Taking a full ICU patient load only 2 weeks into orientation

[Mommy_of_3_in_AL..RN]

Ok, a warning..this will be long, but i really need to recap the last few days and get some input/suggestions/something...

I got my dream job a few weeks ago in an ICU as a new graduate. I was determined to be inthe unit, and feel i thoroughly impresed the management, and was hired over several experienced nurses. I started two weeks ago, and was put with the charge nurse for orientation fr 6-12 weeks or so, until i go to nights, where i will continue to orient for a few weeks. My first day went well. There was adequate staffing and my preceptor was available to help me at all times. I kind of took the reigns and decided to show her what my strengths and weaknesses were. She was impressed, but the next two days she was out sick. I was assigned to the second charge, who was great. I was able to do alot, and take on a lot of responsibility with a very combative vented/trach patient, becuase we were understaffed and someone had to keep her from yanking everything out. I received a lot of praise, and was also told that joint commission would be there this week..and yes i would be there and taking patients..YIKES!! talk about scared!! so, tuesday comes, and i was back with the charge nurse. We took two patients, one that was more critical, and the other a psych/OD pregnant woman who is my age. The critical patient was admitted with DKA and necrotizing fasciatis ( i like to say that word) a couple months ago, and has undergone many debridement/graft/reconstruction surgeries. She has a lot of pain, and is grafted from her breasts to her knees,front and back. She requires a lot of care and attention, so the charge took her as her "primary" patient and gave me the tylenol overdose/pregnant lady (who is a former peds ICU nurse..great). She was incredibly demanding. There wasnt much to do with her other than some lab work and take her for ultrasound. She was not caring for having the new girl be her nurse, and did not agree with unit rules regarding cell phones, visitors, etc. She made it clear early on that she didnt expect us to be in her room unless absolutely necessary, and proceeded to demean everyone all day. But i sucked it up and dealt with it. It was a long day,but i was able to spend time with our other patient enough to get an idea about her needs. The next day when i came in,we had the same two patients. OD patient requested that i not beher nurse, becuase i didnt yank her foley out exactly when she requested (sorry..i was helping to clean the other patient, which takes about 5 people) I was ok with that, and because we were short staffed and joint comm was coming, i took on the other lady by myself. I think i did a great job, and i was commended by everyone from the staff nurses to management and the CNA. Yesterday, same scenario, but we were very understaffed so i took both patients. Again, great reviews. Joint comm went to the other unit, so i was safe. YES!! I took on both patients, placed all the order, called the docs when needed, consulted with family and special services, dischargedthe OD patient to psych, and even assumed semi charge duties while the charge nurse went to the debriefment meeting after joint comm left. (the only other nurses were from float staffing, so i was the only unit employeee there). I was fine with that, and had no problems. he docs seem to approve and trust me, no patient complaints, except not getting that foley out then and there. Family's were satisfied, and i stayed late to help night shift since they were seriously understaffed and had two going bad. The manager and charge nurse were almost in tears at the end of the day, because i was the only positive one when we found out about the staffing issues (my comment was "ok lets get it done. we cant fix it, and the work wont do itself while we *****), and i was told more than once that if i keep it up, i have charge nurse possibilites in my future...like as soon as i complete ACLS). I am very satisfied with my work and myself. But. I still feel like, because i have proven that i can handle some of this, that it will be expected of me to always be like that. I feel now that there is no room for mistakes or questions, and that they expect more from me than may be safe, considering that i am a new grad with pretty much no experience. Should i have gone in thereand acted dumb, like i didnt know how to do anything, so that they would baby me more, or was i right to prove myself early on and show them that i had some knowledge. I just dont know what to do. Suggestions???

Thank you for reading this..lord knows it is long enough..and this is just the tip of the iceburg..i could evaluate a lot more on all of it..but you would have quit reading an hour ago if i had :)

[meluhn]

I think you did good but I wouldn't get them used to you always staying if the next shift is short. They might come to expect it, besides you are still on orientation.

[Oz2]

necrotizing fasciatis ( i like to say that word)

That's so funny...I was just saying that word last night and thinking how I like to say it.

I don't think you should play dumb. But don't let your idea (or their ideas) that they think you can handle everything keep you from asking questions when you need to. And if you suspect you can't handle something, let them know.

Good job!

[tigger2sassy1]

Wow!!! You definitely have potential. I like a new nurse that really isnt afraid to jump in there and get her feet wet. Also like a new nurse that has the want to in order to learn you need to ask questions. Great resources are here for the asking. Congrats to you:yeah:

[RN1982]

I think you did well. DO NOT stay over your shift. It's nice that you want to help out the next shift but you are new and you need to get your rest.

[canoehead, BSN, RN]

Even though you are doing fantastically don't cut your orientation short. There are a lot of things to see and do in ICU, and you want to be able to take advantage of that. I would also avoid having the same patients for more than a couple days. Move on to the fresh sickest patients so you can challenge yourself, and keep your preceptor beside you.