Tomorrow is my first day off of orientation.... nervous!

[TigerGalLE, BSN, RN]

Back in February I transferred from my medsurg floor to ICU. I worked medsurg for 3 years and I was very ready for a change. I absolutely love ICU. I feel so much better when I leave work everyday. I actually have the feeling that I accomplished something and I feel my patient received all the care they deserved. I had a 12 week orientation that I feel was sufficient. I took care of some sick patients and some not so sick patients. I didn't get to see everything there is to see but I know that isn't always possible during orientation. I wish I had more experience with pressors but that just comes with time I'm sure.

I was originally supposed to work 3rd shift but my director came to me about mid way through orientation and offered me a first shift position. I have always worked 1st shift and of course I took it. I hope I made the right decision. 1st shift is busier with more procedures and field trips. I hope I'm not in over my head. I am nervous about going on field trips with my patients. I'm afraid I won't know what to do if my patient codes on the elevator or in CT or something. I don't get my ACLS until July.

Tomorrow is my first shift off orientation. I'm nervous and i had nightmares last night. I dreamed our monitors were down and I had to do manual BP checks every 15 minutes on both of my patients. I also dreamed my 2 patients were on opposite sides of the unit and I had to run back and forth all shift. It was a very hectic dream and I awoke exhausted.

I know the dreams are stemming from stress. I used to have nightmares as a new grad. I guess I just need some words of encouragement!

Thanks for listening!

Tiger

[CT Pixie, BSN, RN]

Congrats on the new transfer. I'm sure you'll be fine. It's jus nerves getting the better of you.

Wish you the best!

[netglow, ASN, RN]

Tiger, my pal :hug:,

I can give little advice to you except from when I did my preceptorship in ICU. For me, first shift meant that I'd be in interdisciplinary report, which was formal with one nurse at a time presenting to all MDs/PA/NPs and management in a conference room. This took me a little time to prep for because I wanted to be able to fully present and be prepared to answer questions (cheat sheet needed). And you do see doc after doc... many procedures were done in room in this ICU. But I also got a little weak in the knees about field trips as a student even if with an RN! Seemed like a good idea to bring pain meds/syringes, pads... etc extra junk you just might need in a large ziplock baggy. What's weird about in-room procedures is that it sometimes feels like someone just showed up and ripped out the carpet in your house, and you had the wrong day written down on your calendar!

I'm sending you a PM.

[getoverit, BSN, RN, EMT-P]

Yeah, congrats on finishing your orientation! You'll get the hang of all the things you're nervous about now. And the dream of having patients on opposite sides of the unit is probably a prediction of things to come....it ain't no fun when they're both going downhill. But you can do it.

Last night my patient was intubated and went into flash pulmonary edema. His hr 130s in bigeminy, bp 215/120, fio2 .70 and his sats were in the low 80s. Gave mso4, lasix, started a ntg gtt, increased his sedation a bit, got abgs/pcxr, etc. The patient started to improve by the time I called the MD, he basically said "If you think of anything else, do it."

That whole ordeal took about 3 hours. When I sat down to chart, my RRT pager went off. On the surgical step-down, a patient 1 day post-op from a TKA was found diaphoretic, tachycardic, unable to speak and marked R side hemiparesis. Checked all labs, EKG, etc thinking the guy was having a CVA....his troponin came back 23+. His 12 lead just showed depression in II, III aVF. I thought he was probably having a posterior infarct. R sided 12 lead confirmed it. We got him squared away, started AMI protocol, took him for a head CT and back down to the unit.

Things like this happen, not all the time but everyonce in awhile you'll find yourself in the middle of it. That's a big part of what being a CCRN means to me. and my co-workers covered my patient (who was stable by then) and gave my charge nurse report for me when the day shift came in. Everyone pitching together is what it's ALL about.

Wish you the best of luck and remember how you feel now when another nurse is feeling the same way.

[TigerGalLE, BSN, RN]

Thank you for your words of encouragement. I had a good day today. Transferred a s/p craniotomy patient out to the floor. My other patient was pretty stable, I had to take her to CT scan which went fine, thank goodness. I'm glad my first field trip alone was with a stable patient. Boosted my confidence some.

I was actually bored today, which I'm not complaining. I'm sure I'll have my days where I am FAR from bored.

Oh and we do interdisciplinary rounds at the bedside. Which seems much less intimidating than doing it in the conference room. I'm used to these by now and I don't mind them too much.

Thanks again guys. It is nice to know I'm not alone in this world :)

My coworkers were great too!

[tri-rn]

Hi Tiger, like you, I was hired for third and offered a first shift position before I was off orientation. Day shift IS more hectic for sure, but one nice thing about it is that the docs are a lot easier to get hold of if things start to head south.

You've got 3 years of med-surg under your belt, I'm sure that will be a huge help. I came straight into ICU as a new grad, and while I wouldn't call it a mistake exactly, I have plenty of days where I wish I'd had some floor experience first.

Hang in there!

Oh, and I STILL hate road trips :)