some advice needed

tri-rn · Sep 27, 2012

First and foremost, quit worrying about being a "great" nurse, just focus on being a competent and safe nurse, ok? Great comes later. In the ICU, it comes a LOT later.

I don't know what kind of relationship you have with your preceptor but if it's possible, see if he/she would be comfortable kind of taking a back seat and only stepping in if they see you making a mistake. Maybe that would enable you to apply the things you do know in a safe manner. And you'd feel more comfortable thinking and acting for yourself knowing someone has your back.

As for priorities, to this day (5 years of ICU and I went there as a new grad too) if I'm not sure what to do first I ask myself "what would cause the greatest harm if it waited?" Of course staying within facility policies for med pass times and such. If you have a lot of things on your plate but none of them are immediately pressing (think Airway-Breathing-Circulation) take a second to think of the most efficient way to get them all done.

If you find out ICU isn't for you, don't think nursing isn't for you. Nursing has nooks and crannies for all sorts of people.

mav7089 · Sep 27, 2012

That is my main focus right now is to be able to know that when it comes down to it, when my pt is crashing, I will be able to intervene and do what I have to do to save their lives. My schedule was a little weird. They had me on days, then switched me to nights, switched me back to days, now I'm going back to nights. During my transition back to days, I didn't feel very comfortable with my preceptor. I felt like she was always judging me. She questioned if I think I can handle it in the ICU and if I can handle ICU patients. That made my confidence go way down. Then I completely messed up and I can see all over her face that I was stressing her out. It's hard for me to come to her and ask her questions, because I just have this uneasiness around her. I am going back to nights to my old preceptor and I hope that he will be able to guide me better. Although I am scared that it might not matter, and that I will still stagger at patient care. My educator said that I need to rebuild my confidence. I just don't know what to do. I want to stay in the ICU and stick it out, but I'm not sure it's for me.

lesdrn · Sep 29, 2012

That is my main focus right now is to be able to know that when it comes down to it, when my pt is crashing, I will be able to intervene and do what I have to do to save their lives. My schedule was a little weird. They had me on days, then switched me to nights, switched me back to days, now I'm going back to nights. During my transition back to days, I didn't feel very comfortable with my preceptor. I felt like she was always judging me. She questioned if I think I can handle it in the ICU and if I can handle ICU patients. That made my confidence go way down. Then I completely messed up and I can see all over her face that I was stressing her out. It's hard for me to come to her and ask her questions, because I just have this uneasiness around her. I am going back to nights to my old preceptor and I hope that he will be able to guide me better. Although I am scared that it might not matter, and that I will still stagger at patient care. My educator said that I need to rebuild my confidence. I just don't know what to do. I want to stay in the ICU and stick it out, but I'm not sure it's for me.

It sounds to me like you got a preceptor who is looking to "weed out" the people she doesn't want. She may have a preconceived notion about you, and your long job search. I don't believe that this necessarily reflects poorly on you, I had the same problem when I graduated almost 18 years ago due to over saturation of the job market. But, not everyone will look at you in the same light. I'm sorry for this. I would go to your manager and tell him/her that you feel much more comfortable with your night shift preceptor and that you feel that you have learned more with him. Then, and this is probably the hardest part, take a good hard look at what you have learned from both people. One thing I will tell you as a senior nurse that I cannot tolerate from anyone, is someone who tries to BS their way thru what they don't know. I don't know it all, I'm not omniscient. That's the beauty of having people who have different experience, everyone has something different to lend. So, if you don't know, you don't know. If you think you may know, it's ok to say, "I think this is the answer." And, then when you are learning the rationale, really learn why you are doing something. It's important to make the connections from a to b to c in critical care. That's how you are going to see the changes in your patient's condition and be able to intervene before things deteriorate. This learning curve takes time and experience. Don't ever be afraid to turn to a coworker and ask their opinion about what to do, that doesn't make you a bad nurse, it means you're using the resources around you. I still ask my coworkers their opinions when I have a difficult patient, and I have been a critical care nurse for almost all of my 18 year career. Buy yourself a CCRN study book, they are great reference guides. Carry it with you to work and use it when you have a question at work. Become resourceful and prove to those around you that you deserve to be in the ICU. Those are my suggestions to you, and those are the things that would impress me if I was precepting a new nurse and I saw her struggling. Always remember that this is your career, not a job. You worked hard to get through nursing school, and you graduated AND passed NCLEX! Give yourself some credit and realize that #1 you can't know everything, #2 it takes time to learn the skills to become a great nurse and #3 you're still new at this, and you CAN do it. I wish you the best, and if for some reason, you make the decision that ICU isn't for you, don't give up on nursing all together.