Who's afraid of the ICU?

After working three years in the ICU, I want to share my experience of starting out, and how I quickly realized how very little I knew about critical care. Hopefully my story can prevent some of the arrogant mistakes that I made. Specialties Critical Article

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 school, I was ecstatic. It was grueling and stressful, but never scary. I breezed through tests and clinicals, and I knew I had made the right choice for a lifelong career. I was made for this!

I worked on a busy Med/Surg unit as a nursing assistant and unit secretary during school (which despite being an ADN program took four years due to an extensive waiting list for the nursing program). I believe the experience I gained from that job made me a better nurse, and I encourage all perspective nurses to be a nurse's aide first (trust me, you can tell the difference from those who don't have that prior hands-on care).

Needless to say, when I graduated and started orientation on that same unit, I felt well prepared for what was expected of me. I was nervous, but not scared. My education and previous experience did not leave any room for fear in me. I quickly got the hang of things and was soon comfortable in my new role. I had my time management skills well honed, and was never late with medications or charting. My patients were well cared for, and my call light volume was low, despite heavy patient loads. I just couldn't understand why it took some nurses so long to chart and get their tasks completed.

I completed one full year on Med/Surg before I wanted to spread my wings. I had always been very interested in critical care, and as luck would have it, a spot had just opened up in our ICU--not something that happened very often. I took a chance and applied. Happily, I was accepted.

I went into this job, one year fresh out of school, brazen and cocky. Of course I belonged there--I had done so well in school and out on the floor. This would be a piece of cake. Oh, how quickly I was knocked off my horse!

The ICU was worlds--galaxies--away from Med/Surg. Even though I felt like I knew everything, my coworkers wasted no time in proving me wrong. 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!

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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

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.

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.

Specializes in ICU, PACU, OR.

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.

Specializes in CVICU, Transplant ICU, CCRN.

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.

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!!!

Specializes in SRNA.

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.

Wow awesome

Are you even a nurse? That's one of the most ridiculous things I've ever heard. In the ICU, we certainly aren't task oriented. Many times when a patient is crashing, it's the nurse who intervenes and prevents a code from happening. I'm saddened to think that you view your own profession in this way. If only being an ICU nurse was as easy as you described!

Specializes in Rehabilitation,Critical Care.

Means to say you learned to be humble. To know that you are not good at everything and that you need people's help to learn and grow. This is what I learned as a new nurse. You ask questions from those who are experienced, learned to be patient, to communicate well, and to know provide care for the patients. Nursing is a lifelong learning experience and career. I am about to embark to becoming a Critical Care Nurse and yes I am afraid but at the same time excited because I love challenging myself and acquiring knowledge aside from caring of ofcourse. I believe that it will be very hard in the beginning but I do believe that I will get better. Thank you for this post.

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