[racing-mom4]

I am a new ICU nurse, just graduated in Dec 07. My unit typically does not hire new grads. The newest nurse besides me has about 5 years of exp.

I posed a question on this board last week about titrating levophed and was amazed at the knowledge base and kindness in all of the responses.
You all really seem to know your stuff!!!

I am learning each week, I am feeling more confident in making suggestions to the Drs. I am learning that I have resources available to me ex: resp/pharm/house supervisor. I feel as I know when to call out for help.

I am wondering though, when will I feel comfortable in my job? Not over confident as I think that is scary, but just comfortable.

Iam OK if I have "kind of" sick patients. But when I get a vent pt, or someone who is crashing fast, I feel like I am treading water and can barely keep my head above. The other night I made the comment, I wis h I could just take care of the patient and not have to chart--as finding the balance of doing my job, then documenting what i am doing can be a struggle. Since I think nursing is on the job training, I take the sickest of patients every chance I can get. As I learn more by doing than watching.

So what do you think? A year? 18mos? I know I have learned more the past 5months than I learned in 4 years of school!

Thanks for all your responses last week, I learned alot from you all.

[ZASHAGALKA]

Took me 3 yrs in ICU to really feel comfortable, and I had 3 yrs experience before I came to ICU. It's a learning curve. The steepness of that curve DOES level off over time.

The trick is learning, as fast as possible, what you DON'T know. Learn your limits and ask for help. I don't mind new nurses in the unit that ask for help. I very much mind new nurses that don't know that they need help.

The next thing is to expand your comfort zone. You mentioned situations that make you uncomfortable. Reach out for those situations. You won't grow with 'not so sick' patients. You need to learn how to take care of complex patients, and how - and when - to ask for help until you get the hang of it. THAT is why you have mentors, or, should have mentors.

~faith,
Timothy.

[pietr422]

Racing-mom:

I also am a new grad in the ICU. I have been working in a busy general ICU for about 3 months, where we see everything, form fresh hearts to ETOH withdrawal on ativan gtts. Today was my 3rd day off orientation, and I can relate to your frustration. Here is my $.02

Accurate, timely, and relevant documentation is a necessary and very important skill of our job that is developed over time. It is necessary in order to protect our licenses as well as provide vital information to those who use it in their decision making processes, including the nurses following our shifts.

As new graduates in the ICU we are constantly faced with novel procedures, diagnoses, and situations that consume a great deal of time. Our number one concern is taking the best care of our patients possible, and documentation can take a back seat to giving that next med, turning that patient, providing oral care every 2 hours, managing alarms, and spending unhurried, quality time with our patients and their families.

Many experienced nurses that I work with have stated to me that it can take at least 1 year to begin to feel comfortable in the unit. Think about it... We are learning a new language (several for that matter), a new culture, and a new way of thinking. We are expected to remember enormous quantities of information with each patient and then we are expected to be able to process that information and provide precise, succinct information to those who need it inthe blink of an eye. (i.e. the information needed by the pulmonologist is not the same information needed by the consulting infectious disease doc, the charge nurse, or the psychiatric evaluator).

I chose to work in the ICU because I knew it would be a challenge, and I'd be willing to bet you did the same. I remind myself of that fact regularly. That fact keeps me motivated and helps me to work through difficult situations. Remember that every time you are faced with a situation that completely overwhelms you, you will be better equipped to handle similar situations in the future.

Here are the best tips that I can give you from the perspective of a fellow novice:

1) Set small goals for yourself... start with the basics and add a new goal as soon as you have accomplished the last one (ie. today I will provide q2h oral care without fail, or today I will not miss a single pt turn, or today I will have my initial assessment, meds, and initial charting done by 10am)

2) Chart as you go! (That next task always seems more important than charting, and often times it is, but if it can wait even just one minute, use that minute to CHART. Once you get behind with charting it is hard to keep up let alone remember what happened for the last 6 hours!!!)

3) Find your resource people at the beginning of every shift. (You know who they are... the people you can count on, the people who know you're green but love you anyway). They may not be in your "pod" but they are in the unit. Know who they are every shift and utilize them. Make friends with PT/OT/RT/Case Management/Pharmacists/MDs) If you want to learn and you make it known, they will want to teach you as it is to their benefit as well.

4) Don't slack on basic pt care... ever. If you slack now, you will develop bad habits. USE HAND GEL, and wash your hands until they hurt, but use non-petrolium based lotion if they do hurt. You don't want to have to wonder if that pt who got VAP got it because you didn't have time to clean the bugs off of your hands from the pt next door. Change expired IV tubing when you notice it. Label everything with date and time. Turn and oral care q2h. Basic skin care always. Ensure VAP prevention, DVT prophylaxis, GI prophylaxis, etc...


You can and will become more efficient!! You are already more efficient and proficient than you were 5 months ago. Take stock in yourself. Be confident (especially when asking "dumb" questions). Take pride in your work, and your patient care skills. Strive to learn every day. Strive to get your patients out of the ICU and take amazing care of them and their loved ones while they are under YOUR wing. We can and will do it!!!

Best wishes...

-AP

[sharrie]

I found my comfort in ICU came and went, after about 6 months I felt fairly comfident and felt I knew what I was doing, by 12 months I had lost that confidence because I realised how little I did know, this is maybe because with experience the acuity of your patients also increase and then this challenges what you think you know.

I suppose I had been in ICU about 18 months before I realised it was ok not to know everything and that the areas that I was confident in others weren't. Once I figured that out it became easier as we all could bounce off each other with aspects of ICU nursing we were unsure of.

[nurseabc123]

I'm coming up on 12 months and I'm just now starting to feel pretty comfortable with everyday things. For example, traveling with vented, sick patients to CT, etc., running to codes on the floor, and just the everyday little stuff. Of course, I'm still nervous with really sick, crashing patients, but you just do what you gotta do.

[pinkeyICU]

when I started in ICU as a new grad I was told that if I felt comfortable before 1 year, confident before 3 years I was a fool who would probably hurt someone. I still have times where I feel that I am barely keeping my head above water...then the cycle turns and I feel okay for some shifts.
In the beginning I wrote everything down on slips of paper & napkins...I notice now that I use fewer napkins and have developed tricks...things I always do a certain way. Also now sometimes I can actually breathe.
The thing that helps me most is getting that first assessment in as soon as possible. AND...knowing resources. We have online meds so I can quickly look up any drug I'm not familiar with as well as IV compatibility & dosage. For me it's quicker than a book. Also I never hesitate to say..."does this look right? Does this sound right? What do you think of this?" On my unit we all bounce things off each other and I have noticed very senior nurses do it too.
Even now, I hesitate to say I feel comfortable, because I don't want to jinx myself. When all the planets are aligned, I've had the same 2 pts for 3 shifts in a row then I start to feel comfortable....then WHAM...heart rate is 170 sbp 65. What the HECK? What's going on? Comfort in ICU nursing (for me) is fleeting and temporary.

[ghillbert]

I would say about a year, maybe 18 months to feel comfortable with any patient. It's different in Australia where I worked though - my year in ICU was completing a postgraduate critical care course - we worked 4 days and studied at uni the 5th day for a year. It really worked to tie the theory and practise together.

If your unit doesn't have a structured education program for new RNs, perhaps you can suggest one. It will help if you write EVERYTHING down - I carry around (still) a notebook and if I see a drug/disease/procedure I'm unfamiliar with, I write it down and write it up later (doesn't happen much now that I'm as old as the hills, but still happens at times..!).

Your best ally in the ICU is a will to learn and be proactive. Noone is going to shove this stuff onto you, you have to figure out what you don't know, and find it out. From your other thread, you sounded like you have a solid basic understanding, so I think you're doing fine from what I could tell - keep it up!

[Michigan RN]

I've been in the SICU since January and I feel somewhat comfortable. I'm trying to follow my nurse manager's advice of taking stable doubles (2 pts) and working on my organization and prioritization although I've had fresh liver transplants from OR right after orientation. I do have to say that I really don't feel stressed out when I leave work so I guess thats good. I try to take patients that I feel comfortable with then move on to something more challenging.

[dorie43rn]

I am a little over a year in the ICU. I feel comfortable due to all the nurses willing to help when things go wrong, and to teach me when I ask questions. I am however a little nervous when I am the only nurse going on a road trip with a critically ill patient. But then again, if something goes wrong, its back to basics abc's.
What helps me alot is while I am assessing, I think about "what ifs" depending on the patients diagnosis and problems, and think about what I am going to do if those "what ifs" happen. For example if my patient was admitted with a GI bleed, I'm thinking in my head what very bad things may go wrong, and what I am going to do if they do. That way if something does go wrong, I won't look like such a newbie when it is time to react.
And it is sweet if things go right and you can get charting done right
away.
My ICU is not a major trauma unit, and I know I have lots to learn and see, but trusting that your coworkers will help you along the way makes you feel more comfortable from the start.

Doris

[cardiacRN2006]

Originally Posted by sharrie

I found my comfort in ICU came and went, after about 6 months I felt fairly comfident and felt I knew what I was doing, by 12 months I had lost that confidence because I realised how little I did know, this is maybe because with experience the acuity of your patients also increase and then this challenges what you think you know.

I suppose I had been in ICU about 18 months before I realised it was ok not to know everything and that the areas that I was confident in others weren't. Once I figured that out it became easier as we all could bounce off each other with aspects of ICU nursing we were unsure of.

This pretty much sums it up for me too. I felt confindent for a while...then I realized what I didn't know! It ebbs and flows, that's for sure.