I think I'm in over my head :/ - page 2

by CrystRN33 | 6,621 Views | 15 Comments

Hello all! I am new to this site and I am just looking for some advice. I graduated in August and got a job in the MICU/CICU. I started in the beginning of November and it was the most intimidating thing I have ever done. On my... Read More


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    I ran into similar things back in 96' when I was a new nurse-it seems nothing ever changes with this profession. I'll let you in on a little secret....preceptor's will set you up to take a fall!!!!!! Most preceptor's have no business being a preceptor-They don't know what they're doing and they love to see people fail....makes them feel all tingly inside and boosts their self esteem. If you're not careful, you'll find your license on the line. You have to remember that, you may be new and in a learning roll but, ultimately, you are an independent licensed medical professional and if something goes wrong, they're coming to you. Don't expect your preceptor to take the fall for a mistake you made....they should but they won't. Also, if a certain person wants to drill me on a patient and give me a hard time, I'll tell them to read the chart and I walk out-It's that simple!!!!! Report is a privilege that is giving from a nurse going off duty to a nurse coming on-duty and if a nurse abuses that, they don't deserve report. You do that a couple of times and they'll learn to not hassle you. HAVE FUN WITH IT!!!!!!!!!!!!!!!
    krazylady likes this.
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    Quote from CrystRN33
    Hello all! I am new to this site and I am just looking for some advice. I graduated in August and got a job in the MICU/CICU. I started in the beginning of November and it was the most intimidating thing I have ever done. On my first day I had my own patients (vent patients) and I felt like I was going to cry!

    My preceptor was no help, in fact to my face she would say I was doing great then I would be called into the educators office at the end of the shift and she would tell me I needed to much prompting. After two weeks of that they decided I needed to go to PCU for a few weeks to get better training.

    I was upset but I have been on the HF/PHU for two weeks now and I feel great however after my last experience with ICU I am terrified to go back! Thankfully I will have a new preceptor but I am still scared I won't be prepared.

    Does anyone have any advice about how to handle ICU?
    I am struggling with remembering my cardiac meds (I know general stuff about them but when they quiz me I need to know every action of the heart it affects). I am looking for tips about how to remember them and break them down. Also, I get a little intimidated when giving report (especially to the charge nurse) I know all about my patient but I never know what they are looking for.

    Do I tell them everything about the patient or just what has happened during my shift and the last shift?

    Thank you for any help!!


    To me this is absolutely tragic. Do they have need of more nurses on the PCU? Stay there for a year, and the transition to SICU will be easier. I mean it will still be a pain for a number of reasons, but you will be better able to deal. I don't know why they expect new nurses to be able to work at the standard of practice in a SICU without a ton of precepting and mentoring. (Please people. No outlier experiences--that too also depends on the kind of ICU setting and hospital and the kind of acuity patients you have. Not all hospitals and ICUs are the same. It's just the reality.)

    I would see about a tele/pcu position. Once you get that in for at least a year, it will be better for you and your patients when you go into ICU. If you are in a community hospital setting, perhaps all you need is a better kind of orientation and preceptor. This tics me off; b/c you just can't get nurse educators to develop and work appropriate and objective prognostic indicators anymore--if they ever had them in the first place. If I were nurse dictator over in-hospital nursing education, this would be job one for me. LOL
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    OK, so which cardiac meds are you having trouble with? The best way to try and understand them is to first understand hemodynamics and of course, for antiarrhythmics or for the number of drugs that can be proarrthythmic, to know your dysrhythmias and basic EKG interp. I mean did they give you a critical care course with any of this information? Seems like a lot of places are forgoing this with people anymore.

    You need to know what effects what and where and how. You need to be secure w/lab interpretations and how labs can affect rhythms and dynamics. Same thing with fluids and electrolytes.

    You need to be a zip at ABG interpretation. And like anything else, the more you work with it, the better you become.

    This guy has a decent site for new nurses in the ICU.

    http://www.icufaqs.org/

    http://www.icufaqs.org/

    Of course it's adult ICU information.

    When you move into dealing with a lot of different types of direct post-op/SICU patients, you have to throw a lot of other stuff into your knowledge base, b/c the management can be very different.

    Same thing goes with PICU and NICU. A good understanding of basic critical is good for these areas as well, but management is much more specialized with the kids. Certain things are monitored and approaches to treatment can be quite different.

    In fact, if there is a pediatric hospital, see if they are hiring nurses on their step down or ICU/s. Usually it's more of a "mother, may I approach" b/c you are dealing with kids, and they don't give you a lot of room for error. Thus, for most of these children's hospitals, orientation/precepting is usually 12 full weeks, and you usually aren't thrown right into the fire. It's a liability thing. Good for newer nurses, but for adult ICU nurses, it can be an adjustment; b/c you become used to working more autonomously. But if you are interested in taking care of critically ill babies and children, you easily accept the change, b/c there's like zero lead time for crumping with babies and kids. Adults you can mark a downward trend earlier on in many cases.

    But what I am trying to say is in most children's hospitals I've worked or been in, they don't throw new nurses to the wolves. They may watch every tiny thing you do and be on your back, that's the nature of critical care areas; but most aren't going let a kid get into trouble for a second. Now I do think if you have experience in critical care, you can get dumped on, even in a children's hospital, but the fear factor is a bit greater in terms of liability. Just MHO>
    Last edit by samadams8 on Dec 5, '12
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    Oh, and I forgot to ask the OP as well. . .

    Seriously is this an actual area in which you want to work. It's cool if it's not.
  5. 0
    Quote from samadams8
    OK, so which cardiac meds are you having trouble with? The best way to try and understand them is to first understand hemodynamics and of course, for antiarrhythmics or for the number of drugs that can be proarrthythmic, to know your dysrhythmias and basic EKG interp. I mean did they give you a critical care course with any of this information? Seems like a lot of places are forgoing this with people anymore.

    You need to know what effects what and where and how. You need to be secure w/lab interpretations and how labs can affect rhythms and dynamics. Same thing with fluids and electrolytes.

    You need to be a zip at ABG interpretation. And like anything else, the more you work with it, the better you become.

    This guy has a decent site for new nurses in the ICU.

    http://www.icufaqs.org/

    http://www.icufaqs.org/

    Of course it's adult ICU information.

    When you move into dealing with a lot of different types of direct post-op/SICU patients, you have to throw a lot of other stuff into your knowledge base, b/c the management can be very different.

    Same thing goes with PICU and NICU. A good understanding of basic critical is good for these areas as well, but management is much more specialized with the kids. Certain things are monitored and approaches to treatment can be quite different.

    In fact, if there is a pediatric hospital, see if they are hiring nurses on their step down or ICU/s. Usually it's more of a "mother, may I approach" b/c you are dealing with kids, and they don't give you a lot of room for error. Thus, for most of these children's hospitals, orientation/precepting is usually 12 full weeks, and you usually aren't thrown right into the fire. It's a liability thing. Good for newer nurses, but for adult ICU nurses, it can be an adjustment; b/c you become used to working more autonomously. But if you are interested in taking care of critically ill babies and children, you easily accept the change, b/c there's like zero lead time for crumping with babies and kids. Adults you can mark a downward trend earlier on in many cases.

    But what I am trying to say is in most children's hospitals I've worked or been in, they don't throw new nurses to the wolves. They may watch every tiny thing you do and be on your back, that's the nature of critical care areas; but most aren't going let a kid get into trouble for a second. Now I do think if you have experience in critical care, you can get dumped on, even in a children's hospital, but the fear factor is a bit greater in terms of liability. Just MHO>
    samadams, thanks for the valuable info! I'm preparing to be in the PICU soon-will be pouring over the info!!!

    OP, If you return to the ICU, I hope you return comfortable. I think you have a lot of valuable information from the posters. Advocate for yourself. Express that you still need support in the CC arena, if they are willing to help give you ideas on remembering hemodynamics, etc.

    Also, ask yourself if this is for you. If you were comfortable on a step-down unit, maybe you can stay there before moving into the ICU...either way, good luck.
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    I have been a nurse for decades and I still work with people who ask "what time was he admitted....what time did this or that happen....."when the patient has already been there for days and they have had the patient and know him. Other nurses will say "what's new" and when you answer "nothing" they say "ok". So who cares what time something happened four days ago? People who think they are better nurses if they bury you in minutiae. They give reprt the same way. Inspite if the fact that you have just been read an overview by the charge nurse they want to reread it to you and go over the entire mar with you and discuss every morsel of food they may have eaten. I'm not sure if they want to try to impress you with how thorough they are compared to you or if they just want to run up a lot of overtime. If most people are satisfied with your reports you have to start thinking its not me, it's them! One poster gave good links to reprt sheets but for some folks it will never be enough because they'd rather TALK about the patient than actually take care of the patient.


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