Am I just a nervous new grad or is the ICU not for me?

survivor08 · Aug 23, 2008

OMG.....Are you living my life with me?????? I had no idea that a bladder could possibly stretch as far as mine has since beginning in STICU in late May. I had to take a couple of weeks off for surgery so I am a little behind but seriously I am no where ready to go out on my own. I have only 4 weeks left with a preceptor and I am pretty sure I will have to fly on my own as we are seriously short staffed. I think that one more month of training would get me closer to where I need to be.

A few days ago I thought (LOL) my 2 patients were caught up and stable enough for me to go to the bathroom and inhale my lunch, I was feeling pretty good about myself...WRONG...one had to go to CT and the other had a bedside procedure and back to q 15's, plus a code in the unit..my first, NOTE TO ALL: unplug the crash cart before racing down the unit with it and if you have never pushed epi before read the box or have someone show you how to put the syringe together before a code rather than during..that shot the day to heck in a hand basket. I am so happy to have found this thread because I have really been feeling like the worlds biggest idiot and wonder how I possibly could have graduated school and passed my boards with out knowing anything. Where did these "new" drugs, machines and procedures come from 'cause they sure were not mentioned in school or during clinicals. Thanks for letting me know I am not the Lone Ranger. Still lovin' it.

Pittfarm · Aug 23, 2008

Survivor08,

you CRACK me up! Keep in touch. We WILL get there and thanks about the hint regarding the crash cart!!!

Wendy

Humbled_Nurse · Aug 23, 2008

What you are feeling is very normal. I started in NICU as a new grad and it took me a good year before I felt somewhat comfortable and even into the second year there were many situations that still made me very nervous. It is all very normal. What kept me going is I knew that NICU was my passion. It sounds like you are just a nervous new grad rather than the ICU not being for you. Nursing school really doesn't prepare us for the "real world" of nursing. Nursing school really only just covers the basics and personally I think that is all that they should be responsible for. The real learning comes when you get that first job. It really is no different than the person that graduates from law school or med school. They don't necessarily "hit the floor running" either. Their real learning also comes over the next several years after they graduate. It is no different with nursing. I think some people expect for nursing school to teach them everything they should know and that just isn't reality. It is up to you to take the initiative and learn on your own. Subscribe to relevant journals, get books related to your specialty and read, read, read. It is amazing what gaining some knowledge will do to your confidence.

Good luck and hang in there. You're doing great!!!

sicushells, RN · Aug 24, 2008

"
Eliza..........the person that wrote that was[n't] attacking YOU personally and didnt say the degree of intensity is HARDER, but that it was "Different", which it is...
BTW........I think the fact that your reading through the ICU section of the site shows that you already have some interest in it. Am I mistaken?

Eliza, I wrote a response to your comment, but this sums it up perfectly (thanks Joeyzstj) I have nothing but respect for floor nurses. Taking care of 10 patients is still work. In my first post I certainly didn't say "floor nurses have it easy, ICU nurses do all the work" so don't take it that way. Our specialties are different, and yes... I do think the ICU is more intense, but I don't think the floor is easy either. q1h vitals, I&O's, etc make for a very full day, and that's before you add on family/patient teaching, multiple new doctors orders (they round approx three times on day shift in my unit), procedures that we have to accompany the patient for (I've been down in CT-guided drain placements for literally 5 hours. can you imagine what that does to my time management?) So while I absolutely empathize with you for feeling stressed out and overwhelmed, don't patronize me for having "only" two patients. :twocents:

geekgolightly, BSN, RN · Aug 26, 2008

If you'll note, eliza is a CCRN.

And, it is a bit condescending to talk about the "degree of intensity" being so different. I am in ICU right now, and have worked various floors and telemetry, and some floors are a breeze and others make you want to cry every day after shift. Juggling a multitude of patients on the floor takes talent and skill. With the right training any ICU nurse could do it, and with the right training any floor nurse could do ICU. It's just plain different.

joeyzstj, LPN · Aug 27, 2008

If you'll note, eliza is a CCRN.
And, it is a bit condescending to talk about the "degree of intensity" being so different. I am in ICU right now, and have worked various floors and telemetry, and some floors are a breeze and others make you want to cry every day after shift. Juggling a multitude of patients on the floor takes talent and skill. With the right training any ICU nurse could do it, and with the right training any floor nurse could do ICU. It's just plain different.

Again, I think the point she was trying to make was that it is "Different" as you put it. The degree of intensity is different. I have worked agency and been on several floors and units. You cant honestly say that as a critical care nurse that the environments are the same. As a Critical Care RN the amount of information you are required to know and use on a daily basis is profound. As a floor nurse the amount of patients you are required to look after is greater. The hospitals give a larger amount of patients on the floor for obvious reasons...........they are less critical, have little or no drips, require less frequent assessment and dont have the potential to become critial as do the patients in critical care. The thing is the thread went from someone making a comment that wasnt an insult to someone insulting Critical care nurses. The job IS different. The degree of intensity IS different, and if you have been paying attention and giving the level of care that an ICU patient should have and deserves then I think you would be in agreement of that.

sicushells, RN · Aug 28, 2008

Geekgolightly

-None of my comments/advice for new grads (only recently out of the classification myself, btw) were meant to be condescending towards floor nurses... which I've said before. Floor nurses can be awesome (I was going to say "are" but there are some lazy people everywhere and I don't want to include them with those who bust their butts all day), and it's hard work... like ALL nursing. Again, I never said 'floor nurses are dumb, lazy, [place your own negative adjective here]' I just said ICU and floor are different... which you agreed with, so why do I feel like you're attacking me?

geekgolightly, BSN, RN · Sep 5, 2008

Again, I think the point she was trying to make was that it is "Different" as you put it. The degree of intensity is different. I have worked agency and been on several floors and units. You cant honestly say that as a critical care nurse that the environments are the same. As a Critical Care RN the amount of information you are required to know and use on a daily basis is profound. As a floor nurse the amount of patients you are required to look after is greater. The hospitals give a larger amount of patients on the floor for obvious reasons...........they are less critical, have little or no drips, require less frequent assessment and dont have the potential to become critial as do the patients in critical care. The thing is the thread went from someone making a comment that wasnt an insult to someone insulting Critical care nurses. The job IS different.

hmm

The degree of intensity, as a phrase, indicates that there are higher and lower levels of intensity. That is what you mean, right? And with that, I assume that you mean that floor nursing is a "lower level" of intensity. Under that assumption, I absolutely disagree. The degree of intensity does not change, but the type of work does. Floor nursing is stressful and intense.

The degree of intensity IS different, and if you have been paying attention and giving the level of care that an ICU patient should have and deserves then I think you would be in agreement of that.

Honestly, I have found that my stress level is less in the ICU than on the floor. I believe that it's because I work much better when I focus on two patients very closely, rather than six patients. I am calmer and happier in ICU. I can OCD as much as I want and no one is neglected. I am not built to be a floor nurse. I did it for five years, and finally feel at home in the ICU.

geekgolightly, BSN, RN · Sep 5, 2008

Geekgolightly
-None of my comments/advice for new grads (only recently out of the classification myself, btw) were meant to be condescending towards floor nurses... which I've said before. Floor nurses can be awesome (I was going to say "are" but there are some lazy people everywhere and I don't want to include them with those who bust their butts all day), and it's hard work... like ALL nursing. Again, I never said 'floor nurses are dumb, lazy, [place your own negative adjective here]' I just said ICU and floor are different... which you agreed with, so why do I feel like you're attacking me?

Do my posts really sound like an attack? If they come across like that, I am sorry. It is not my intent. Maybe I should use more smilies to convey intent, as obviously my writing is a bit stiff?

I just wanted to put my two cents in as well as point out that the woman who became defensive about floor nursing was, in fact, a CCRN. I thought that might have been missed as people were addressing her as if she only worked on the floor.

joeyzstj, LPN · Sep 5, 2008

hmm
The degree of intensity, as a phrase, indicates that there are higher and lower levels of intensity. That is what you mean, right? And with that, I assume that you mean that floor nursing is a "lower level" of intensity. Under that assumption, I absolutely disagree. The degree of intensity does not change, but the type of work does. Floor nursing is stressful and intense.
Honestly, I have found that my stress level is less in the ICU than on the floor. I believe that it's because I work much better when I focus on two patients very closely, rather than six patients. I am calmer and happier in ICU. I can OCD as much as I want and no one is neglected. I am not built to be a floor nurse. I did it for five years, and finally feel at home in the ICU.

Well...........Hmm..........let me try to explain it like this, and then Im all out of explanations. I have worked in both environments and currently work in CVICU. In my CVICU day before yesterday for example I had a Simple post Meth induced MI patient on a vent in ARDS AC 35, PEEP of 22 on 100% who codes and goes into a "dial a rhythm" type of code Brady-Torsades-Vfib-asystole-vfib-idioventricular-ect who regains a pulse and a pressure. This patient has multiple body fractures in a C-Collar on 70 mcgs of Levophed, 20 mcgs of Dopamine, 300 mcg of NEO and 2.4 units of vasopressin, Bicarb Gtt, who had an MI early in the morning. Goes to CCL and comes back. 45 minutes later patient has another MI with 5mm elevation in inferior leads. Taken emergently back to CCL and brought out on balloon pump, Swan PA Cath, now in Acute Renal Failure due to ATN. Due to all the pressors Im unable to pick up a sat, so I am doing hourly ABG's with vent changes. In the meanwhile my patiens K is 7.6 and acidosis is through the roof despite my HCO3 drip due to all my pressors and my 22 of peep. Every few hours this patient goes in and out of vtach and into an idioventricular rhythm. Im pushing D50/insulin/HCO3 to attempt at getting the K down until I can get a doc to insert a access for dialysis for this patient. Finally get a port in and start CRRT, so now instead dealing with everything else I have, I get to deal with running the CRRT machine in addition to the IABP which by the way is giving me problems due to the rhythm and pressure issues. Im maxed on all pressors, and Im also checking hourly ACT's to get the cath sheath removed. ACT has to be 150's and it takes half the day to come down from 300's. In addtion to all of this I am dealing with 6 doctors, a wife high on meth, 3 sons who are great, but havnt seen their dad in years due to the meth and are very upset...........They are fighting with one another. The wife keep sneaking in the locked unit doors and yelling at people. I still doing hourly labs on top of all my other hourly stuff, charting Q15 minute vitals and assesments, running orders, calling pharmacy for missing meds becasue we dont have a med nurse or a tech, looking at x-rays, turnining becuase all of the pressors are starting to seriously breakdown his skin (least of his problems at this time). This cycle just repeats over and over all day long. Meanwhile Im talking to the family about DNR status because the two primary docs left at 4:30 and new docs didnt know that much about the case and didnt want to get involved with making DNR decision until reviewing the 3 charts the patient has.

Meanwhile, in the unit we have 4 other patients going in and out of V tach, all of our crash carts are in patients rooms, we have a fresh ACB, AVR, MVR that is bleeding like crazy..............1500 mls in CT's in 15 minutes, meanwhile we are recieving a Respiratory Arrest/code from the floor because the 75 year old chronic renal failure patient was given 25 mg's of IV phenergan and 4 of morphine IV. This was a day where nobody in our unit could stop and help anyone else due to everyone having their own critical issues.

My point is...........this is the "difference in the type of intensity" with my "TWO PATIENTS". No, this is not the intensity of dealing with 6 patients wanting pain medication at the same time or dismissing and admitting 2 or 3 patients at the same time, however it is a different level of intensity. I have done both types of work with an agency....floor and critical care, and I stick to what I said before. I have never experienced the same intensity anywhere else.