Confident yet?

  1. 0
    I work in an ICU and have been off orientation for a little over 5 months now. Although I feel more comfortable with semi-critical patients, I find that I'm stuck with patients very stable and who may even have move orders. When I have had critical, unstable patients in the past, I've been told by charge nurses how great I am. I try to attend all CE classes at our hospital, in services, and read lots of materials at home in my free time. I love this field and really want to do well.

    My question are: When will I start getting harder patients? What do I need to do to gain the trust of the charge nurses making assignments?
  2. 4 Comments so far...

  3. 1
    I think all ICU nurses would prefer the most critical assignments, all the time. My unit has a new director and she actually just addressed this issue in an email last week. Apparently nurses were calling in before their shift and discussing possible assignments with the charge nurse. Our director put the smack down on that.

    Also, the most critical patients on our unit are often CRRT, Arctic Sun, or IABP, which not all nurses are trained for. However more nurses are being trained in these modalities all the time, which the charge nurse making the assignments may not be aware of. Therefore, the same nurses were getting CRRT, etc. over and over. Our director instituted a formal rotation sheet so that all nurses get a chance to practice and keep their skills up to date.

    It's probably not possible for anyone to make an adequate assessment of your situation based only on the information in your post, but I will share a few of my generic thoughts as a brand-new nurse.

    Even though many patients may seem "stable" to us as ICU nurses, they are still critical care patients, requiring a higher level of monitoring and care. In fact, that is what the majority of the unit is made up of. My unit has 20 beds. On an average day, I would say probably 2-4 of those beds are acutely unstable, decompensating, on pressors, going for emergent scans, etc. There may be more patients on the unit who are stable on pressors... but pressors do not make a patient automatically interesting for us in the ICU, lol. So when you think about it, there will be 10 nurses on the unit, and less than half of them have those really critical patients. But, that doesn't mean that you will be one of those nurses half of the time. Since continuity of care dictates most of our assignments, you might end up going weeks between "fun," exciting patients. It's just luck of the draw.

    One thing to think about--who are you taking/giving report from/to? If it is mostly other newish nurses, then maybe you are truly being discriminated against. But, when you take & give report to more experienced nurses, there is no reason to think that assignments had anything to do with a "lack of trust."

    Hope this makes you feel a little better. If not, I would recommend going straight to the source--ask your charge nurses and managers, "just out of curiousity," when you can start taking more critical assignments.
    poppycat likes this.
  4. 1
    I am a new grad in PICU, Week 3 of a 10 week orientation. The way that they are organized is that when I get off orientation, I will take the more "stable tier" patients; by 1 year, I will go for the CC classes-ECMO/perfusion, CRRT, etc.

    I actually like that I will be able to get to the point of taking the critical "CRITICAL" pts, not just taking them as soon as I get off orientation. The first three weeks, there was at least one day I had a pt increase in acuity, where they became a critical "CRITICAL" pt. Although I handled the situation well in terms of assessment and interventions, I am still a new grad, and it will take me time and experience.

    I say enjoy the ride...you will get those "Critical CRITICAL" patients soon enough.
    poppycat likes this.
  5. 0
    Agree with Ktliz - you need to be having this conversation with your charge nurse &/or manager. Remember, no one can read your mind so you need to let them know what your're thinking.
  6. 0
    Thanks so much. This really helps a lot. I have noticed I've been getting more serious patients since I spoke up.


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