New Grad in ICU feeling terrible...,

[janelicurn]

I just began a job in the MICU in a large teaching hospital as a new grad 7 weeks ago. My orientation is 12 weeks long, which includes 7 weeks of working 2 days a week with preceptor and doing ecco course 1 day, 5 weeks doing three day weeks with preceptor. During my interview, the management was pretty hesitant about letting a new grad work in their unit. I left the interview feeling like there was no way I would get the job, but then I did! I feel so lucky to be in my dream position right out of school, but although I feel like I am a "cream of the crop" new grad (I graduated first in my class w/ BSN, did an externship in a level 1 trauma center ED, etc), I am still A NEW GRAD.

Long story short, I alternate between 4 preceptors (which is a problem in itself) and one of them really thinks its unacceptable that they must teach me "basic nursing" rather then only the critical care component. I was told all along in school, you really learn how to be a nurse in your first job in a new grad program. Well, my program wasn't designed for new grads, it is the same program "New to the ICU" nurses go through (that's what all my documents state--new to the icu RN).

Regardless, I am meeting the minimum goals for each week. I am, however, still slower then most nurses at many things. I am still learning to organize and time manage. I feel like they don't understand that my 6 month externship does not bring me up to the same starting level as an RN who worked years in tele or medsurg.

I am just wondering, are there expectations of me unrealistic?

Is a new grad RN supposed to be learning basic nursing things (by this I mean becoming comfortable with giving report, talking to doctors, organizing your day)?

If I am the one who is wrong, I would like to know, because in that case maybe I am truly NOT ready for icu yet...

[CCRNDiva, BSN, RN]

You've made some good points but not all ICUs are created alike. I can't tell you how many times our director has proclaimed the acquisition of an "experienced ICU RN" only to find that their ICU experience is not equivalent to ours, but that may be because we tend to get the sickest of the sick in our unit and we are a level II trauma center.

I still think it depends on the person but we can agree to disagree

[msboss331]

I am having a similar experience. I am a new grad who signed on for 22 week orientation.Which was supposed to be 50/50 day/nights. I have been on nights exclusively for 6 months. I have had more than a dozen preceptors all teaching me something but many methods are contradictory to the so called hospital policy. (I have brought this to mgmt attention).I came in with 4 other individuals. Since my 3rd week I have been called into a 2-4 hour impromptu management meeting weekly.Usually after I have completed my 12 hour shift. I have asked and none of the other 3 new grads have been approached about their progress. We have progress worksheets due weekly but apparently mine is the only one requiring attention. The first meeting I was told that "I act like a know it all." The second meeting I was told that "I am quiet and unapproachable" So by the third meeting I made it known that I felt like I was being singled out. The fourth meeting I was given a write up to sign stating my 5th preceptor felt I was "unteachable" although she never said anything to me and completed our time together. I work in a pediatric ICU. Take in mind my patients and their families have bragged to my charge nurse and preceptors of my bedside manner and how they love me. I recently had a medication error that was due to my preceptor instructing me to administer a PRN medication and it was noted/discussed as such. I got wrote up for that also. Most recent impromptu meeting (because I never know in advance that I have to stay over) was this past week and I was instructed that two weeks will be added to my orientation "because I haven't been offered a good experience" according to my manager. So at this point I am feeling hopeless. I don't want to think that this is a racial issue but I have no other explanation for the hazing. I love what I do and take pride in my work.

[NewToICU_17]

Hi msboss331, I can relate to your feelings! I'm a new grad in a SICU. I've been on orientation for 16 weeks, night shift. I've rotated through about 7 different preceptors throughout my time. This is supposed to be my last week of orientation. Though, now I'm worried if they'll keep me on.

I met with my Nurse Manager, Assistant Nurse Manager, and Clinical Educator on the morning of 1/11/16. I felt so good about finally completing all of my requirements for a new admit without hesitation or missing anything - all 20 minutes before shift change (my charge nurse did the past medical hx, they almost always do on my unit). Anyhow, I'm thinking I'm in that office for a check-up meeting to make sure I'm ready to come off of orientation. Nope. I'm made aware that some of the staff basically think I'm cocky and a know-it-all. My managers want me to be successful and so they gave me this heads up and suggested communication tips so I can basically please those around me at work.

THAT NIGHT A.K.A. THE VERY NEXT SHIFT I forget to put in a physicians order to change Q4 hour PRN breathing txs to Q4 hour SCH breathing txs. I was 4 hours late in entering it because I wrote it on the nearest paper, went to do pt care real quick, and then forgot until my chart checks. My own error, yes. I'm most likely going to get written up for it (incident report in my file). I feel so embarrassed and worried. The pt was fine, no harm occurred. Just so you know your experience and feelings are shared!

[PMFB-RN, RN]

NewToICU_17 said:

Hi msboss331, I can relate to your feelings! I'm a new grad in a SICU. I've been on orientation for 16 weeks, night shift. I've rotated through about 7 different preceptors throughout my time. This is supposed to be my last week of orientation. Though, now I'm worried if they'll keep me on.

I met with my Nurse Manager, Assistant Nurse Manager, and Clinical Educator on the morning of 1/11/16. I felt so good about finally completing all of my requirements for a new admit without hesitation or missing anything - all 20 minutes before shift change (my charge nurse did the past medical hx, they almost always do on my unit). Anyhow, I'm thinking I'm in that office for a check-up meeting to make sure I'm ready to come off of orientation. Nope. I'm made aware that some of the staff basically think I'm cocky and a know-it-all. My managers want me to be successful and so they gave me this heads up and suggested communication tips so I can basically please those around me at work.

THAT NIGHT A.K.A. THE VERY NEXT SHIFT I forget to put in a physicians order to change Q4 hour PRN breathing txs to Q4 hour SCH breathing txs. I was 4 hours late in entering it because I wrote it on the nearest paper, went to do pt care real quick, and then forgot until my chart checks. My own error, yes. I'm most likely going to get written up for it (incident report in my file). I feel so embarrassed and worried. The pt was fine, no harm occurred. Just so you know your experience and feelings are shared!

WOW!, talk about being thrown under a bus!

[msboss331]

I am so sorry that you are going through a similar experience. After I completed my extended orientation I was called into a meeting to suggest that I stay on days with a new preceptor for two additional weeks. At this point I was way past annoyed.I felt comfortable in my ability to safely take care of my pts and will never know everything but its time to fly solo. i have been on my own since Thanksgiving and still feel nervous with every shift. My experience as a new nurse has made me disgruntle with my facility. What I once felt was an opportunity for me to live my dream career until retirement has turned into getting 1 years experience and looking for alternate employment. This whole experience has made me wonder why I even wanted to be a nurse. I still enjoy the rewards of helping/healing my patients but I am not sure that I want to continue at the bedside.

[VANurse2010]

PMFB-RN said:

I am a big believe in training new grads to be ICU nurses. Doing so has been proven safe and very effective. Some hospitals prefer new grads for ICU nurses. For example in one hospital where I work they will not even hire med-surge nurses into ICU. There are only two paths into the ICU. Either through the nurse residency program, or be hired as an experienced ICU nurse. I see this happening more and more among the more progressive hospitals. However there needs to be a special program in place for that.

I went from nursing school directly into a large trauma/surgical ICU. However I went through a 9 month nurse residency program specifically designed for new grads.

I've seen too many new grads make mistakes and too many floor nurses do well in the to ever believe such a mindset is appropriate.

[OhioCCRN, MSN, NP]

Some new grads sink, some swim

I think it depends on the acuity of the ICU

my SICU has a very high acuity and medsurg nurses tend to do better because they are familiar with their practice and the learning curve is a lot lower

[kadyijal]

Hello,

Could you please share the ICU worksheet with me? Thank you!

[Raven Sierra, BSN, RN]

ProgressiveActivist, thanks for the worksheet! It's awesome.

[TiffanyRoseRN]

I would like the worksheet also if anybody has it.

[ilovebo]

Wow my orientation as a new Grad is only 10 weeks

[armyicurn]

ProgressiveActivist said:

The reason that most nurses don't want to orient is that we have taken new nurses under our wing, helped them develop skills and confidence - and then had them stab us in the back. I guess that is just the nature of the business. I am very jaded when it comes to mentoring or precepting because I have given 100% and then been treated like crap once the new grad can function independently. It sucked and I will never ever do it again.

Been there too... Kudos for sharing part of your CCTK-critical care toolkit.