Should I quit my ICU job?
- 1May 24, '11 by StellaMarisRNHello Everyone,
I am a new grad nurse going into my fourth month in the ICU. So far, I'm grateful to have made it this far and I get along with my coworkers, patients, physicians, and other staff workers. I just have a few worries.
For as long as I have been working with her, my preceptor has been brushing me off. I am the first person that she has ever precepted with and I understand that it might be overwhelming for her to deal with both me and the patients. However, I'm at the point now where I'm taking on 2 critically-ill patients at one time yet having to run to her for everything and when she makes herself scarce, I end up running around looking for anybody else to help me. My preceptor picks up the things that I forget to do or overlook, often without telling me. I don't feel comfortable with this because I'm going to need to know how to organize my time and all of the "little details" that I might overlook, such as reporting critical lab values to the physician, etc. (And yes, I know critical values are a big deal but when you're new and trying to pack everything into your brain along with take care of sick people, you forget sometimes). Several nurses have commented that they don't think that my preceptor is doing a good job with me and it's to the point now where I'm thinking of switching preceptors...is this a bad idea now? Am I too far along?
I've asked the nurse educator for honest feedback about my progress. I asked her if she, my preceptor, and I could meet to discuss my strengths, weaknesses, and issues that I could "work" on. That was weeks ago. I keep asking but no one will meet with me. The only thing that they told me is that "if they had a problem with me, I'd know already." The thing is, I don't want to let it get to the point where I make a serious error and then get reprimanded/fired. I feel that I have the right to receive feedback but it's been over two months since anybody sat down with me and told me their observations of me and how I might best improve as a nurse. Am I expecting too much?
My head nurse just quit her job yesterday because it was too stressful for her so for the time being, we are being managed by another unit. I had planned on meeting with her to discuss my concerns after she returned from her extended leave, but she then quit and moved on. I don't know who else to go to.
I am also worried because my unit is incredibly short-staffed and the nurses, even new nurses, frequently pick up 3 very sick patients on vents/cardiac drips/neuro checks, etc. at a time. One girl, a new grad nurse who started two months before I did, was given 3 patients on her first night shift by herself just last night. Another new nurse that I took report from yesterday was mentioning quitting her job because she kept getting 3 patients and she felt that she was giving them awful care night after night.
Our head shift supervisor worked as an ICU nurse back in the 1960's when patient's weren't so acutely ill and one of my coworkers once told me that he felt that if "he could work with 3 patients, so could we." I even know one nurse who worked with 4 ICU patients. I'm not trying to put down my unit but I really don't think that it's fair, especially since many of our nurses get floated out to work at the "favorite" unit upstairs, which brings in the most money to the hospital with its surgical patients and open-heart patients.
I am very, very afraid of what is ahead of me in this unit. I don't feel that I'm getting the training to give good care to two patients, let alone three or four. I don't want to quit because it took me six months to get this job, but I am very afraid that I won't have adequate training from my preceptor in order to "swim" instead of "sink." Has anyone else ever been in this position and if so, what did you do?
Thanks so much for any advice you can give me!!
-Stressed out New Grad
- 3May 24, '11 by CoffeePlease, RNI am a new grad without a job, so I know absolutely nothing but here are my $.02.
I am a career changer and I can say that in every new job situation that I was scared crapless all the time that I was going to make a critical error. I also know that fear in a new situation is normal. If your people aren't worried about you, have confidence in their abilities to judge you. They have been around longer and know more. Yes, it sounds incredibly stressful, but it seems like you are doing just fine.
Have confidence in your abilities, ask for the help that you need, and keep chasing your preceptor. If you can figure out a way to be a benefit to her, she will probably be more receptive to helping you. Talk her up among the other nurses, spread the good word around about her, and believe it yourself. I bet it will come true. Don't get weird about it, just be positive that you are in the right place at the right time and that you have all the resources you need.
I hope this helps!
- 2May 24, '11 by Katie5At some point in time, you have to have confidence in your skills. Not too much bravado because you're dealing with human life, but enough to want to learn.
Your preceptor will not spoon-feed you everything. Keep your eyes open.Constantly assess and reassess your patients. Read their charts and anything you don't know, immediately look it up- you retain it more that way.
You have it good.Stay positive
- 5May 24, '11 by KeepItRealRNAny precepto who makes himself/herself scarce sucks a preceptor in my opinion. I have precepted dozens of new ICU nurses. I'm not saying your preceptor should make your life easy, but she should certainly be available and if you go to her for advice should not belittle you for it. I would much rather have a new nurse ask me something that I think she should know then have her be afraid to speak up and pretend to know. That is simply irresponsible.
Sounds like you work in a place similar to my last place of employment. 3 patients on a night shift happened often. In that unit, nurses either were survivors or ran for the door screaming after a few weeks.
- 1May 24, '11 by AngelicDarknessDo the best you can do. That is all they can ask of you. If you go home after your shift knowing you gave the best you could under the circumstances, you'll do fine. Agreeing with a previous poster, keep on top of assessments and reassessments. Write things down constantly. This situation sounds tough, but with a little time management, I think you'll do fine. I have 96 residents at the facility I work in. One nurse per shift to medicate roughly 70-80 of them. Time management is my best friend as a new grad.
- 5May 24, '11 by LouisVRNI have mixed feelings about this. I know ICU has more comprehensive technology and techniques than med/surg but after 4 months of orientation as a new grad you'd be on your own by now and you are taking 1/2 pt load. I've precepted a lot of people and know that sometimes I have to make myself scarce - making sure my preceptee knows where I will be but not immediately available or they will never feel confident to do anything on their own. I would recommend you sit down and talk to your preceptor and tell them you want to take complete control of both of your patients including calling lab values etc. I would also ask her to approach you before providing any care to your patients. I would talk to her about things that you need to do in order to provide the best quality care for your patients. Additionally, however you need to know that their are often times policies in place. For example where I work we have 20 minutes to call a critical lab to a physician, so if I tell my preceptee they need to call on this lab and 15 minutes later I see they are still in the same patients room i will probably tell them again but if they aren't excusing themselves in a timely manner I'm going to go ahead and call and discuss with them why this needs to be a priority later. it sounds like you are just lacking some communication.
- 1May 24, '11 by SkiMamaIf I were you I would not quit. You sound responsible and thorough. Yes, it's scary to have so much on your shoulders without the feeling of confidence in having solid back up in your preceptor. However, if I were you, I would love up to some of the good nurses who are willing to answer your questions and do not be shy in seeking them out. And THANK them for being there for you. Make a point of offering compliments about their leadership and educational support to you to management.
And when you have time with your preceptor, make the most of it. I wouldn't rock the boat too hard on this one b/c you have not been there that long, but long enough to be nearly through working w/this preceptor.
Work safely, ask when you need to, look up what you need to, and know that you are in the process of becoming a great nurse
- 5May 24, '11 by HouTx GuideI would agree with LouisVRN. After re-reading your post, it appears that you are lacking confidence in your own abilities and second-guessing yourself a lot - "I'm taking on 2 critically-ill patients at one time yet having to run to her for everything" Exactly why do you need to keep running to your preceptor? Don't continue to ask her to validate/verify everything you do - only request help if you: 1) don't have a clue and don't have the abilty to look it up or 2) need physical assistance.
You probably need to focus on prioritization - that's the key to time management. In an ICU environment, you are 'sandblasted' with continuous information. You have to mentally prioritize everything - sorting based on the urgency with which you need to respond. Critical Values - that's up there with the other OMG stuff than can have an immediate impact on your patient's safety. Other stuff may be important, but not urgent... you can put it off for a bit & there is also stuff that can be delayed to the next shift if you just don't have time because you have been dealing with super-urgent stuff. But never (never ever) expect the next shift to do something if you don't have a realllllly good excuse for not doing it.
If you've come this far (4 months) without any major screw-ups, you are doing very well! Take pride in that and run with it. Despite their attitudes, every one of your coworkers, even your preceptor, was in your shoes at one time.
Now - take a deep breath and get back in there!!! You can do this.
- 1May 24, '11 by Summer BreezeThis is a wordy reply... I bolded my main point. Haha!
I can definitely relate to your anxiety Stella! During my orientation in the PICU I felt the same way with my preceptor. She kind of let me be on my own, even in the beginning of orientation. She would be busy chatting with other nurses and not around. She'd say I was doing a great job. But I was a new grad and this was my first nursing job ever. I needed some guidance and I wasn't really getting it from her. She wouldn't help me time manage, she kept saying things like "I can't even teach you all that you have to learn until you get better on time management." Yet she wouldn't give me pointers on how to be better. I seriously didn't learn very much from her, since I felt like I was on my own from the beginning. She wouldn't explain anything to me! For example, I was new and didn't know all of the doctors, apn's, residents. I asked her how she knows who to contact, where she finds this info from. She's like "oh you'll figure out who is who with time and just know." In reality, there was a call list and it would tell you who was on for the day/night. I didn't learn this until the second half of my orientation when I was on night shift. I would always panic over who to call if something bad happened, yet all it would have taken to ease my anxiety was if she showed me the call list!!!! I kind of felt like our personalities just didn't click and my learning style did not meet her teaching style. By my first month of orientation, she would seriously yell at me for asking questions... so I'd have to go to other nurses I met to ask them things. She would say things like "you should know this by now, you need to be more confident." But in reality I just didn't know and needed her to just help explain things to me. I remember drawing blood from an arterial line for the first time on my own after weeks of seeing it be done. I was a little nervous. She was on the computer so I told her I wanted to go over the steps as I drew from the line. I talked the steps out loud to myself and her (its the way I learn) and she just snapped at me that I've done this before and should know how to do it now. She didn't want me to explain the steps to myself as I did it. At this point, she stopped answering all of my questions and started to ignore me. She explained to me and my educator one day that this is the PICU and I'll be under stressful situations so I need to learn how to handle them on my own. I think she missed the point that it was orientation and I needed some guidance.
Sorry for my rant! But on to something more positive: I had another preceptor while on day shift for the cardiac icu part of our PICU. And I couldn't believe how much I was learning and growing with her. I learned so much from her, but she didn't have to spoon feed me anything. She was just there and knew how to teach and explain things. She was ALWAYS there for support. I learned time management (even though this took a while! It wasn't until I was on my own that I really learned how to time manage better), she helped guide me on my plan for the day. I wish my educator listened to my complaints with my first preceptor. I wish those first few months didn't get wasted with her. I still feel anxious at the thought of working on day shift, I don't feel prepared for it at all.. so I work straight nights currently.
My point is... it doesn't hurt to ask for a different preceptor. Some people just aren't compatible, and that's fine. You may need a different teaching style to help you get it. It wasn't until the end of my day shift orientation that I had a new preceptor for a short while and she was amazing. Luckily when I switched to night shift, my two preceptors were awesome and I learned so much from them. Advocate for yourself! It will be better in the long run, not only for you, but for your patients as well. As a new grad, going into an ICU setting is intense. You need someone to help you along your journey, it isn't fair to not get the full experience of the orientation because of a lousy preceptor.
The idea of taking care of 3-4 ICU patients is also a little scary. Are the assignments fair? Are the patients a bit more stable than the others on the unit? I know the PICU that I work at, sometimes assignments can be 3 patients if we are short staffed... but those patients are usually the most stable. Even then, its sometimes the kids who are ready to transfer to the floor/go home that end up coding.
- 1May 24, '11 by BiffbradfordHang in there. If you've made it this far, then you've got what it takes to make it. If your preceptor isn't helpful, then try other co-workers. If you just can't seem to wrap your brain around a problem, drag someone else in to help problem solve. Even if they don't have time to come to your bedside, ask anyway. You can always call pharmacy for drug/drip questions, lab for lab questions, radiology for xray questions. Try to build team work by offering your help if you've got a few free minutes. Do a blood sugar for someone, clear their pumps at the end of the shift, help with a turn, empty their laundry for them. It's a tough job that's made easier with a strong team. You can do it!