory therapist. It clogged at the change of shift. The day nurse spotted it before even getting reported. PT was couging badly. It made me look so bad. Does it happen to you? DO you forget to do those things? Obviously nurses before me did not it. HOwever its ABC.
    I get enought sleep, I eat well. I have been always been told I am smart, I speak 3 languages.
    I am not cut out for ICU nurse?
    Please tell me, does come with the time? Or I should already get it all done?
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    Being ridiculed for emptying things 30 minutes early is ridiculous. At my hospital, we have a 30 minutes window before and after the designated time for assessments, meds, clearing pumps, and fluid I/O. In the ICU there is no way you can do everything at the exact time, especially when something unexpected happens. I too am in a new grad ICU program and we get about 12 shifts in the 4 different ICUs. It is expected that after doing 12 shifts x 4 units (48 shifts) we have a good understanding of typical ICU procedures (safety checks, assessments, iv meds, pumps, vasopressors, vents, etc) based on the fact that if you're in the MICU or SICU, a vent is a vent and a vasopressor is a vasopressor. So for a lot of the overlapping ICU knowledge requirements, we are expected to be competent by our 3rd rotation. But regardless of the unit, time management, prioritizing care, and clustering care are my 3 biggest struggles. I understand pathophys well and know why I'm giving the drugs and what I'm looking for in my assessments, but clustering all that care, troubleshooting a lines, cvps, occluded IVs, titrating drips, traveling to CT or MRI, contacting the docs for critical value labs, changes in my patient's status, etc can really put me behind schedule and make me feel like I'm barely keeping my head above water. I've been in this program since August and I still don't feel 100% in being able to handle 2 pts on my own. But every ICU nurse and instructor I've talked to has said that this is a "normal" feeling until 6 months out working on your own. Best of luck to you (and me lol)
    VanessaRN likes this.
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    Quote from MarcM86
    ...My question is, does 8 shifts seem a little short to anyone else? Granted, i was oriented in the neuro unit, but shouldnt there be a bit more leeway coming into the new unit, especially as a new graduate having not experienced 90 percent of what goes on there? I was told that since other rotators are able to pass, i should too, and that they dont have the budget for someone who needs a longer orientation. Am I truly not fit for critical care nursing? Thanks for any advice
    It sounds to me like you're doing a terrific job given the allotted time on the unit. 8 shifts for a new grad on a new unit sure doesn't sound like enough to me, and you seem to be doing great in the time so far. It's frustrating how those watching you don't realize all the effort you're putting into this (i.e. all the drug information you've been learning). I hope things turn around soon. Realize that you ARE doing a great job, and believe that you can push yourself to continue in that direction. Good luck!
  12. 3
    Wow, sounds tough! 8 shifts before going solo in ICU? Yikes.

    Although I must say, it's a relief to read all of these comments and know I'm not alone. I too am a new grad in ICU-- graduated in June '10, worked as a camp nurse until Sept. and then got a job in ICU in Oct. I've been on orientation for a total of 8 weeks on days and now they're hoping to let me fly solo... problem is, I suck when I'm on my own. Time management is poor, critical thinking is zero.. I feel like I spend most of my day running around trying to do things on time and I forget to just think about my patient in a holistic way. My understanding of patho and meds also isn't where it needs to be. Bottom line? I wish we all had more time on orientation!

    Sorry to hear about your crazy coworkers... hope they are reminded of their first 6 months as a nurse and give you more grace. Stick with it! We'll be giving advice to new nurses before we know it.
    keepitrealnurse, elumine, and VanessaRN like this.


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