Help!?! New to SICU. Cried second day. Terrified

  1. I posted this in the wrong area so posting here, too!
    bring it on nurses!! I need soem
    serious help and guidance:


    0Hi All,
    I just started a clinical care training program at a county hospital. It's a 13 week program with a mix of didactic and clinical time.
    There are about 35 of us in the program. The majority of the people are new grads... some have a couple years or less experience in a different discipline.
    I graduated in 2015 and started working in a chronic outpatient dialysis clinic in addition to doing some registry work. I've never worked in a hospital.
    This job basically fell in my lap... I never had huge ambitions to work in a hospital and never ever imagined I'd want or be in an ICU. My self esteem is such that I would never think I have the competence or ability to do what I consider such advanced and sophisticated nursing (God, just disclosing this opens all kinds of invitations into my broken thinking). So while I am super grateful for the opportunity I have also entered this with a somewhat paralyzing amount of fear and trepidation.
    I have just completed two days with one of my two preceptors (my primary preceptor).
    First impressions: she absolutely terrifies me. She's fast, talks fast, does fast, moves fast, has a thick accent that is sometimes challenging. She's incredibly intimidating. She's abrupt, abrasive. She's a "take no prisoners and take no ****" kind of gal. She's knowledgeable, experienced, proficient. She is required to precept and she openly disclosed to me she avoided it for years. She's impatient, particular, and hard around the edges.
    Yesterday, my second day on the unit, we were in conversation... I can't remember the exact content of the conversation, but whatever it was she told me I responded with, "I don't think I'll be ready for that." She quickly shut me down, told me that is the wrong attitude, told me I should reconsider if I want to be in the ICU, told me the NM would flip out if she heard me say that. I, in turn, began to cry. I felt so small. So embarrassed. So weak. So incompetent. So useless. And so incredibly lost. And I was thinking, "****, i'm the girl that cries. I don't have what it takes to be and ICU nurse... my second day and I'm already in tears. I'm too sensitive, too vulnerable....."

    Now, in all fairness, while by and large her personality and mine clash, she does show me certain things, she pushed me into a room with a fresh heart patient straight from OR to see how that all looks (I didn't understand a thing about what was going on at all)... but I feel like her expectations of me might be a little unreasonable.

    I don't do super well with the "tough love" method. I freeze. I buckle. I don't have enough of a foundation to feel confident and secure. When i worked in dialysis long enough to feel my footing I was not so sensitive to being challenged or yelled at.... but here, I just don't have a clue. I'm overwhelmed... I feel like a nursing student again. I feel like I'm being set up to fail. I don't know how to prioritize. I don't know **** about the meds, the procedures etc.... And I noticed today that we haven't gone exactly according to the orientation program schedule of what were supposed to be doing Day 1 and Day 2. She had me charting yesterday - in Epic.... my god, none of it is intuitive and she would yell at me for forgetting things or tell me I'm charting too little or too much and I don't really understand where I'm supposed to get into detail and where I don't need to get into detail. I 'm getting mixed messages.
    I don't feel comfortable or "safe" with her.... I mean emotionally. I know she's not there to coddle me. And I can appreciate that I need to put in the work, too. I get that. But I look around at some of my peers in the program with me and their preceptors seem so much more gentle, more patient, soft spoken....
    Should I not be expressing my fear? Should I reconsider the ICU? When is enough time to know it won't work?
    She did suggest I write down questions/concerns we can discuss next time. I go back Saturday and will be with my other preceptor. I've met the secondary. Truthfully, she doesn't seem much better. .... but I'm open to see what happens Saturday.
    I can't help but imagine the secondary will already know I've cried....


    God, I'll take any feedback or guidance or help.
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  2. 5 Comments

  3. by   oceanblue52
    'This all sounds very stressful. I would probably feel similar to you! You are only 2 days in though, I think you should give it more time.

    A few random thoughts:
    1) if someone says something that upsets you, take a deep breath or two before reacting, if possible. That can sometimes help center you and give you better control over your reactions.
    2) Buy an ICU/critical care review book and study as much as your brain can handle during your days off. You will only succeed if you take an active part in your learning. Review meds and pathophysiology first, those are the foundation to developing critical thinking skills.
    3) EPIC is NOT an intuitive program. It's cumbersome and comes with time.
    4) Even if you don't feel confident, it's important to act confident, and take an active part in your learning. It's okay to admit that you might need help with a procedure, but it's important to jump in and be proactive in the acute care setting.
    5) Take care of yourself! Hot baths, massage, reading a book...do whatever you can to decompress after a shift. Self care increases resiliency, which will help you adapt to the uncertainty that's prevalent in critical care.
    6)Don't take your preceptors brashness personally. Perhaps you can reframe your fears into something more positive? Sometimes we can learn things by observing how others handle situations.
    7) If after a few weeks you are not feeling any better about this, it is okay to quit and try something else. Acute care is not for everyone. It is always better to have something lined up though, so you are not scrambling to find a job that might be equally awful.

    I wish you you the best! *hugs*

    Disclaimer: I have only worked in community health as a nurse, and as a CNA in acute care. These tips are just things I have heard from other friends of mine that started as new grads in the ICU.
  4. by   jlv613
    I can't even begin to tell you how helpful this is and how grateful I feel to have your support and encouragement. I return to the unit Saturday with my secondary preceptor. I've done some good self care ... gone on long runs, slept late, did laundry, did some soul searching....
    I've written a list of questions, written some personal objectives, and written how I think I learn and what will be helpful for me... I"ll keep you all posted on my progress.

    Again, thank you for all the kindness and encouragement!



    Quote from oceanblue52
    'This all sounds very stressful. I would probably feel similar to you! You are only 2 days in though, I think you should give it more time.

    A few random thoughts:
    1) if someone says something that upsets you, take a deep breath or two before reacting, if possible. That can sometimes help center you and give you better control over your reactions.
    2) Buy an ICU/critical care review book and study as much as your brain can handle during your days off. You will only succeed if you take an active part in your learning. Review meds and pathophysiology first, those are the foundation to developing critical thinking skills.
    3) EPIC is NOT an intuitive program. It's cumbersome and comes with time.
    4) Even if you don't feel confident, it's important to act confident, and take an active part in your learning. It's okay to admit that you might need help with a procedure, but it's important to jump in and be proactive in the acute care setting.
    5) Take care of yourself! Hot baths, massage, reading a book...do whatever you can to decompress after a shift. Self care increases resiliency, which will help you adapt to the uncertainty that's prevalent in critical care.
    6)Don't take your preceptors brashness personally. Perhaps you can reframe your fears into something more positive? Sometimes we can learn things by observing how others handle situations.
    7) If after a few weeks you are not feeling any better about this, it is okay to quit and try something else. Acute care is not for everyone. It is always better to have something lined up though, so you are not scrambling to find a job that might be equally awful.

    I wish you you the best! *hugs*

    Disclaimer: I have only worked in community health as a nurse, and as a CNA in acute care. These tips are just things I have heard from other friends of mine that started as new grads in the ICU.
  5. by   nurserobinson281988
    So sorry to hear that you're struggling. I hope your second week was/is better. A couple of pieces of advice:
    1. It sounds like you and your preceptor do not mesh--personality wise. That is going to prevent you from getting the most you can out of a very important orientation. It would benefit you to address this much earlier rather than later and discuss changing preceptors with your manager. I just started precepting a new grad on nights who had a very competent preceptor dyring her day shift orientation. While the preceptor was very intelligent, she was very harsh with her, and some do not respond well to this "tough love" while they are trying to learn. Consequently, she is BERY discouraged about being a nurse in the CICU at this point. It is best to be placed with someone with a personality and teaching style that is more similar to your learning style, so that you know for sure that there are no adjustable factors that could be interfering with your ability to be a good fit in the ICU.
    2. Learn as much as you can about the disease processes involved with the patients you are taking care of. Buy review books, watch youtube videos about drugs and their differences (vasoactive meds, sedatives, and other commonly used meds in the ICU) Try to focus on the big picture: signs and symptoms of deterioration and do whatever you can to stop these things from occuring or worsening. PAY ATTENTION and take your time. I have seen some very careless mistakes made by nurses who felt rushed (with stable patients, and for no identifiable reason). Be a safe nurse. I know you're not a new grad but this is a very different environment for you).
    3. Ask questions as much as possible and learn from the answers as well as your mistakes. You will not know everything or even 1/10 of everything but your ability to realize what you don't know and to set aside your pride at times to ask questions will separate you from a dangerous nurse who doesn't do so.
    4. When you get to the bedside, assess your patient and then go read the physicians' notes and everything else you can in the chart. You will find a lot of things that were missed and changes in the treatment plan that were not communicated to you this way.
    5. Do your best, TRY not to stress. I came into the ICU with three years of acute care experience and it was still horrifying to me, but I am a great ICU nurse now--according to my charge/stemi nurse who has a very similar personality to this primary preceptor you speak of. That being said, the ICU is not for everyone, and maybe you need a year or two of Tele experience or some other unit before you are reasy for the ICU. Good luck!!!!
  6. by   jlv613
    Wow! Thank you so much for the time and thoughtfulness you put in to your reply.
    It has definitely improved since my second day, however, I still find it quite challenging... But I like it... at least I think I do.
    And I've even come to appreciate my preceptor... she still kind of scares me.... but she is good... and I feel foolish for being so reactive so fast....
    This has been incredibly challenging in ways I couldn't have possibly imagined... and I feel like if I can survive this I can survive anything!
    So, for now, I'm sticking with it... I'm showing up, taking notes, definitely asking tons of questions, and doing my absolute best!
    I will keep you posted.

    Thank you for all the kind and sage advice.... I always appreciate the feedback and support!




    Quote from nurserobinson281988
    So sorry to hear that you're struggling. I hope your second week was/is better. A couple of pieces of advice:
    1. It sounds like you and your preceptor do not mesh--personality wise. That is going to prevent you from getting the most you can out of a very important orientation. It would benefit you to address this much earlier rather than later and discuss changing preceptors with your manager. I just started precepting a new grad on nights who had a very competent preceptor dyring her day shift orientation. While the preceptor was very intelligent, she was very harsh with her, and some do not respond well to this "tough love" while they are trying to learn. Consequently, she is BERY discouraged about being a nurse in the CICU at this point. It is best to be placed with someone with a personality and teaching style that is more similar to your learning style, so that you know for sure that there are no adjustable factors that could be interfering with your ability to be a good fit in the ICU.
    2. Learn as much as you can about the disease processes involved with the patients you are taking care of. Buy review books, watch youtube videos about drugs and their differences (vasoactive meds, sedatives, and other commonly used meds in the ICU) Try to focus on the big picture: signs and symptoms of deterioration and do whatever you can to stop these things from occuring or worsening. PAY ATTENTION and take your time. I have seen some very careless mistakes made by nurses who felt rushed (with stable patients, and for no identifiable reason). Be a safe nurse. I know you're not a new grad but this is a very different environment for you).
    3. Ask questions as much as possible and learn from the answers as well as your mistakes. You will not know everything or even 1/10 of everything but your ability to realize what you don't know and to set aside your pride at times to ask questions will separate you from a dangerous nurse who doesn't do so.
    4. When you get to the bedside, assess your patient and then go read the physicians' notes and everything else you can in the chart. You will find a lot of things that were missed and changes in the treatment plan that were not communicated to you this way.
    5. Do your best, TRY not to stress. I came into the ICU with three years of acute care experience and it was still horrifying to me, but I am a great ICU nurse now--according to my charge/stemi nurse who has a very similar personality to this primary preceptor you speak of. That being said, the ICU is not for everyone, and maybe you need a year or two of Tele experience or some other unit before you are reasy for the ICU. Good luck!!!!
  7. by   canoehead
    You and your preceptor may adapt to each other. She may be a pussycat underneath all that crank!

    Even if you decide in a few weeks or months that this is too intense, or not the environment for you, concentrate on soaking up as much knowledge as you can. You'll still use it. Try to get ACLS if you don't have it, that will put some organization into the bedside chaos.

    ICU folk tend to be type A personalities, perfectionists. They may speak sharply, but it's in response to the stress of the unit, NOT to you personally. Try to let it roll off like a duck. Of course, some people are just jerks

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