Should I Quit Now?

[NewTexasRN]

First, let me say that my respect for you ICU nurses have grown! It sounds kind of strange to start of a thread like that but after being on orientation for 4 weeks it's been overwhelming and awesome at the same time. Some days I have to admit that I honestly feel stupid. I basically went wrong when I chose orthopedics. I didn't realize that specializing in orthopedics would make the transition into critical care so difficult for me. Even though I have made some improvements, my orientation has been like trying to reverse all my bad habits and way of thinking. Even the basics are challenging to me. My focus wasn't about reading rhythms, vents, trachs, interpreting ABG's and so forth. Now, I'm in a place where I'm thinking about quitting. I respect my preceptor and all the knowledge that she has, but she constantly tells me what I am doing wrong all day long and I don't feel as if I'm improving.

My question is, was the transition difficult for anyone who decided to switch from a different specialty to ICU? We basically get 3 months to orient on the unit and I honestly feel that if my preceptor wasn't there, I would struggle just stay afloat. I've just started to get used to dealing with one pt. I can't imagine what I would do if I have 3 pts on drips. I see even the experienced nurses struggling with being trippled! My question is, I have two months of orientation to go, should I just quit now instead wasting everyone's time. It would have helped to take the critical care course, but I'm scheduled to take it January of next year. In addition, I do study when I'm off. I try to look the pt's diagnosis, calculations, labs etc.

[detroitdano]

How you can even function on the unit without a proper orientation is beyond me. You should quit and go to a hospital than isn't bass ackwards. You can't be expected to know things you've never formally learned. I can imagine orientation being stressful and a daily struggle if I learned everything on the fly with no formal exams/practicals/etc.

That's like being in nursing school and going to clinical and giving out meds when you've never had pharmacology. Come to think of it, it IS the same, except this time it's on your license. You're expected to titrate drips, push meds and are seeing them for the first time? That's unsafe as can be.

Get out while you can. And FWIW, 3:1 is not the norm everywhere. We are max 2:1.

Find yourself a better gig.

[NewTexasRN]

I really appreciate your support. Honestly, it's been more like torture. My preceptor doesn't explain things. For example, We got a pt diagnosed with DKA. She stared talking about anion gap and the disease process. Honestly, every time I go there I feel more and more discouraged. You are so right. Thank God someone understands what I'm going through. Sometimes I like feel as if my preceptor wants me to quit. All day long she is basically like "You need to stay in the room. You can seem to focus on anything. You need to do this and that..." She printed a rhythm strip and told me to interpret it, very well knowing that I haven't taken the EKG class yet. It's more like a degrading experience to tell the truth. I have told my friends about standing up to her, but I'm just tired of fighting. I have thought of just leaving the profession all together. I don't want to keep fighting with people all day. Again, thank you so very much for you encouragement. At least I don't feel crazy anymore.

[Good Morning, Gil]

I'm new to the ICU, as well, with pretty limited nursing experience. I just started on orientation, have learned a lot, but have a lot yet to learn. It sounds like you are doing everything you can, studying on your own time, etc. What I have noticed in my limited time in the ICU is that it really is just trial under fire. Preceptors don't always have time to explain things to you because it is just so busy, so you just learn as you go, and if there's time to ask questions, ask. Of course, when it comes to patient safety questions, drugs/dosing, etc, etc, I always ask if I am unsure. But the "just for your knowledge" questions, like why did they order this pressor instead of that one? you may not get to ask until the end of your shift (or not at all). If that's the case, google when you get home or write your questions down for next shift (if there's time to ask then lol). I know confrontation stinks, but if you are feeling as though you are not improving, then talk to your preceptor. Ask them what you could do to improve and explain how you feel...explain that you're open to criticism and that you want to be a great ICU nurse, etc, etc. If there is a certain topic you don't understand, try to read about it and then ask your preceptor if maybe they could get you assigned that patient next shift (like one with multiple titrations or a pre-op, etc). Keep your chin up! They hired you because they want you to be there...remember that! And...3 patients?....that sounds like a lot to me. We always have 2.

[suanna]

12 weeks orientation and you have given it 4? I'd stick it out a couple more weeks if it were me. Getting the basics down and arriving at the point when you can start setting priorities, troubleshooting a differential, making educated decisions about the direction your patient is taking- that is when it gets fun. I know you had some of this in school- however long ago it was- you just need to refresh and update. What you need to decide is if this is something you want to do for a career. If the stress factor is greater than the fun factor- maybe ICU isn't for you, but I don't think you can decide that after only 4 weeks. Even if you don't complete orientation- ther are other options. A stepdown unit to hone your asic skills, Tele unit to strengthen you rhythm interpritation, ER to get used to thinking on you feet and making decisions on the fly. ICU involves a lot of different skills you can develop in less demanding areas.

[Good Morning, Gil]

Oh, and I forgot to mention icufaqs.org. This site is awesome because it is written for a new ICU nurse (and new nurse in general). It gives "real life" explanations for certain drugs and teaches you about things that you will encounter (that you have never used before if you didn't work in an ICU). Vents, pressors, labs, arrhythmias, etc are all on there. It has helped me. I know you said you haven't taken the official course yet, but I would still study the arrhythmias. You'll feel much more confident walking into your shift knowing that you're armed with knowledge, so to speak. What I do, for instance, is focus on one thing at a time outside of my shift. Like, maybe I will spend a few hours on my day off studying hemodynamics, study that again, and then study pressors, etc. And, then jump to respiratory, vents, etc once I have a better understanding of that system as it relates to ICU equipment, etc. But, what works for me may not work for you. Like the other person said, it's a huge learning curve, and be patient with yourself (I know...easier said than done). There's many new ICU nurses learning with you....you're not alone! :)

[NewTexasRN]

Thank you for your encouragement. This really means a lot to me.

[Freedomsong, NP]

That's right, you're not alone. I'm a new nurse in ICU and I just came off orientation 3 weeks ago! I just study at home and try to do my best during my shifts, it's difficult starting out but self motivation and team support does help this huge learning process. I wish you the best :)

[nyrn5125]

you should speak to the manager to get out now. if you haven't taken an ekg class and read strips then you should not be in the ICU yet. and the critical care class is supposed to be given before you start working in critical care. sorry that they are running things so poorly but you should speak up and demand those classes or get out

[ICU-RN<3]

Hi NewTexasRN,

I am on week 12 of my 12-week orientation and I still feel like there are so many things to learn... But I can tell you it gets better after the EKG and Critical Care Course - especially the latter that allowed me to really "connect the dots". However, it's one thing to have the knowledge, it's another to apply it at bedside... People have told me that it takes about a year to feel better about things. I was also told that ICU experience opens doors to many opportunities, so it may be worth it to give it a little more time :)

[mamsrn]

I absolutely agree that you should have had introduction to critical care class and add additional classes as your orientation progresses.

There appears to be a mismatch with your preceptor. Investigate if a different preceptor is available(I know, you don't want to step on toes-but you need a supportive preceptor) Is it possible that the sensory overload that your experiencing is sensitizing you and when instruction given, it feels as your being scolded? If you haven't, purchase pocket book guides on critical care to guide you. The American assoc. of critical care has many references and apps that you can purchase. I'm an experienced critical care nurse and I always carry my palm pilot to research new meds, check on interactions, obtain information on critical care(sepsis bundles), etc.. Many of the companies that produce the equipment you use have education on their web sites.

When you enter a patient's room utilize ABC+Ds: airwary,breathing, circulation and drugs(IV fluids, IV pressors present) to start with. There are some free online articles/classes that you can take to help yourself build the knowledge you need,but-------You need an interpreter on your side to help you utilize what you are learning. Find out from the staff members which nurses they go to for information/analysis of information. Get somebody to support you.

[NewTexasRN]

Well, the last 2 weeks of my life has been agonizing as far as my decision to leave or stay. In the end, I had a talk with the manager and I made the decision to leave. There were many variables involved. I felt that this particular hospital environment wasn't for me. The nurses seemed stressed all the time and because I'm already burnt out, I don't think I could handle the stress. Only you can know how much stress you can tolerate. It kills me that I have worked to so hard to get there and only to walk away in the end, but I guess that's life. I'm in the process of getting a travel nursing position. I will be where the wind blows. For all the people who gave me advice on here, I would like to say thank you. I also appreciate everything I have learned in that ICU.

Steph