A year and a half into ICU nursing and still not feeling like I'm getting it

Sour Lemon · Feb 18, 2019

I've heard it takes two years to feel OK and seven years to feel competent to handle most things. I've found that to be true for myself.

salexandra · Feb 18, 2019

Thank you, this is more comforting than you’ll know.

Advanced Practice Columnist / Guide · Feb 18, 2019

At a previous job I had, nurses don't even recover fresh open heart surgery patients until they've worked in the CVICU for 6 months. Reach out to your co-workers and ask questions without feeling like you're being judged. I'm sure they know where you're coming from and that your background experience is in something else.

Try to make an effort to be friendly by offering assistance even with just something simple as a turn. Show interest when you hear co-workers talking about patient situations that they are dealing with. You can try to read up on your patient's conditions and care too.

You'll have to be interested in the CVICU population to keep a degree of enthusiasm for this area of ICU nursing so if you don't feel that you have that passion for it, it's not going to work.

verene, MSN · Feb 19, 2019

You may have a year and a half of ICU experience but you have only a little over 5 months experience in this particular job, it's okay to be new and to ask questions! Even if you were coming in with years of experience as new job always has a learning curve.

I've been told repeatedly that it takes about 2 years as a new nurse to fully have your feet under you, and having spent my first 1.5 years in just one setting - I think that is probably true. I know a lot more than I did when I started, and have a lot more confidence, but there are still days I question my competency.

TriciaJ, RN · Feb 19, 2019

On a side note: friendships develop more quickly when you're all new together. When you go into a work place where everyone else has been there awhile, it just takes more time.

They're taking your measure. Do the best job you can do and don't be afraid to ask questions when you're unsure. Even if you have to ask a question you've already asked. It may be annoying to them in the moment, but they'll think a lot better of you than if you try to wing it and then screw up.

We live in an instant gratification world. In reality, feeling confident as a nurse requires more time than you've had so far. Friendships outside of school take longer as well. Hang in there.

Ruby Vee, BSN · Feb 19, 2019

20 hours ago, salexandra said:
I hope this topic helps me, along with other nurses stuck in the middle like myself.
So my background: I graduated nursing school in May 2017. I passed my NCLEX in July '17 and was hired right away onto a SICU at a level I trauma center/teaching hospital. I was miserable the first 4 or so months of my job, as I had very little confidence and had an incredibly patronizing preceptor. I thought I was an idiot and had no business being a nurse, much less an ICU nurse. However, by 6-7 months in, I started to gain some confidence and felt fulfilled through my job. I started on night shift with 6 other new grads, and I found many friendships at this jobs as we always had 8-9 workers at night. However, I was moving to South Carolina to live with my boyfriend I had met in college. I was very sad about leaving this job, but was hopeful for my future. I'd like to think of myself as very easy to get along with and likable.
I accepted a job at a very small hospital- 8 bed general ICU but a day shift position. This job was a nightmare. It was incredibly short staffed, I was floating to the floor (which I had no training on) constantly, and I felt my license was at stake. I also did not feel challenged enough on my nursing and critical thinking skills. This being said, I applied to a larger hospital in the city on a CVICU where I thought I would be a lot happier. It was night shift, but no weekends and I was going to have a higher base pay too. I also thought it would be a way to make new friendships as I hoped their would be other nurses close in age to me there as there weren't at the small hospital.
I started on this unit back in August (maybe 25th?), and right away was very intimidated by it. I quickly realized how completely different a surgical ICU is from a cardiovascular ICU. I had no knowledge about the heart, how to admit an open heart patient, and honestly all of my critical thinking skills were incredibly rusty from being away from the SICU for the past 4 months. My preceptor was very nice, but I began to hear word from other workers that she teaches her new hires basically nothing.
I was fairly content on day shift orienting, but as soon as I flipped to being off orientation onto night shift, my overall feelings completely changed. For one, there are maybe only 4-5 nurses on night shift as we usually only have 5 patients or less. They were never welcoming from the start. I don't mean to speak poorly of them, as they're nice enough, but they just did not go out of their way to befriend me despite my own efforts. As I previously stated, I was used to being surrounded by a bunch of other new grads and a large staff at night at my first job.
Secondly, they all have 2-5 years of CVICU experience, so I struggle a lot to relate to any of them. I constantly fear looking or sounding stupid as my concerns and questions are not ones they can relate to at this point in their nursing careers.
Third, I feel stupid ALL the time on this unit. It has been 6 months, and I feel as though I'm asking questions that the other staff feels I should know the answers to by now. I still struggle with my confidence on this floor greatly- a huge reason being that I learned by relying on paging a resident for every single problem I came across with a patient to now a non-teaching hospital where I have to rely on my own instinct and protocols to make incredibly important decisions.
Lastly, to make matters all the worse during my M-W shifts, I don't see my boyfriend at all. I understand why this may seem like a silly point to make- but I still have no close best friends in the area and he is my entire support system. So, basically, through each work week, we go until Thursday nights without contact except for quick 30 minute phone calls when I'm driving from and he's driving to work in the morning. With little support from my coworkers and little interaction with my best friend, I'm feeling so isolated and depressed at this new job.
Now with my background covered, I suppose my problem and question is has anyone else been past their 1 year mark in their nursing career and still struggled with confidence in their knowledge? I guess I justify it to myself constantly that I feel as though I started over completely in my nursing career when I started on a CVICU. We have to make so many critical decisions I never had to make on my own previously. I also am learning the body in totally different way of thinking, as I said before, knew nothing about the heart. I had felt incredibly confident at my last place of employment, so I just think the unit has something to do with it. I know I wanted to be challenged, but this is just depressing.
I constantly consider applying to a new job or returning to the job I was at before this current one. At least I was miserable with an incredibly supportive staff and saw my boyfriend. However, I am dying to just be somewhere for at least a year and I'd feel like I'm only complicating my critical thinking skills further if I leave after only 6 months at this place. That would be 8 months at one place, 3 months at another, and 6 months here. I should try to stick to something. But then I just think that maybe I am incapable of learning critical thinking and I should just apply for a slower paced job somewhere.
Can anyone out there relate? Please say yes.

I cannot relate. THREE jobs in 15 months? You don't have a year and a half of experience; you have six months or so of experience three times. No wonder you're not getting it. And yet you're thinking of taking a fourth job? No, NO, NO! What you need to do is stay where you are for a year and a half. Then you'll have two years of experience in addition to six months two times.

I'm flummoxed by how you could be in fear of losing your license at the second job, but didn't feel it challenged your critical thinking skills? Any nurse with less than two years of experience who claims that her critical thinking skills are not being challenged just isn't doing it right. There is so much to learn about so many different things -- if you're not challenged, you're not paying attention. So you quit your first job to move with your boyfriend -- it would have been better if you had waited four months and got your year in, but OK. And you quit the second because despite feeling as though you weren't being challenged, you were afraid of losing your license? That just reeks of excuses.

And now you want to quit another job because you're not seeing your boyfriend enough and you don't have any friends????? You chose to move away from your friends and your support system. So suck it up and deal. Make new friends. Find another support system. I know it's hard. Do it anyway.

And another thing -- it is not up to the established employees at your work to go out of their way to befriend you. You said they're nice enough. That's what you get -- that's what workplace relationships are about.

The only thing I think you got right is that you lack confidence. Thank God you lack confidence! You don't have a year and a half of ICU experience. You have about six months of experience three times. Stay in one job and figure out how it works, learn as much as you can and challenge yourself. In another year and a half, hopefully you'll have some confidence -- and a bit of competence to go with it.

salexandra · Feb 19, 2019

1 hour ago, Ruby Vee said:
I cannot relate. THREE jobs in 15 months? You don't have a year and a half of experience; you have six months or so of experience three times. No wonder you're not getting it. And yet you're thinking of taking a fourth job? No, NO, NO! What you need to do is stay where you are for a year and a half. Then you'll have two years of experience in addition to six months two times.
I'm flummoxed by how you could be in fear of losing your license at the second job, but didn't feel it challenged your critical thinking skills? Any nurse with less than two years of experience who claims that her critical thinking skills are not being challenged just isn't doing it right. There is so much to learn about so many different things -- if you're not challenged, you're not paying attention. So you quit your first job to move with your boyfriend -- it would have been better if you had waited four months and got your year in, but OK. And you quit the second because despite feeling as though you weren't being challenged, you were afraid of losing your license? That just reeks of excuses.
And now you want to quit another job because you're not seeing your boyfriend enough and you don't have any friends????? You chose to move away from your friends and your support system. So suck it up and deal. Make new friends. Find another support system. I know it's hard. Do it anyway.
And another thing -- it is not up to the established employees at your work to go out of their way to befriend you. You said they're nice enough. That's what you get -- that's what workplace relationships are about.
The only thing I think you got right is that you lack confidence. Thank God you lack confidence! You don't have a year and a half of ICU experience. You have about six months of experience three times. Stay in one job and figure out how it works, learn as much as you can and challenge yourself. In another year and a half, hopefully you'll have some confidence -- and a bit of competence to go with it.

Your advice is truly revolutionary. YOU are what’s wrong with the way nurses treat one another and I don’t need a lifetime of experience to see that.

It absolutely blows my mind that you chose to get on this post and those are the words you chose. You could have easily been kind, but chose to be rude instead.

I pity the struggling new nurses that are ever taken under your wing.

Thanks.

salexandra · Feb 19, 2019

4 hours ago, TriciaJ said:
On a side note: friendships develop more quickly when you're all new together. When you go into a work place where everyone else has been there awhile, it just takes more time.
They're taking your measure. Do the best job you can do and don't be afraid to ask questions when you're unsure. Even if you have to ask a question you've already asked. It may be annoying to them in the moment, but they'll think a lot better of you than if you try to wing it and then screw up.
We live in an instant gratification world. In reality, feeling confident as a nurse requires more time than you've had so far. Friendships outside of school take longer as well. Hang in there.

Thank you so much for this ❤️

TriciaJ, RN · Feb 19, 2019

56 minutes ago, salexandra said:
Your advice is truly revolutionary. YOU are what’s wrong with the way nurses treat one another and I don’t need a lifetime of experience to see that.
It absolutely blows my mind that you chose to get on this post and those are the words you chose. You could have easily been kind, but chose to be rude instead.
I pity the struggling new nurses that are ever taken under your wing.
Thanks.

Whoops. Ruby actually gave you good advice. Blunt is not the same as rude. The inability to take constructive feedback could be getting in your way more than you realize.

Blunt feedback isn't always nice to receive, but it's usually more valuable than unicorns and rainbows. Responding by lashing out will not serve you in the long run. Ruby has a long career under her belt and knows what she's talking about. The Rubys of the world can end up being your best friends, if you let them.

salexandra · Feb 19, 2019

6 hours ago, TriciaJ said:
Whoops. Ruby actually gave you good advice. Blunt is not the same as rude. The inability to take constructive feedback could be getting in your way more than you realize.
Blunt feedback isn't always nice to receive, but it's usually more valuable than unicorns and rainbows. Responding by lashing out will not serve you in the long run. Ruby has a long career under her belt and knows what she's talking about. The Rubys of the world can end up being your best friends, if you let them.

You’re absolutely right, blunt is not the same as rude. Constructive criticism, gee did not realize that “suck it up” was a form of constructive criticism. I’ll make sure to make note of that.

Interesting how my concise, calm response is considered “lashing out”, yet Ruby’s elaborate “you’re a dumb cry baby, your coworkers don’t have to be nice, shut up and get over it” story was “constructive criticism”.

Hospitals literally have retention and recruitment boards, of which the units are 100% supposed to be implementing. I’m not asking anyone to be my future brides maid, but coworkers should absolutely be making an effort to get to know you and creating a relationship with new employees. Coworkers, especially nurses of all careers, should be making sure their new employees like their jobs, enough to want to stay, and would recommend it to a fellow nurse. To dispute that and offer useless advice such as “your coworkers don’t have to be your friends, go make friends” is not blunt, it’s just plain ignorant. Imagine if that was the thought process managers had. No new grads would work for their units.

I have absolutely every right to protect my license that I worked so hard for by leaving my previous place of employment- to call risking my license and endangering the lives of patients a form of “challenging my critical thinking” is SO absurd. That is a huge problem with nurses as whole- putting up with so much bs from companies who would throw you under the bus faster than you can say your name. If more nurses would get the balls and self worth to leave these terrible work environments more often, we’d probably get better treatment. But instead we tell each other to “suck it up.” I care deeply about human beings and I will not work for a place that subjects them to unsafe conditions. So sure, I suppose I did challenge my critical thinking skills at this place by coming to work every day wondering how to protect my patients from greedy hospitals and their lack of safe environments today.

You must have empty, useless platitudes confused with good advice. Ruby simply had to say, “you’re problem is you’ve not stayed anywhere long enough to gain confidence, stick with this place. Good luck.” Or perhaps, her own new nurse story. Or better yet, maybe just not have said anything at all! Instead she went on a tangent about how she is so completely baffled by my moronic choices. While there was some good advice in that piece, it was so hard to find with all the patronizing cut downs thrown in. There were reasons for my choices, and I shouldn’t have to provide traumatic sob stories to elicit empathy from someone whose whole livelihood is based off of compassion. But I digress.

My perspective as a new nurse is just as valuable as the perspective of a seasoned nurse but for different reasons. I can give my own constructive criticism of your all’s version of compassion. I can guarantee you if I asked any of my fellow new nurses if they found Ruby’s response helpful, I’d get an overwhelming “no”. New nurses do not benefit from the 1950’s pick yourself up by your bootstraps, suck it up bit. We’re usually millennials and we have a different way of thinking- learn to adapt to teaching them. They benefit from guidance, support, patience and constructive criticism. Of which I have received plenty enough to tell the difference between blunt and just plain rude/unhelpful.

I’ve met many of the helpful veteran nurses and then I’ve met the Rubys of the workplace. I’ll choose the former as my best friend. But if we go off of Ruby’s logic, no one should be my best friend in the workplace.

How absolutely disappointing to have received awesome advice from you, just for you to have turned around and defend the essence of where my struggles stem from.

Nurses eat their young isn’t just a saying for fun. This was a wonderful example of that. Thank you.

brownbook · Feb 19, 2019

Yeah, no, you lost me at your reply too Ruby Vee.

"You are what’s wrong with the way nurses treat one another and I don’t need a lifetime of experience to see that. You could have easily been kind, but chose to be rude instead. I pity the struggling new nurses that are ever taken under your wing. " These are rude responses.

“You’re a dumb cry baby, your coworkers don’t have to be nice, shut up and get over it” were not in Ruby Vee's reply.

I have been reading Ruby Vee for ???? 10 years. She is one of my top favorite's on Allnurses.