Who's afraid of the ICU? - page 2

I won't say that I always wanted to be a nurse, but it is a near thing. Even when life got in the way, and delayed my career for several years, nursing was always in the back of my mind. When I finally did get into nursing... Read More

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    Interesting perspective dh07RN. I think that for a long time our profession has experienced this tension between an identity as task-oriented blue collar workers and skilled professionals who are constantly faced with the complex judgments of triaging, prioritizing and educating. Monitoring and assessing the patients, administering treatments and knowing when to call the doctor may sound simple and straightforward but these "tasks" require a fair amount of expertise and carry a high degree of responsibility.
    weirdscience, Dalzac, and Trissity like this.

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    Quote from jennycRN
    Interesting perspective dh07RN. I think that for a long time our profession has experienced this tension between an identity as task-oriented blue collar workers and skilled professionals who are constantly faced with the complex judgments of triaging, prioritizing and educating. Monitoring and assessing the patients, administering treatments and knowing when to call the doctor may sound simple and straightforward but these "tasks" require a fair amount of expertise and carry a high degree of responsibility.
    ^This...our "tasks" have a meaning behind it...our skills in assessment/"investigating" and judgement help identify things missed and help prevent further complications. Each pt is individualized; there are no set rules...we may report issues to the providers, yet we have to assess, and MOST of the time, we are recommending actions and are guiding the plan of care by confirming whether to add, take away, or try an entirely different plan of care, with THOUGHT...not just action behind our clinical practice.

    We have moved VERY far away from the "tasks" or "just doing what the doctor ordered"-in the many years I have practiced as a nurse, I have collaborated and many of times, guided care and decisions, especially when there is interdisciplinary team driven environments. Never in my practice has it been "whatever you say Dr." Blindly doing "tasks".
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    Quote from dh07RN
    You just need to remember, all we do is collect data, crunch numbers, and report anything out of the ordinary, and remember to chart the memo that said you notified the doc. Blue collar workers just like everyone else. In reality, hospitals don't pay us to sit there and think, but to follow orders and report anything out of the ordinary...I know we like to make nursing like some fluff and puff high and mighty calling...but it's not, it's a job, and that's the reality of it all.
    the same thing a stock broker on wall street and I wouldn't call them a blue collar worker
    nrsang97 and Ixalia like this.
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    Quote from Trissity
    My preceptor, and ICU nurse for more than twenty years, bombarded me with questions constantly, about things I'd never had to think about before. Not just the "how" and the "why" of things, but the "what else", "what if", and "what do I need to do to change this". These are critical thinking skills that I thought I was using already, but clearly was not. It is hard to critically analyze your patient's care when you're busy completing tasks. I quickly learned that we don't do tasks in the intensive care unit, we manage patients. And it is an absolute must to know what you're talking about at all times. There usually isn't time to look up references when you're not clear on something. And I knew next to nothing.

    I would leave every morning after a long and stressful shift in tears. I wasn't good enough, or smart enough, or fast enough for this job. Doubt started creeping in about my life as a Med/Surg RN, and I begun to fear that maybe I wasn't even as good at that job as I so arrogantly believed. There were many days during my orientation that I had to talk myself out of quitting. How could I be trusted with patients' lives?

    Slowly, but surely, it got better. I immersed myself in critical care textbooks and journals every day. My eyes would go cross-eyed reviewing my patients' charts making sure I knew everything that could potentially go wrong with them. I asked questions. I practiced. I survived.

    It's been three years now, and I look back on that time with embarrassment. It was my own over-confidence that made for such an awful experience. No brand new nurse would be expected to function on the same level as seasoned pros. And a 3.9 GPA doesn't prepare you to recognize minute changes in your patients as an impending disaster...only experience can do that. I still don't know everything, but the difference is, I know that now. I know more than I ever did, and I'm learning more every day, which is the beauty and the point of nursing--that endless supply of new knowledge. I am eternally grateful for my preceptor, who saw right through me, and believed enough in me to make me change and grow. I hope to someday be a tenth of the nurse she is.

    My advice to prospective ICU nurses is to be afraid. Something's wrong if you're not scared, and you're most likely not ready. Learn. About everything. Listen to the nurses that have been doing it for years. Stick with it. Nothing is more exciting or rewarding than balancing on that thin line between life and death, and these patients need good nurses. Welcome to the club!
    Awesome post. I was a new grad in critical care and spent my time learning, learning Learning, asking "Why does this work like that ....?" and "So if we do this, then ...?" "What should I be looking for next?" and learning to put it all together.

    I also particularly like the line about not being able to do critical analysis if you're focused on tasks. This is a theme you'll find in all my poor attempts at teaching here-- tasks are not skills; the skill is in the knowing how to think and ask questions and synthesize and generalize to new situations. I used to ask my students all the time, "Why do we care about this?"

    Well-said, and I hope will be taken to heart by every new grad with a 3.8 who thinks she'll be perfect for critical care.
    Vincent_ and dawniepoo like this.
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    Quote from dh07RN
    You just need to remember, all we do is collect data, crunch numbers, and report anything out of the ordinary, and remember to chart the memo that said you notified the doc. Blue collar workers just like everyone else. In reality, hospitals don't pay us to sit there and think, but to follow orders and report anything out of the ordinary...I know we like to make nursing like some fluff and puff high and mighty calling...but it's not, it's a job, and that's the reality of it all.
    Calling and job or not, you have to have some brains to know what you're doing, when to call, when to look more closely, and yes, how to think. You bet they're paying you to think. If you don't believe me, look at what it costs them when you don't. If you can think about that.
    ICURN3020 and Amnesty like this.
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    I'd rather call it "Stage Fright". Each time you take care of a patient it is the first time for them and just like a stage performance, the patient (audience) deserves the same level of delivery and presence from the nurses that care for them. When you feel you've "got it", that's when complacency and overconfidence sets in and mistakes can arise. Every patient is different despite the sameness of the diagnosis.
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    What a timely article...I've been a RN since 2006. I've worked as a Med Surg and Kidney/ Liver Transplant nurse. Though the transplant floor is under the umbrella of ICU, we only dealt with vasoactive drips, A-line, and CVP monitor. Well, in two weeks, I will be starting a new position as a CVICU nurse and I am scared out of my mind. As an experience nurse, this is a new territory and I always approach life as a student because it sets up my mind to accept and learn new things. I actually like the fear because it will cause me to think critically. Thanks for such a great article.
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    I like your insight that after 3 years you still don't know everything. After nearly 30 years in critical care I still don't know everything!!!
    Dalzac likes this.
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    You said you were cocky and on your high horse, but you were confident. You knew your strengths and you knew that you were smart. This attitude probably helped you out a lot. Yes maybe head high in the clouds but you knew who you were and what you can do. Your preceptor probably saw this confidence too so it wasn't a bad thing. It just needed a bit of tweaking. They brought you down because you can handle it and then you brought yourself back up and you are doing very well. Be proud of your confidence and knowledge. This is a good part of you that many of us lack.
    Trissity likes this.
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    Wow awesome


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