I think I'm in over my head :/

  1. 0 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!!
    Last edit by Joe V on Dec 5, '12 : Reason: spacing
  2. Visit  CrystRN33 profile page

    About CrystRN33

    Joined Dec '12; Posts: 1.

    15 Comments so far...

  3. Visit  WorkEatSleepRepeat profile page
    0
    I get somewhat intimidated too, when giving report. Granted I've only been at this whole nursing thing for about 5 weeks in terms of real-world experience. It depends on the charge nurse, too. I've had some rough experiences with one particular charge nurse and I dread giving report to that particular person, but I won't elaborate. I'm pretty sure that has a lot to do with it, because when I get pulled to other floors and have to give report, it goes much more smoothly. Some people will actively try to point out things that you're leaving out and perhaps it's a good thing if they are focused on the patient and trying to get you to give better reports in the future. Yet, if it comes off as them always trying to find the slightest flaw in your report, it's quite annoying, and possibly detrimental to your improvement.

    Several nights I've left dayshift and had to call-in and mention some things to the night shift nurse, which I forgot to mention during report.
  4. Visit  WorkEatSleepRepeat profile page
    0
    I try to squeeze in at least 15 minutes during the day to look over my patient's Kardex summary and write in any patient situation that has changed during my shift. Sometimes I have to do it during a break. But I can tell a huge difference in my reports if I manage to get those 15 minutes to look over their info, versus those busy days when you look up and the next-shift nurses are already clocking in. (Crap!)
  5. Visit  turnforthenurseRN profile page
    0
    When I first started (and even as a student) I always got so nervous when giving report. I'm not sure why. Now I don't, even if I don't even know the nurse accepting my assignment. It gets better with time. Try to take some time to look over your patient's kardex (or unit equivalent) and look at the MD's progress notes. There will be some days where you just won't have time to do that, however. When I give report, I tell the oncoming nurse about why the patient is here (admitting diagnosis), a very brief summary leading up to admission then what happened on my shift (along with other pertinent information like the patient's history, code status, O2, cardiac rhythm, etc etc etc). When I am finished, I ask the oncoming nurse if I forgot anything or if they have any questions for me. That is so that both of us know everything was covered.
  6. Visit  umcRN profile page
    6
    It doesn't sound like you're getting a very good "welcome to the ICU" experience. In my unit when new grads start the first shift or two is just shadowing me, learning where things are, learning some of the resources. Then we start with basic assessments on stable patients, we do them together, we talk about them, then we chart together, go through the computer charting system. It starts out the first week with the preceptor doing 100% of the work and each week the orientee gradually picks up a little more of the workload and at the same time the acuity slowly increases. Obviously the preceptor might go back to doing more work when the pair has their first open chest together or something like that but its a 6 month orientation and by the end the orientee should be doing 100% of the work with their preceptor sitting on their hands in a corner somewhere. Our orientation program is very standardized with weekly goal sheets of what things should be accomplished, what things the orientee should be focusing on etc. We also have classroom sessions for our new grads on top of clinical time.
    ASpe63464, gemigarden, Barley, and 3 others like this.
  7. Visit  Esme12 profile page
    5
    Welcome to AN! The largest online nursing community!!

    You need some good brain sheets......here are a few. Don't let them intimidate you....a good ICU nurse is willing to share her knowledge...the one who intimidates is afraid they'll be found out that they actually don't know very much at all.

    mtpmedsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient
    gemigarden, dgraham, SRNA4U, and 2 others like this.
  8. Visit  1busymaniam profile page
    1
    Hello CrystRN,
    You should not be taking vent patient at this stage of your career without a proper orientation. Ok, you can do this! People ask me how I can take care of patients that can't talk or are sedated. That is easier than taking care of patients that can talk. I don't care if it is a newborn or someone on a vent. I prefer to work from an xray or lab or ekg or something like a monitor, vital signs. Verbal patients can confuse the POC. Parents or family input/history get in the way at times. As always I suggest to new nurses to watch youtube.com videos.
    Good luck............. 1busymaniam@excite.com
    x4livin likes this.
  9. Visit  krazylady profile page
    1
    Sorry to hear about your experience. I am a new-grad too. I started my job in June, with a 1-month general hospital orientation. Then I spent about 3 weeks on ICU shadowing my preceptor, learning where and what things were. After that, I spent a month on med-surg to hone my assessment skills, get the computer system down, etc (with a great preceptor, starting with 1 pt and working up to 4).

    I am now back in the ICU. I have taken a 3-day arrhythmia class and am now taking a once a week critical care nursing class (that will last about 20 weeks). After 4-1/2 months at the hospital, I was off orientation for telemetry patients, but still working with a preceptor at least 2x a week with ICU patients.

    Now, 6 months into the job, I feel so much more confident. I don't understand why they would throw you with a vent pt your first day. I probably would have run away and never returned. I have an excellent preceptor. She doesn't hover, she tells me when I made a mistake or need to do something different, and she offers encouragement after particularly bad days. She does not sugarcoat or handhold. I also have an amazing manager, who still loves to be at the bedside and I have learned so much from him. I am actually taking care of vent patients now, along with A-lines, all kinds of drips and drops, etc. Last week, I went on a CAT call, assisted with intubation and assisted with putting in an A-line.

    You can do this, but you need more support. I hope you come back with a better preceptor. Good luck!
    gemigarden likes this.
  10. Visit  poppycat profile page
    1
    umcRN,That is exactly how an ICU orientation should be done. You cannot throw a new grad into a full patient load the first day they're in ICU. I can't believe the educators think this is a good idea.
    umcRN likes this.
  11. Visit  x4livin profile page
    0
    Only you can answer that. Ask yourself these questions, then be ok with your answers. How much do you want it? Do you want it now? Which do you value more? Is it ok to stay where you are? Achieving that goal, or having calm peace of mind and confidence?

    You should be allowed to work with someone else who is giving report for a few shifts. It is the mood of the place and of the day and depends on the patient, as to how much info is necessary.
    My format:
    Name age/sex doctor(s), diagnosis, current history and response to treatment, past history, airway/o2/vent settings(size, depth, mode(assist control) tidal volume rate peep whether there is pressure support, toerance), lungs, belly, urinary, extremities, skin(include all drains or monitors and current results eg sinus rhythm, 96%) IV's, drip rates, devices(vigaleo, foley temp probe, co2 monitor, CRRT, auquaphoresis, balloon pump, passwords, family issues visit times etc, and any orders or meds that I kow of that oncoming needs to note and complete in the first half hour or so(when they might miss it because they are not yet aware..eg med due at 0730)
  12. Visit  johnnybravo8802 profile page
    1
    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.
  13. Visit  samadams8 profile page
    0
    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
  14. Visit  samadams8 profile page
    0
    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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