New ICU nurse wants some kind words

  1. So I just started at a new Lev 1 teaching hospital in the MICU. I have previous 1 year experience at a sub med/surg level. They take in new grads so they were willing to take me on and train me. I'm paired with a 20+ year veteran who has suggested several times that maybe ICU isn't for me, which is terribly discouraging. Although I've had some easy patients, on shift #4 the preceptor chose a patient with:

    had previously coded
    hemodynamically unstable, BP would crash just from being turned
    3 pressors
    insulin drip
    multiple antibiotics and vitamin infusions
    Art line ABP monitoring
    CVP monitoring
    bladder pressure monitoring
    pt was up 10+L of fluid in the past 24 hours

    An alarm or something needed changed about every 10 minutes (or more) for the entire shift.

    Meanwhile, I'm still trying to learn simple things like assessment and charting, different supplies vs my last hospital, where things are located on the floor, the paging system.

    I felt it was pretty rough to say I needed more initiative, that I needed to handle a steeper learning curve to start my 2nd week on the floor. I'm expected to have 8-12 weeks orientation so why the pressure so early?
  2. 7 Comments

  3. by   smf0903
    While it may seem like sucky assignments to get the worst in the unit, it's what you want during orientation. Take the worst while you have a preceptor because you have a preceptor

    The charting and the other "everyday" stuff will it overwhelming? Yes. BUT your preceptor is really doing you a great service by giving you the most unstable patients. It may not seem like it while you're in the throes of it, but you will appreciate it when you're on your own.

    Just keep plugging along!! Maybe your preceptor thinks that telling you that will light a fire under you, maybe that's how they learned, maybe they're just a crusty ol' bat...whatever the case just make the most you can out of your orientation time and try your best to get some specifics from your preceptor as to what you need to improve on.

    Good luck to you!!!
  4. by   bclark297
    Was this your only patient???

    But yeah, sounds like a average ICU patient to me. You've already been a nurse for a year so you just need to fine tune your time management. You'll be caring for this acuity of patient when you're off orientation, maybe two!!
  5. by   outdoorsRN96
    I can't pretend to have all the answers or a ton of experience. I'm just a fellow new grad (May) who started my first hospital job in a 20 bed combined med/surg/neuro/trauma ICU at the end of July. I like the nuts and bolts of things, I love to dig in depth into patho and etiology, and I thought that critical care would fit me.

    For sure, it is a steep learning curve going into the ICU as a new grad, one that I recognize I am just at the start of. We have an amazing critical care nurse educator and my organization put me through critical care specific new grad classes that really helped.

    I will say this: no one can decide for you if the ICU is where you should or should not be, only you can make that determination. If you are enjoying your work, determined to do the best you can for your patients, and are willing to spend free time, both on, and off shift, researching and educating yourself further in critical care nursing, than there is no reason you can't make it work.

    I wasn't planning on starting in critical care, I actually thought I had a cardiovascular progressive care/tele job lined up, but wound up accepting a new grad program here in Colorado. It's intimidating for sure, but that's a good thing: it means you care. I got a little over 12 weeks orientation, take all the precepting your organization is willing to give you.

    It sounds like you are with a nurse who is a wealth of knowledge. I know that not all nurses are warm and welcoming, and it doesn't sound like the criticism you are receiving is really fair, but everyone has their own way of motivating and approaching teaching. I would go into each shift with an open mind, prepared as possible, and ask questions non-stop. If it turns out your preceptor truly has a teaching style and or attitude that is hindering your learning and won't budge to fit your learning needs, I would respectfully ask to orient with someone who may be more compatible.

    Like someone else mentioned, having the sickest patients on the unit sometimes during orientation is really a blessing. You have a preceptor for a reason: they are there to take the lead when you are over your head, answer your questions, provide back-up, and help you to learn. That's the best possible time to have those patients.

    Just know that if you are determined, you can make it work. And truly, you are not alone. I know I don't have all the knowledge I need to have to be a fully competent ICU nurse, but I like to think that if you know when to seek out help and advice from your fellow nurses/charge, RTs, know when to call your physicians, and are dedicated to advocating for your patient and improving every day, then you are making a positive impact and well on the way to becoming a rock star nurse.

    Hopefully the ICU you work in has a very team oriented culture. When your fellow nurses are all hands on deck for a new admit or crashing patient, always ready to help you out, offer wisdom, and reassure you, then both the patients, and you as a newer nurse, will benefit immensely and have the best possible outcome. At least that's been my experience.

    Take a deep breath and try to learn every day and enjoy what you are doing. As a fellow new grad along for the wild ride, know you're not alone in how you feel. I think if we approach each day with the commitment to better ourselves as nurses, work as a team, and advocate for our patients, everything will turn out alright.
  6. by   LiveFit99
    My unit gets the sickest patients in the entire state. Of course I want to work with them while on orientation. However, I question if it was appropriate to have one of the sickest patients on my 4th shift! What about starting with more stable patients to learn the basics and become familiar with equipment and procedure? Instead, I had a crashing patient while being yelled orders across the room to work equipment I didn't know how to use, then belittled for not performing well. I don't feel that's a good learning environment.

    I've since changed preceptors and have had some shifts with more stable patients where I can go at a slower pace that allows me to learn along the way.
  7. by   jdub6
    For me personally, i can attend teaching sessions, read policies and manuals and talk through use of equipment and certain procedures, but the only way i actually get comfortable is to actually do it in real life. If there are certain procedures or pieces of equipment that aren't used that often in your unit it can be difficult to make sure staff has enough exposure to be competant, without them having to learn in a high stakes situation. it sounds like that patient was complex and this was a great opportunity for you to get your hands dirty with a lot of different skills while on orientation. since its early in your orientation, you have time ahead of you to seek out practice with the things you had the most trouble using.

    Having oriented to several critical areas, my feeling is that the best way to learn is to not run away when you're uncomfortable. Keep doing it until you ARE comfortable. Even once fully oriented there will be situations that scare you silly-but if you avoid them you won't ever get more confidence.

    BUT...its important that through this process your preceptor is there to both ensure patient safety and also to encourage you/provide constructive feedback/help you feel comfortable. A preceptor who lets you sink or swim but is there with a lifeboat and words of encouragement can be helpful; the same assignment with a preceptor who stands back without helping while rolling her eyes at you and badmouthing you you other staff is not so helpful.

    Generally I'd say to look at these challenging assignments as chances to learn and as signs that your preceptor and the unit think you can hack it and want to invest in your learning. if the pulse is plummeting and the doc is shouting to turn the pacer on at rate of x and energy of y and you simply can't do it then it's your turn to call out for help- "Jane, I don't know how to set the rate, please show me." If no one is around/able to help, that's a problem. In that case i would go to your educator and discuss exactly what happened-at which points did you not know what to do and have no backup? Then go through those procedures and learn them and also find out what the plan is to ensure that in the future, you will always have someone there who can step in and do what's needed if you're over your head.

    As long as the patient gets what they need, I would advise you to keep accepting challenging assignments. If you feel embarrassed about learning in these situations remember that good/experienced staff were all new once, too, and the best clinicians are those who allow others to learn and improve. OTOH if there are 3 nurses, 2 interns and 5 students in the room all "learning" from just 1 doc who knows what to do, that needs to be discussed with your educator too-everyone needs to learn but not all at the same time.
  8. by   nugspugsanddrugs
    On my third shift in icu while I was precepting, I had a patient that had coded the shift before, on rotoprone, crrt, 3 pressers, and an epi drip. At the time it was super overwhelming and my preceptor wouldn't let me touch anything. Looking back I understand why she wouldn't let me touch anything as it was my third shift in icu, but she wanted me to at least see it because we don't always get those kinds of patients (I work in sicu). While I'm sure in micu those patients are more common, the point of orientation is to expose you to as much as possible while you have someone there to guide you. As you get more and more of those patients you'll become much more comfortable caring for them.
  9. by   brap740
    Give it Time, you'll find that the sicker they are the easier they are to take care of......

    If you're second week, just stay in it until your boss says you're not a good fit. But stay in contact with your boss and educators.preceptors can't read minds. If you show you really want to be there you'll do fine.

    and I don't agree with watch and learn precepting. You gotta let the new hire do the work. Push the buttons. Program the pumps. Logon to the computer, walk to get supplies.

    Too often i see "oh I'll get that for you. Oh I'll get another MED from the Pyxis, oh I'll get a pressure bag. Oh I'll....". NO-if this happening to you stop your preceptor and say "please guide me but let get the hands on."