Beginner's Blues?

myraybans&i · Oct 21, 2013

Thank you for sharing. I think you're being too hard on yourself. You have to realize that the nurse that you gave report was also in your shoes at some point in time. Not everyone enters the ICU frontlines 100% prepared and ready to face the challenges that arise with working in that type of environment. You seem like a keen individual, and the nature of keen individuals are such that they are never satisfied or content with what they do, or they feel like they forgot to do XYZ. If the people around you are saying you are doing fine, then be open to that feedback. I think it would be far worse to hear from them that you're not excelling and that you are not ready for the ICU. Keep doing what you're doing. Continue to ask questions and admit to things you don't know. It takes time. You will become more and more comfortable as days, weeks and months pass. Good luck!

jrsRN07 · Oct 21, 2013

You are certainly welcome.

I guess you are right. Maybe I am being to hard on myself. Thanks so much for the encouragement and putting things in better perspective for me.

Thank you for sharing. I think you're being too hard on yourself. You have to realize that the nurse that you gave report was also in your shoes at some point in time. Not everyone enters the ICU frontlines 100% prepared and ready to face the challenges that arise with working in that type of environment. You seem like a keen individual, and the nature of keen individuals are such that they are never satisfied or content with what they do, or they feel like they forgot to do XYZ. If the people around you are saying you are doing fine, then be open to that feedback. I think it would be far worse to hear from them that you're not excelling and that you are not ready for the ICU. Keep doing what you're doing. Continue to ask questions and admit to things you don't know. It takes time. You will become more and more comfortable as days, weeks and months pass. Good luck!

Biffbradford · Oct 21, 2013

If you're having a hard time remembering things, then write them down. There have been times when I finish my shift with a whole stack of notes written on ICU note paper (paper towels). Hang in there, you'll get it.

detroitdano · Oct 21, 2013

I am trying my hardest to see where I am doing a good job. With keeping the patient alive? documentation? giving medications safely? I am having a hard time with getting my report to be ICU perfect, keeping up with the documentation while handling all the orders and issues that arise with the one or two patients.

That's all that's expected of you as a new ICU nurse. The rest comes with time. Critical thinking skills come from experience and you'll trip over your own two feet over the next year or so, but give it time and it comes second nature. If after that time you're still struggling, then you should do a real self-evaluation.

As a new ICU nurse, you just don't know what's important for report without someone giving you feedback. Don't think of people bashing your report as a bad thing; take notes, learn who only wants to know what, etc. ALWAYS give a report that would allow someone to perform safe and basic care, but the extremely detailed report, not every nurse wants to hear that. Some people don't care about the expiration time of their type and cross, or the results of the 2D echo from yesterday. Give just enough info to not put the patient in danger and add a little pizazz on top of that if need be.

You'll come to find out some nurses read their entire medical record after you give report. Others probably go the entire shift without knowing their patient's names. So not everyone is going to expect the same report. Every unit has that one nurse they dread giving report to, because they want to know when the patient was diagnosed with cancer, what and when their treatment was, etc., even though they're only on your unit for something entirely unrelated. That's excessive info not necessary for report, so if that happens to you, just smile and say "I'm sure it's in their record if you want to look later."

vera4130 · Oct 27, 2013

If you're having a hard time with ICU basics you might do an online course. Med Ed Seminars has a couple for ICU that are good, AACN has some although I don't know how good they are.

It takes a while to get report down. You'll forget to ask important questions. In the beginning I made my own report sheets and got there early to look at labs, H&P, and any consults or tests they've had.

You will never please some people in report. There is a nurse I used to work with who would ask the most ridiculous stuff. I felt better after realizing it wasn't just me. I don't worry about it anymore.

You'll also figure out who to watch for because they're notorious for not getting orders done or leaving things out.

NPOaftermidnight, MSN, RN, NP · Oct 28, 2013

I started as a new grad in a Surgical/Trauma ICU in July. The biggest things that have helped me are 1) writing EVERYTHING down. we have an excellent report/organization sheet that our manager actually requires we use while we're on orientation and it's hard to miss anything when we're filling that out and 2) realizing that NO ONE expects you to know everything. You are not expected to know the same things as the RN that has been there for 20 years.

If your work doesn't provide you with a good organizational/report sheet, I would create one yourself. I honestly could not get through my day (especially giving report) without it.

I have found that my fellow nurses and managers in the ICU give me very honest feedback. If they are telling you that you're doing well - you probably are. Just keep the good attitude and continue learning everything you can. You are probably doing 100x better than you think you are, you're just being hard on yourself - and that's what is going to make you an excellent ICU nurse : )

Sugarcoma, RN · Oct 28, 2013

This is a clear cut case of growing pains in my opinion. Welcome to the ICU. It is terrifying isn't it?

I can remember vividly how it felt. I was convinced that at any moment my manager was going to ask me to leave. I would listen to the other nurses offer treatment suggestions, talk things out among themselves etc. and think I will never be that smart, this is hopeless. I almost quit on several occasions. I think everyone goes through this.

You are new. You need time to grow into your role. It will be difficult! People will not always be nice or understanding. You need to give yourself permission to not know everything. Permission to learn from experience, and permission to need assistance. When I would find myself getting flak from a coworker or physician I would repeat over and over in my head "It is o.k. to be new, it is o.k. to not know, it is o.k. to need the help of my coworkers." As long as you do not let those feelings stop you for asking for help or clarification when you need it you will be o.k.

ICU is a pressure cooker. It attracts a lot of strong personalities. They are not always nice about offering assistance. Once your coworkers begin to realize that you are trying your best, and that you are not dangerous, they will begin to soften towards you. I remember well one nurse who would go into the room of my patient and do a complete assessment before I gave report. He would question me about every single little detail. I hated him and thought he hated me as well. Today we are buddies and he goes out of his way to follow me. I asked him one day why he was such a butt in the beginning and he told me that he has been burned so many times that he doesn't trust anyone until they prove themselves.

You WILL be stupid! You WILL be slow! You WILL feel like an idiot 99% of the time! You will suffer from information overload and you will feel like the dumbest one in the room in most instances. The main question is are you SAFE? It seems to me that both your preceptor and managers have answered that with a resounding yes, whether you believe it or not. 10 weeks is plenty of time for an experienced ICU RN to judge whether or not a new nurse will be safe. Trust me when I say that in this economy they have plenty of people they could get in a second to replace you if they had any doubt!

my_purpose · Nov 26, 2013

I am exactly the same way. We have to IM and share helpful notes. I so can identify with YOU!

calivianya, BSN, RN · Nov 26, 2013

My best advice is to find a really good report sheet. The one we have at work is awesome. It's hard to mess up report when your sheet has a section for neuro, respiratory (including blanks for all vent settings), cardiac, GI, skin, renal, a section for drips, a section for lines, labs, culture results, what antibiotics the patient has, what services are consulted, past procedures, future procedures, patient diet, mobility, a section for family issues, and more I'm sure I can't remember. If you have a really thorough report sheet, you can give almost perfect report from just reading off your paper.

shotguns&syringes · Nov 28, 2013

You are definitely being too hard on yourself - but that's not necessarily a bad thing. Working hard to succeed is a good one to have in ICU, you'll be just fine :-) Just remember, everybody has to start somewhere. And no matter how much experience you may have had somewhere else, everybody is a "new grad" when they start ICU. It's a completely different kettle of fish. In a year or two, you won't be crapping bricks before walking into the hospital and you'll actually start to feel that you've got the basics down and that you're able to learn! In the mean time, you will feel like you're not doing anything right and that the doctors think you're stupid. But don't worry, we have ALL been there. Even that crabby, 20 year ICU veteran felt exactly like you do. Chin up, you'll do great :)

Lots of pointers here - definitely the top 2: A good report sheet and to write EVERYTHING down. I had what I called my "Dummy Book" when I first started in ICU - I never worked a shift without it. Even things I thought "why am I bothering to write this down?" proved to be useful time and time again.

There will always be those nurses that you'll dread giving report to or to get report from. Unfortunately, we can't avoid them haha But just tell them what you'd think they'd need to know to safely look after the patient and the pertinent things that happened that shift. Our institution has a "Summary of Events" sheet we fill out at the end of shift as a quick overview, which is nice to get your head in the game before report.

nightengalegoddess · Jan 3, 2014

Don't know if you, poster are still reading here....you have probably gotten homey by now...because it sounds like people like you . That is the most important thing, I have found, in ICU. That your team feels they can rely on you to help in whatever capacity you can. As said, your higher ups would have told you if you were unsafe.

I am a very private personality. I also have spent years in med-surg areas where we are on our own. I had a hard time joining the group...only child syndrome. Even though I was competent, those I first worked with doubted that because my personality is so quiet. I didn't do enough "hey look what I did tonight!" stuff. You are lucky. They like you. That is the main thing. There will always be those who challenge you because perhaps they are distrusting, as mentioned, or just burned out or mean. Let it go. Unless the manager has you in there.....keep trucking.

I had to learn to be louder, brag more....express darker humor......and when pulled into CNL's office.....continue to ask....."have you looked at the charting?"......and "this is what I have learned from the AACN"......I also had to transfer to a different ICU because I was being picked on without real evidence. I had to get out before they got me. No clinical evidence was brought up but my introverted personality made me suspect of weirdness.

You are well liked. That is mostly what ICU nursing is about. We all learn expertise ongoing. It takes a lifetime of career to do what you want to be doing right now. I felt the very same way.

I've learned to be very easy on myself. And I remember that very few people are willing to even try to do the job we do;much less step foot in the hospital. I try to remember that as long as I do no harm.....and hopefully do good...(more good in more time).....I am being all that I can be.

As a private person.....I have learned to talk small talk even though it does not come natural. I have found my coworkers will trust me more when they feel I am not isolating myself as I had to do on Med Surg to advocate strongly and survive.

Everything we need for out patients is at our fingertips in ICU. It is the best and most privileged place to nurse as I see it. Make sure to take advantage of all the resources. No question is stupid. The more questions the better.

I know it will in time become second nature.

Yes, report can be weird for some weird nurses. Just give your report. They need to give you respect and listen. You do not want to be responsible for something unsaid because they are laise' faire and/or just seasoned. If something goes south and you did not mention it in report out of intimidation.....that is on you. So suffer slings and arrows of narrowed eyelids for your ethics.