bored already?

[nursecass]

I am a new grad (have been off orientation and on my own since October last year), and am finding that very little challenges me at work lately.

I was (and still am) a very motivated learner-I always seek out things I don't know and ask/learn about them. I am very proactive about my own education on the floor. But my problem is that I'm only a year out and I'm finding that I'm in a bit of a rut already. I loved my first 8 months or so-every day I went to work I learned something new and it was great!

Lately I've been going in and not learning anything new, and it leaves me a feeling down. I still go into the heart rooms (or any really critical pt for that matter) and review their gtts and their hemodynamics, and depending on the nurse do potential trouble shooting, but really I haven't been challenged in a while. I've made it known to our charge nurses that I would like a challenge, and they try to find complex things, but it just hasn't been happening lately.

I've been signing up for classes left and right, and am on the list to cross-train to recover open hearts, but I'm wondering if any of you have any ideas for me? I feel like I'm getting stagnant-and I'm FAR to young in my career to be feeling that way. I'm getting bored, and I feel like I can't just change units after mine put so much time/energy/$$ training me so thouroughly. Please-any advice is appreciated! Thanks!

[DaveCRNA]

It sounds like you are doing the right things so far. I think you find you will like open hearts since you seem to like being challenged. It's all we do on my unit. I float down to the CCU sometimes and I like learning new things there and the different perspective on managing cardiac patients.

I admire you commitment to the unit, because it is very expensive to train new nurses.

I would continue to address these issues with charge nurses, and nurse managers. Are there opportunities to precept new nurses on your unit? Precepting is challenging in that you have to try and explain what you are thinking or what you just "know" about the patient by looking at the patient and monitor.

Are you on any committees? Or seek out opportunities to teach within your facility. Are there other training opportunities available, devices?? i.e. IABP, VADs etc...

I have about the same amount of ICU time as you and have sought out all of these opportunities on my unit in order to stay challenged and continue learning.

I will orient to our pediatric population as a next step.

Hang in there and keep your eyes and ears open for these other learning opportunities. Just my

[Putu2Sleep]

for you only having a year of experience i find it hard to believe you are not learning anything or feeling stagnant. we get people in my icu that think they know everything after a few months and feel they can take the sickest of the sick patients and its just not the case. these people seem like they know everything but in reality it seems they're just not knowing what they need to learn. maybe your icu is just not getting the sick patients or the unit just doesnt feel giving you the sick patients yet cause you are still new.

the ones that scare me in the icu are the ones that feel they can handle everything right off the bat. im not sayin you think you know everything but with only a year of experience there is still alot to learn and maybe you thought this icu would be something different than it really is.

just my 2 cents

[ghillbert, MSN, NP]

There's so much to learn in CTICU

eg. Do you have enough hours to start studying for CCRN? That's a huge challenge right there.

[putmetosleep]

My advice to you would be to stick it out and to keep expressing your desire for more complex patients to your charge nurses and especially to your nurse manager. From what you say, I think you will really enjoy taking care of the open heart patients--they are always a challenge, and always require very critical thinking (even the "stable" ones that are textbook perfect!). I loved taking care of fresh hearts--keeps you on your toes.

But seriously, you should start studying for the CCRN exam. I guarantee it will give you a deeper understanding for WHY you do things you do everyday, and overall it will make you a better, more competent nurse. Any area of nursing can feel boring--there are tasks that need to be done, schedules to keep, etc. I really believe that the first year in the ICU teaches you HOW to do the things you need to do to keep the patients alive. Once you're comfortable with the "how", you need to start looking at the "why". Learn the patho behind the disease states. Study the pharmacology of the drugs/gtts you administer everyday (receptor sites etc); also learn the physiology behind the interventions/treatments you do everyday (positioning/vent settings/IABP, etc etc). I promise once you start learning these things you'll look at even the boring patients on the unit in a different way and continue to learn.

Not only will the CCRN help you learn these things (trust me, even if you think you know it all, you will learn from this exam--it helps you "put it all together")--but it's a challenge in itself.

Good luck and keep us posted on how you're doing! And congrats for surviving your first year in ICU!:loveya:

[Zookeeper3]

Agree with putme to sleep. The CCRN is an excellent system review, you are sure to come across some area that is new. Consider joining a local AACN chapter or if you have an interest in certain areas, consider doing presentations for staff or staff on the step down floors. You'll find something!

[iluvivt, BSN, RN]

Also start reading some of the advanced practice journals and the nursing research and studies related to your areas of interest. You will be shocked at what you do not know.

[Creamsoda, ASN, RN]

When I worked CCU, I found alot of the patients were very similar, and treated in much of the same ways as it is such a specialty area. Thats not always the case, but in our small CCU, it was, as most were MI's waiting for angioplasty. I floated ICU/CCU and prefered ICU way more. So I quit the hospital I was at, and applied at a large trauma center, and never looked back. I now work in a large Trauma ICU. WE get everything medical/surgical except transplants. Every patient is different, and thus treated different. I am always learning something. We run hemodialysis, crrt, TPE, have pacemakers, swans (rarely), EVD's, run to codes, ect. Theres alot of certifications to be had, so theres always something to learn. Maybe consider a different critical care area such as trauma ICU?

[kelseybel]

Wow, I have worked in my unit, cardiac surgery ICU for over a year now and I still learn something new everyday, honestly. Admit a few patients straight from the OR, who were pretty sick to begin with and that will put you in your place in no time! How about a patient on epi, vaso, levo, milrinone, lasix, insulin, diprivan and an IABP??? oh yeah, and add an open chest. Now that's a challenge, just managing your gtts and hemodynamics. How about taking a pt. with a VAD? Or on CRRT? There are so many opportunities, I feel like I could work in my unit forever and never be bored..........but that's me. Seek out new and challenging opportunities, but never get too comfortable, that's when a surprise will come up and bite you in the butt!!!:wink2:

[trvlngrn22]

Wow, I have been a nurse for 17 years, primarily in CVICU, and I still learn every day. I am a travel nurse and am surprised by the places I go where staff feels like they know it all... but can't read a Swan waveform properly, or adjust the timing on a IABP etc. If you feel stagnant, I feel sorry for you because you are missing so much. If medicine was always A+B=C I could see your point. But no one is the same, everything affects everyone differently and the number of problems and scenarios is infinite. Why is this patient on a small amount of epi with good results but the next bed doesn't respond to the max amounts? Why is this patient having trouble with oxygenation although they are vented on 100% FiO2?

I have my CCRN and think it is a worthwhile test of knowledge, but know that many times even that knowledge base is not enough. I suggest that you start looking into a little more than just what you need to finish your shift. This may seem harsh, but no one should believe they know it all and have nothing left to learn.

Some of the above had great suggestions, learn all their is about all of your equipment, all of your drugs, disease processes etc. The PACEP modules (available on AACN, SCCM etc) will thoroughly test your knowledge on Swans. And then the books, Bojar and Dvoric (sp?) are a couple of good ones. I still refer to them.

Good luck to you at the start of your career. I hope that you take advantage of the learning opportunities available to you everday.

[registeredin06]

Maybe you're expecations are too high. Not everyday is going to be an obvious life/death event with codes and emergent intubations, etc on your assigned patients, but if you look a little deeper, it is life/death and you're responsible. That's why they're in ICU, and it's up to you to be aware and educated on their disease process, constantly looking for s/s of their status declining to PREVENT the codes. I'm afraid you would miss the small stuff when looking for the huge hoopla.

I've been nursing for almost 3 yrs. and even if I have intermediate overflow pt.s, I have an immense amount to learn. I look over their chart and labs--why a cortisol stem test on this pt--I wonder, I wonder, I wonder my whole shift. And I find out. Either by researching, discussions with Rns or MDs. It's never ending. When you're "bored" is when someone gets hurt. Be careful and try to be patient. The devices will come, but you must first understand the patho and meds.

[ahw.cvicurn]

I Think You Should Think About A Change. As Long A You Trnasfer Within The Facility, Then They Have Not Lost Money By Training You. I Work As A Cvicu Rn. I Recover Open Heart Pts. I Love My Job And I Find That Every Day I Learn Something New. No Pt Is The Same. I Am Constantly Challenged. If You Like That Kind Of Nursing I Think You Could Benefit From This Change. I Have Been Doing Open Heart Recovery For 2 1/2 Years And I Never Get Bored, Even On The Slow Days I Still Enjoy My Job And I Always Feel Rewarded When I Leave.