Considering ICU.... among several other options

[Name9335]

Hello All!

Sorry for the long read

Currently, just beginning to explore the possibility of ICU nursing (among many other options....). I am NOT convinced that ICU is going to be a good fit for me, even though ICU nursing has always been my dream.

Please look back at my previous posts for some more background, but here is the very basic details of where I have been and my current situation.

I started out in my first job (2 years ago) (middle of July) at a neuro med surge unit (later apparently designated as a step-down unit long after I had left the facility). I started out ok, but as the acuity and number of patients increased, it became apparent that management had concerns regarding my critical thinking, reasoning, prioritization and delegation. I TRIED to fix their concerns, but by the end of October, it had become clear that I didn't' really fit on the unit and that it was not going to be safe for me to continue on my own out of orientation. I resigned.

I started on as a PRN at a local nursing home, even though that was not really what I wanted to do. Very shortly afterwards, I found a position at a smaller general med surg unit at the hospital across town (ages 0-100's). Unfortunatly, I think at this point, my confidence had been completely shattered after what I had been through the first hospital. I only lasted about a month at this second hospital.... with the same concerns that were noted at the first place.

I then went full time at the nursing home..... Things seemed to go fine for almost a year. Then at some point, the providers for the patients became concerned with the same concerns that the other facilities had. I was terminated after about a year and a half at that facility. That was almost 6 months ago. I have not worked in nursing since, until I can reevaluate and figure out where I am supposed to go next.

Here is the deal/problem/confusion, ect. I do GREAT when it comes to critical thinking/prioritization/decision making ON PAPER (NCLEX, case studies, ect), but when it comes to the in person critical decision making in the moment, when I am trying to prioritize between several different patients/residents/tasks, i struggle.

I am a very task oriented/check the box/black and white thinker, but CAN think critically according to case studies and tests.

I posted this in another nursing group, and surprisingly, several actually suggested ICU (which I thought was crazy considering the issues that the facilities stated).

I don't really have any nursing friends/mentors in real life that are able to help me with this, although I am working on it and am trying to get in contact with some of them.

What I can't figure out is if these issues would be lessened/I would do better if I was in a more 1-1/1-2 situation like an ICU, or if I just completely need to get away from the bedside.

I am NOT convinced about the ICU yet, although, it would be a miracle if that ended up being something I could pursue.

I realize that it is basically impossible for people on the internet to fully know my situation and tell me what to do. That's not what I am asking. I am just looking for experiences/suggestions on what it takes to potentially work in the ICU.... or if I should completely mark it off my list of options that I am pursuing (including non bedside options)

P.S.

Other options that I am considering: MDS coordinator, Pre-op nursing, diabetes nurse educator, hospice??, outpatient infusion, outpatient clinic.... others....

Honestly overwhelmed with all the options in nursing. All I have EVER had a passion for was the bedside.... so learning that my brain isn't wired for it has been disappointing. But I need to pull myself up and figure out what the next thing is going to be. Don't have much of a passion for anything other than ICU, BUT I need to know that I am going to be safe for my future potential patients. I HATE that we cannot do shadowing in nursing due to HIPAA, as then I really have no idea what the other areas look like or if they would fit my strengths better.

I am currently working with a counselor/job coach and we are making some progress, but not as much as I would have liked

[RNNPICU, BSN, RN]

1 minute ago, Wuzzie said:

That's the problem...she can't seem to keep a job that long in acute care. The longest job she had was LTC for 18 months and they fired her for the same issues. I'm concerned because these kinds of facilities are desperate for staff so the issue must be fairly significant.

Wuzzie:

I think this area that I highlighted is what speaks the loudest. Most nurses choose to leave LTC, not asked to resign. There likely is some larger underlying issue. And I agree ICU or any of the other places the OP listed are definitely not the place to try.

[beekee]

OP, I don’t think you have really HEARD what the issue(s) are with your performance. I highly doubt you were fired from the LTC because you called the on-call MD with a lab value before assessing the patient. The issues are deeper. You keep banging your head against the wall. Stop banging and reflect, honestly.

[caliotter3]

47 minutes ago, beekee said:

OP, I don’t think you have really HEARD what the issue(s) are with your performance. I highly doubt you were fired from the LTC because you called the on-call MD with a lab value before assessing the patient. The issues are deeper. You keep banging your head against the wall. Stop banging and reflect, honestly.

Ditto this and the previous remarks.

[Nurse SMS, MSN, RN]

This reminds me a lot of a previous poster with a different name.

[caliotter3]

Consider extended care home health where you are in the room with only one patient who usually has only routine care expected of you. One can’t get more basic than that. But be prepared to get pigeonholed and to be offered only LPN level wages for doing LPN level routine care.

[Name9335, BSN, RN]

Alright everyone. Thank you for all your comments... As I said before, I was not really convinced that ICU was going to be the answer (although I was secretly hoping). I went to bed shortly after I wrote this last night, so I am going to try to answer some of the questions. Give some examples and maybe ask some more questions.

1. I was forced to resign from both hospitals. Terminated from the LTC.

2. Although there were several concerns that probably led to the termination at the LTC, here was the situation that essentially put the nail in the coffin....

We had a resident.... parkinsons.... baseline shaky and not very verbal.

When mad/irritated, resident became markedly more shakey and yelled out

We had a newer aid that day. Aide came to me and stated that he was having one of these episodes..... I stated to her that he does this sometimes and to just ensure his safety and let him calm down.

Aide wasn't happy and went to other nurses and management.

Honestly I am not sure how I feel about this situation. I honestly thought I WAS using my nursing judgement and didn't believe that it was an emergent thing that I needed to go and assess. Perhaps if it had continued? Again, I don't know how to feel about this situation.

Some of the concerns at the second hospital were as follows "lack of progression in orientation, mis-prioritization of nursing assessments, reminders to assess and document routine cares, lack of asking questions when uncertain...."

While I don't necessarirly say that this is "unfair", I am a much more quite person..... I don't always say outloud what I am thinking/planning/questioning. I believe they took that as me not being safe and asking questions. To my recollection, there were no specific "incidents" at the second hospital that were of concern. It was more an underlying concern.

At the first hospital, I did make one major mistake, and to this day, I regret it. I had a patient that was a known difficult straight cath. I was on "transition" at that point, so my preceptor wasn't right next to me. I had the assistance of the nurse aide, but attempted to cath that patient too many times (3-4). I was not aware that there was a policy of how many times that I could try. And even when I had asked for another nurse to come and take over, they stated I was doing fine and declined to attempt to cath the patient.

I learned something that day, and honestly I hate foleys now. I avoided them as much as possible. I would NEVER make that mistake again.

Some of the other concerns at the first hospital,

There was a situation where I was dealing with a brace on a resident. I had stepped out of the room and had asked for help (which I believed at that point that I was following the coaching to ask for assistance. There was also the orthotics provider in the room asking me a bunch of questions about the brace. I honestly believed that he would be the expert about the brace and was throughly confused as to why he was asking me all the questions. The patient/family became concerned because they believed I didn't know how to handle the brace (I hadn't dealt with one before, so no I didn't, but i would have learned!)

There was another incident with a patient where we recieved a call from central monitoring. I said something about that I was concerned about his head, rather than his heart. It was a neuro floor and his heart rate was increasing or something.... So I believed it was possible that perhaps there was some swelling in the brain or something neuro related. They also stated that the preceptor had to prompt me to go and get vitals and assess the patient. This I completely DISAGREE with. As stated earlier, I was kind of quite. I already knew and was planning on getting into that room asap to assess and get vitals.

So, the question becomes, where do I go from here. I realize that it might not be the bedside. While I am incredibly saddened by that, I also am begining to "accept" that might be my reality...... but I don't know where to go next. I have a BSN and am licensed. Really have no passion for anything else, especially outside of nursing. I tried, trust me. I HATE this.

Thanks for hearing me vent. I am taking ALL the comments into consideration and am trying to work through what my steps will be

[Cowboyardee]

14 minutes ago, Name9335 said:

Alright everyone. Thank you for all your comments... As I said before, I was not really convinced that ICU was going to be the answer (although I was secretly hoping). I went to bed shortly after I wrote this last night, so I am going to try to answer some of the questions. Give some examples and maybe ask some more questions.

1. I was forced to resign from both hospitals. Terminated from the LTC.

2. Although there were several concerns that probably led to the termination at the LTC, here was the situation that essentially put the nail in the coffin....

We had a resident.... parkinsons.... baseline shaky and not very verbal.

When mad/irritated, resident became markedly more shakey and yelled out

We had a newer aid that day. Aide came to me and stated that he was having one of these episodes..... I stated to her that he does this sometimes and to just ensure his safety and let him calm down.

Aide wasn't happy and went to other nurses and management.

Honestly I am not sure how I feel about this situation. I honestly thought I WAS using my nursing judgement and didn't believe that it was an emergent thing that I needed to go and assess. Perhaps if it had continued? Again, I don't know how to feel about this situation.

Some of the concerns at the second hospital were as follows "lack of progression in orientation, mis-prioritization of nursing assessments, reminders to assess and document routine cares, lack of asking questions when uncertain...."

While I don't necessarirly say that this is "unfair", I am a much more quite person..... I don't always say outloud what I am thinking/planning/questioning. I believe they took that as me not being safe and asking questions. To my recollection, there were no specific "incidents" at the second hospital that were of concern. It was more an underlying concern.

At the first hospital, I did make one major mistake, and to this day, I regret it. I had a patient that was a known difficult straight cath. I was on "transition" at that point, so my preceptor wasn't right next to me. I had the assistance of the nurse aide, but attempted to cath that patient too many times (3-4). I was not aware that there was a policy of how many times that I could try. And even when I had asked for another nurse to come and take over, they stated I was doing fine and declined to attempt to cath the patient.

I learned something that day, and honestly I hate foleys now. I avoided them as much as possible. I would NEVER make that mistake again.

Some of the other concerns at the first hospital,

There was a situation where I was dealing with a brace on a resident. I had stepped out of the room and had asked for help (which I believed at that point that I was following the coaching to ask for assistance. There was also the orthotics provider in the room asking me a bunch of questions about the brace. I honestly believed that he would be the expert about the brace and was throughly confused as to why he was asking me all the questions. The patient/family became concerned because they believed I didn't know how to handle the brace (I hadn't dealt with one before, so no I didn't, but i would have learned!)

There was another incident with a patient where we recieved a call from central monitoring. I said something about that I was concerned about his head, rather than his heart. It was a neuro floor and his heart rate was increasing or something.... So I believed it was possible that perhaps there was some swelling in the brain or something neuro related. They also stated that the preceptor had to prompt me to go and get vitals and assess the patient. This I completely DISAGREE with. As stated earlier, I was kind of quite. I already knew and was planning on getting into that room asap to assess and get vitals.

So, the question becomes, where do I go from here. I realize that it might not be the bedside. While I am incredibly saddened by that, I also am begining to "accept" that might be my reality...... but I don't know where to go next. I have a BSN and am licensed. Really have no passion for anything else, especially outside of nursing. I tried, trust me. I HATE this.

Thanks for hearing me vent. I am taking ALL the comments into consideration and am trying to work through what my steps will be

One thread running through several of your issues is either dismissing concerns/abnormal findings/symptoms/etc sight unseen (whether that's merely a verbal dismissal or actually failing to investigate), or else offloading the responsibility for assessing abnormal findings onto another health care worker (e.g. the doctor you called with lab results before evaluating the patient in question).

Ultimately, evaluating the patient and ensuring that they receive appropriate care and interventions is the single most important part of your job. Seemingly too often, you fail to do this and then excuse yourself for it afterwards.

Don't be that easy on yourself.

You're inexperienced - it's fine to admit this and not to know everything and not to have the ultimate say in exactly what might be happening with your patients. But you have to make a good faith effort to find out.

[Name9335, BSN, RN]

2 minutes ago, Cowboyardee said:

One thread running through several of your issues is either dismissing concerns/abnormal findings/symptoms/etc sight unseen (whether that's merely a verbal dismissal or actually failing to investigate), or else offloading the responsibility for assessing abnormal findings onto another health care worker (e.g. the doctor you called with lab results before evaluating the patient in question).

Ultimately, evaluating the patient and ensuring that they receive appropriate care and interventions is the single most important part of your job. Seemingly too often, you fail to do this and then excuse yourself for it afterwards.

Don't be that easy on yourself.

You're inexperienced - it's fine to admit this and not to know everything and not to have the ultimate say in exactly what might be happening with your patients. But you have to make a good faith effort to find out.

Thank you for your comments. I am taking everything into consideration

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

I would recommend sitting down and writing career goals. It sounds as if you are uncertain about which direction you want to go in. However in the nursing field the more bridges you burn the harder it will be to obtain any new ones. Think about the advice they gave you each time you were terminated a try to find a solution for the problem.

[Name9335, BSN, RN]

2 minutes ago, Lovethenurse2b25 said:

I would recommend sitting down and writing career goals. It sounds as if you are uncertain about which direction you want to go in. However in the nursing field the more bridges you burn the harder it will be to obtain any new ones. Think about the advice they gave you each time you were terminated a try to find a solution for the problem.

That is what I am currently trying to do. I don't know what my career goals are now. I am honestly lost as the only thing I have EVER wanted to do (bedside nursing) apparently is not a safe option for me to continue in. I am lost. I know there are so many more options, but nothing is exciting me:( That is why I am currently not working in nursing (working full time retail) until I can figure out where to go next

[Cowboyardee]

1 minute ago, Name9335 said:

Thank you for your comments. I am taking everything into consideration

Don't get me wrong, btw - I'm not trying to make you feel bad. It's just that we all come out of nursing school as pretty weak and unskilled nurses, but you specifically seem to have some defense mechamisms in place that keep you from honestly confronting your mistakes and learning from them.

You sound like you'd like to be a nurse for a long time to come, and in that case you'll be much better off in the long run if you do the temporarily painful work of acknowledging to yourself that you have some serious deficits in your job performance.

That means dropping some thoughts that might be comforting right now. No, you dont have excellent critical thinking either on paper or in real life - which means you have to work harder to assess patients well. No, being quiet doesn't mean that your coworkers misunderstand you - they correctly see a nurse who lacks skills and knowledge and refuses to ask questions to help compensate for that and practice safely. I'm afraid you'll just have to speak up more even if it's uncomfortable.

You can do this, but it will be hard and require you to be brutally honest with yourself, making hard changes as necessary.

Best wishes in improving your career, your life, and the lives of your patients.

[Name9335, BSN, RN]

Just now, Cowboyardee said:

Don't get me wrong, btw - I'm not trying to make you feel bad. It's just that we all come out of nursing school as pretty weak and unskilled nurses, but you specifically seem to have some defense mechamisms in place that keep you from honestly confronting your mistakes and learning from them.

You sound like you'd like to be a nurse for a long time to come, and in that case you'll be much better off in the long run if you do the temporarily painful work of acknowledging to yourself that you have some serious deficits in your job performance.

That means dropping some thoughts that might be comforting right now. No, you dont have excellent critical thinking either on paper or in real life - which means you have to work harder to assess patients well. No, being quiet doesn't mean that your coworkers misunderstand you - they correctly see a nurse who lacks skills and knowledge and refuses to ask questions to help compensate for that and practice safely. I'm afraid you'll just have to speak up more even if it's uncomfortable.

You can do this, but it will be hard and require you to be brutally honest with yourself, making hard changes as necessary.

Best wishes in improving your career, your life, and the lives of your patients.

Thank you