Having trouble applying knowledge, pls advise

Specialties MICU

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Hey all, I have 1 yr exper in ICU and just got my CCRN. HOWEVER, the manager at my new ICU job feels I'm not ready to come off orientation yet after 5 weeks and is telling me that I'm smart but have trouble applying my knowledge at the bedside.

Like I said, I had no trouble passing CCRN on the 1st try and I scored very well on my hospital's own critical care exam when I was hired ... and yet somehow I have trouble with the most basic things.

What's the deal with that? I feel so incompetent. I'm not lazy, I study hard and do well on exams. I feel like I have a good knowledge base ... why is it so hard for me to put it all together at the bedside? Has anyone had this problem? How can I improve upon this?

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Hi Ashley-

I have been an MSICU nurse for five years now, hired as a new grad. You sound very intelligent and great at testing- brains are not your problem, you just need a little more experience. Five weeks of orientation is pretty short, even for an experienced nurse. Don't get discouraged, just make sure you have some good critical care pocket guides, and read everything you can get your hands on pertaining to critical care, esp. any areas you have difficulty with. Good luck!!

Celia

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Specializes in Managed Care, Onc/Neph, Home Health.

There are a whole lot of "book smart" nurses out there, who just can't pull it together at the bedside. Its sad to say, but a reality. I am sorry you are having a hard time, but sometimes GPA's and 4.0's and all that dosent really matter, when after 1 year, doing the same job, and one still is having a hard time. So really the CCRN is a personal accomplismnent, a nice accronym behind the RN. I will tell ya, thats not a good sign if you are in the ICU and having trouble with "basic things". My suggestion would be maybe come out of the ICU to a Med-Surg floor and get more hands on with "basic things", then work your way back up to the ICU when you gain more confidence. Maybe your manager see you are lacking confidence, thats why he/she won't release you from orientation. I don't blame them, you would be a liability. Good luck to you, and take heed.

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Specializes in ICU.

When you say the most basic stuff, what do you mean? Unfortunately book knowledge will only get you so far. Eventually you have to be able to apply that critical care knowledge in emergent situations. What kind of feed back does your preceptor give you? How did you do in your first year in the ICU?

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Specializes in CMSRN.

How did you do in your clinical rotations? Did your instructors mention this as an issue at that too also? Just curious. Good luck!

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Specializes in CTICU.

It's difficult to advise without specific examples of what you're having trouble with. Could you maybe elaborate?

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Specializes in ICU.

I agree, a specific example would help us advise you. But a small gem of advice that was passed on to me from an instructor is that no matter what go back to your basics. Perhaps you are just trying to do too much, think too much, maybe a simple review of basic concepts will help you.

It's great that you score well on exams but as my preceptor told me the test world and the real world are pretty different. It sounds like you need to forget about all the tests that you have passed and just become a student again. Think of it this way, you get to soak up all the knowledge of those around you! Also don't be afraid to ask questions, ask ask ask!

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Specializes in Trauma/Tele/Surgery/SICU.

Is this ICU a different type? Higher acuity? I too think 5 weeks is too short even for an experienced ICU RN. Are your nerves getting the better of you? I have an issue with anxiety and feel that I need to be perfect especially when on orientation (feel like everyone is judging me and if I am not perfect they will fire me). This impacted my performance and a couple of times I found myself unable to do things that had been second nature to me at my previous job. Once I got my anxiety under control I was able to perform well. Could this be an issue for you as well?

I agree with other posters that specific examples could help us give you better advice.

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Specializes in Trauma, Critical Care.

I think we're a lot alike, Ashley. I'm def more book smart than common sense smart, but I still don't have any issues functioning as a nurse and was recently asked to precept. A couple things came to mind when reading your post that may be affecting you: 1) performance anxiety 2) lack of experience. I def get performance anxiety. There's an intensivist where I work that probably thinks I'm an idiot. She's regarded in our facility as an amazing doc and I swear whenever she's around I just freeze bc I value her opinion so much and want her to see what a good nurse I am. Maybe you are doing the same with your coworkers bc you are new and are trying to prove yourself. Also, a year is not a long time to be a nurse anywhere. I didn't really feel compatible and 100% confident until around 1.5-2 years. Good luck. Everything will be fine!

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Specializes in CCU MICU Rapid Response.

You've only been a nurse for a year! It takes time to feel good in the nurse shoes and apply all those book smarts. I started in the unit as a new grad and the first year is tough... It is learning basic nursing and a specialty all at once. You need to learn a variety of things, and honestly you won't know how much you've yet to learn and experience until you've done just that. Going to a new place after 2 years, I received 6 months orientation. Im in A high acuity 24 bed icu with balloon pumps, cvvhdf and arctic suns. Lots of drips and lots of things I had never seen prior in my 8 bed unit. Take advantage of all the orientation, relax and enjoy it! The pieces will fall together... It just takes time! Good luck :) Ivanna

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

a single year of experience really isn't that much. it takes about two years to make you competent, or what i refer to as "a low maintenence co-worker." (that would be someone who is proficient in critical thinking, troubleshooting and problem solving and knows when to ask for help -- and when not to.) so five weeks of orientation seems a bit low to me. unless you're going from somewhere like the cleveland clinic or johns hopkins to the 4 bed icu of goat spit, mt. but even then, you'd get a lot more variety, so probably more orientation would still be a good thing.

book smart is not the same thing as being competent at the bedside. but with only one year of experience, you have time to grow.

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Specializes in ICU.

I agree with you. You need to have a mentor that will guide you as you go. Some hospital has ICU orientation program for the new grad and teach them how to develop their critical thinking and let them handle critical cases during their training. That is the only way to learn to have exposure to this cases and learn from it. Having a mentor will help a lot and at the same time you have to take some critical care courses. AACN is offereing ECCO online and you need to ask your education department if they pay for it because that will help you a lot.

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