Worth the read? Long!

[Studentnurse365]

Hi all.

I am a some what new grad [December 2014, hired end of may] to the ICU] The educational opportunities were phenomenal. The program consist of 2 months on days with a preceptor guiding and educating you on the ins and outs of the ICU and 2 months on nights doing the same. Unfortunately, the preceptor I was was first assigned to on days was more focused on her own schooling that she requested easier assignments and she did her homework while I took care of the patients. I all about sink or swim, sometimes that's a great way to learn, but I wasn't sinking... I would do all patient care and charting but she always put in orders. I never even realized she was doing it [just assumed the docs were doing them, ha!] Until the doc told me to put it in. I would always run through my plan with her and when I got to put in the order she said already done. I knew then that I had been missing out. I spoke with her about it and she said I was slow and needed to pick up the pace, the doc orders needed to be implemented right away which is why she put them in. Ok I get that, but maybe help me time manage instead of doing?

After 1.5 months with her and 1.5 months of detoxers and maybe 2 or 3 real icu patients I asked if I could have a new preceptor. One who wanted to teach. [No I didn't just change because she put in the doc orders for me, there were a few other things that Warranted a new preceptor]

I got a new preceptor and it was like my eyes had been opened. Real icu patients. Drips and vents plus she asked me what I thought about each situation. I was learning. I improved tremendously in a couple short weeks then off to nights I went and felt like I was starting over.

Néw night preceptor was super laid back, cocky and nice. He new everything and he was ok if you knee it. Since he hasn't been in icu very long I was back to low acuity patients. Still some vented and sedated but nothing major. I learned a few new things, a fee new policies and improved my charting.

I have been on my own for 1 month. I have had nothing but detoxers and a couple repeat patients. I don't mind low acuity patients right now. I am a SLOW learner, but when I learn it, it's for life. If I have low acuity patients now, I am able to work more on my time management help other Co workers read their hx and develop more of my critical thinking skills perfect my charting and learn new policies.

I often ask questions when report to the day nurse is over about charting, patho, labs or policies just to really solidify and tie together what I did during the night. This morning my manager told me that a couple day shift nurses have expressed concern that I may need more time in orientation. I told him that I am still having a lot of firsts [hung blood for the first time a few nights ago and was told by my charge that she was shocked I didn't do it in orientation] but as long as there are people willing to help I am alright with being on my own since you are never truly on your own. I figured I wouldn't be able to see everything in orientation anyways so how would more orientation help?

I do like bouncing ideas off people and I sometimes wonder if I irritate my pod mate when I start talking to them about my theories on who knows what about why the pt is hypotensive or febrile or ect.

My manager ended up suggesting that I ask for more complicated assignments and ask that they put someone strong as my pod mate. 1. Didn't know we could request 2. Might be tough... it was me and another new grad in a pod alone the other day and her pt was very very critical. Mine was more crazy than critical.

Do you all think I should take more orientation or just keep asking for help when something comes up that I don't know what to do?

Sorry this was extremely long.

Oh, if it makes any difference, I've had 4 brain surgeries for epilepsy and even though I am fully functional neurologically and am smart [very book smart] I am now slower. It takes me longer to process and understand. Once I get it, it's in my hallow head for good but it does take some extra work to get it in and sometimes explaining things in a different way. Let's see, some people can set up a cvp 1x and they have it, I've set up 5 and I still have to focus. I used to be like that with setting the pumps, but I'm a pro now. I am a bit slower. I eventually want to be a critical care NP and want to really know my stuff sooooo any thoughts suggestions advice comments anything is greatly appreciated :]

[Stitch3296]

I'm a new grad too, started work in September so I don't have been there done that advice, but wanted to offer a few encouraging words!

I would ask specifically what the day shift nurses concerns were. If you don't know, you can't change or focus on that area. Could be something as simple as how they want to receive report. I would also say advocate for yourself. If you're comfortable being on your own, then fight for that. I think the suggestion of asking for more difficult assignment when possible with a strong pod-mate is a great suggestion. You seem very self aware, and I would continue to advocate for your needs. It sounds like normal new grad learning to me. There's a huge difference between school and real life nursing. You mentioned bouncing ideas off coworkers...this us a great way to learn. My mgr. Always says she'd be more worried about her new grads who weren't asking questions. Good luck to you!

[SubSippi]

The fact that when you hung blood for the first time as an ICU nurse is when you were off orientation tells me that you DO need more orientation. Not because there's anything wrong with you, but because your orientation wasn't adequate, for whatever reason. New grads are supposed to need help looking at IABP waveforms and 12 lead EKGs, or to double check that they're weaning down the right pressor first. But hanging blood...after a 16 weeks orientation you should be able to do that in your sleep. Part of a preceptor's job is to make sure whoever they're training gets a variety of experiences under their belt before they're on their own, and it seems that you were failed in that regard.

However, you are on your own already, so if I were you, I'd take your manager's advice and start taking more critical patients. BUT, you should also schedule a day about a month from now to where you can follow up and see if you're improving, with the plan that if you're not, that you can get a little bit more orientation. Maybe even weekly feedback meetings, if your manager is up to it. If there is an experienced coworker that you trust, I'd also try and get feedback from that person as well. But don't go all over the unit asking people what you did wrong, that would probably make you seem whiny.

Also, do your coworkers and boss know about your issues with epilepsy? Not just that you have it, but how it has actually affected your brain? Although it is certainly none of their business if you don't want them to know, being aware of what you're going through could make the difference between, "that girl is suck a flake," and, "she'll get the hang of it eventually." Just a thought.

And one last word of advice...start making your own little procedure book. If you have trouble with the steps when you're learning a task, write it down. That way, you won't be having to grab people and ask them for help with all those basic things they think you should already know! I used to have trouble with all the discharge paperwork and navigating our charting system, so I made a notebook with step by step instructions, which literally included exactly which buttons I needed to click, and what order I needed to click them in, to find certain documents I needed to print...AND where on the screen I should look to find each button. I also made up a ton of check lists, which include lists as simple as materials needed to pull a chest tube and random quirks of each of my surgeons (example: one always wants an update around 2100 on his fresh hearts and I would ALWAYS forget). It seemed a little silly, but it was a HUGE help, and as it turns out, I've had people ask me to borrow it wayyyyy more than once!

I don't have epilepsy, but I am very scatterbrained and can come off as an incredibly flaky, head-in-the-clouds type. But I have compensated by being almost obsessively organized. If it weren't for all my lists, I would NOT have been able to do this job at first!

[Mavrick, BSN, RN]

Based on what you've written, your first preceptor dropped the ball. Now that you're in charge of your own learning I think it's a great idea to request higher acuity patients if you also get to pick a strong podmate. Pick some one you want to be like (not like your slacker preceptor). It's gonna be tough but you learn more when there is more to learn.

If you're a slower learner or perhaps need a more hands on approach (learn better by doing rather than reading/being told) then just accept that. No need to mention any brain condition. You're asking good questions and as a PP said you're very self aware, a big plus in my book and compliments to you.

Speaking of books, keeping a brain book is a very wise suggestion. Common meds, drip charts, phone numbers, procedures, people and their quirks, hints and hacks, etc, stuff you can refer to on the fly without having to keep asking or looking up in the big policy manuals. Wear the thing out until you know the major stuff by memory then add the not-so-common weird stuff (like the code to the morgue, kind of thing).

Some ICU nurses have their own "report sheet" to stay organized. There are some generic "brain sheets" available here (head to toe, systems, chronological) but also ask workmates if they have one that works better for your hospital.

Many fine ICU nurses are a bit OCD and it serves them well. You've got a good shot at being great despite a rocky start.

Hopefully, you'll be back advising newbies in a year.

[OnlinePersona, LPN]

Didn't know they have new grads in the ICU, very interesting.

If I were you, I would respond to your Supervisor when they say you need more time, "that's fine, next time get me someone who is actually interested in teaching and not doing her homework. Thanks".

If people without epilepsy fails the NCLEX and you pass it with it... its not an issue :-).

P.s. I got epilepsy too

[Studentnurse365]

I've been so busy I haven't been back on this site. Subsippi, you make great points. My orientation was mostly ciwa patients and I still mostly get ciwa patients.... I have talked to the charge nursed about assigning me more challenging patients and they have agreed when there is adequate back up. My coworkers and manager do know about my epilepsy and I believe some know about the brain surgery, I don't believe they make the connect to why I am a bit slower though. I was one of the students with the highest grades in school, but it took me 2x as long to learn the material. Since I don't have a lot of cvps, titrations, vents, going to CT ect. I had it engrained to my memory. I need a couple weeks of true icu pts, pts with the works to be more confident.

That is a good idea about the procedure book. I am constantly asking about different things. I am also still finding out so many new things that I wasn't told in orientation, so having a book I can look back at would be really nice.

I do have a brain sheet, I am very ocd and have every thing on it.

My charge nurse did follow up with me about the nurse who complained saying I needed more time to my manager. My manager talked to my charge as well to get an opinion. When my charge nurse gave me the behind the scenes details she said that the day nurse complained because I missed a consults and my pts room was a mess. Had a crazy night with 2 ciwa patients both trying to get out of bed and one pulled his picc out. To make things better, it was just 2 new grads in the back alone. I did explain that to my manager about how it was a bad situation and how we had no help.

I did apologize to her in advance about the room and told her I would straighten everything up before I left and apologized for such a crappy report-new admit and didn't have time to do much research. I didn't know about the consult or even where to look for consults. I never thought to check the unit clerk tab for orders through out the shift... well consults go under unit clerk and I didn't do it cuz I didn't know and had never done one.

She showed me. I gave report to her the next day and she told the manager I did much better. I do agree I need a ton more experience. I started to notice it when someone who started a week ahead of me was getting very sick patients and I was still getting ciwa or pcu patients. I won't learn if in not exposed to it tho.

Hopefully I will start getting more of a challenge with help of course. Will be making that book! Thanks for the replies!