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

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

11 minutes ago, Name9335 said:

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

Being nervous is okay and completely normal dont be afraid to get your feet wet. An ideal nursing setting for you would essentially be in the hospital. Given the fact that in an emergency there is other nurses and providers around to help you. Do not be so resentful to bedside nursing because most non-bedside nursing jobs require at least a year or more of bedside nursing experience. Also be open to advice from senior nurses, new graduates do not naturally know it all we learn gradually overtime.

[Emergent, RN]

My guess is that there were many more occasions of concern than the ones you cited here. Also, you are probably committing major social faux pas that you are unaware of, and have poor communication skills. Often, not fitting in socially will tip the scales in nursing.

[Name9335, BSN, RN]

9 minutes ago, Emergent said:

My guess is that there were many more occasions of concern than the ones you cited here. Also, you are probably committing major social faux pas that you are unaware of, and have poor communication skills. Often, not fitting in socially will tip the scales in nursing.

Thank you for your comments. I am quite introverted, but I wouldn't necessarily say that i have poor communication skills or don't fit socially. I do fine in a retail setting, but financially and career goal wise, I don't see myself doing something like that long term. Nursing is my passion, even if I end up not at the bedside

[Cowboyardee]

4 minutes ago, Name9335 said:

Thank you for your comments. I am quite introverted, but I wouldn't necessarily say that i have poor communication skills or don't fit socially. I do fine in a retail setting, but financially and career goal wise, I don't see myself doing something like that long term. Nursing is my passion, even if I end up not at the bedside

My guess would be that you are reasonably competent at your retail job. Your coworkers might take a while to get to know you, but as long as you're pleasant and do the job well, they don't worry about you.

Imagine, if you will, an introverted retail employee, quietly hanging shirts upside down and inside out on the rack. A fellow employee wanders over to inform them that's not quite the preferred way of doing it, and the introverted employee smiles politely and thanks them before hanging yet another shirt inside out and upside down, placing a clearance sign on the wrong rack, and wandering away or offering no meaningful feedback whenever someone tries to approach them about their job performance.

Being introverted is only really a problem when you don't know what you're doing, refuse to ask for help or advice, and no one can effectively talk to you about it or figure out what you're thinking.

[Wuzzie]

11 minutes ago, Emergent said:

Also, you are probably committing major social faux pas that you are unaware of, and have poor communication skills. Often, not fitting in socially will tip the scales in nursing.

And just so you know, OP, there are a LOT of us who have had to work through these kind of issues so you aren't alone nor are you a bad person. It just takes awhile and can be quite painful at times.

[Name9335, BSN, RN]

3 minutes ago, Wuzzie said:

And just so you know, OP, there are a LOT of us who have had to work through these kind of issues so you aren't alone nor are you a bad person. It just takes awhile and can be quite painful at times.

I guess if this IS the case.... (not saying it is or not.....) If I am not aware of what I am doing wrong/can't wrap my mind around it..... How can I fix it? I am truely asking! Or is it just a matter of how my brain is wired and there is no "fixing" it. This is where the frustration lies.... And no one (in my real nursing life) seems willing to talk with me/help me figure it out. I have reached out to my former boss (at the nursing home) as well as a professor at my nursing school and none of them seem willing or able to talk with me about my journey. So then I am forced to come here and speak with strangers that don't fully understand my journey and therefore can't fully help with my situation (and that's not in "anger" or anything, that's just the nature of the beast with the internet.

[Wuzzie]

22 minutes ago, Name9335 said:

And no one (in my real nursing life) seems willing to talk with me/help me figure it out.

Do you have a friend who would be willing to be brutally honest with you?

A therapist or coach may be able to help you identify any issues too.

[Name9335, BSN, RN]

Just now, Wuzzie said:

Do you have a friend who would be willing to be brutally honest with you?

I have some people in mind that i am trying to get ahold of... Some of the nurses/NP's/retired nurses from my church as well as a family friend that is a nurse, but none of them have worked with me or know me super super well..... I also have my counselor/job coach that I am working with, but she isn't in nursing. She is helping all she can, but it's hard when you don't know the industry

No "friends" from previous work places..... There was one, but she just kept saying to keep trying.... that I would find my place, ect....

[Closed Account 12345]

I agree with the previous posters that ICU sounds like a poor fit, and an unlikely opportunity given your employment history.

A couple of possibilities that might work:

-Occupational health nurse - typically routine, policy based, repetitive

-Public health nurse in routine, task-based environment like STD clinic, TB clinic, etc.

-Jail health: Again, a routine, task-based role like med administration nurse (would not recommend working in any acute care or inpatient jail unit for you based on your posts)

-Small private practice clinic with a patient provider who is willing to teach, probably in a specialty where you can really hone your knowledge to 1 particular body system and its related treatments (not a large practice, or a busy practice, or a hospital-owned practice, nor anything broad like family practice/internal medicine)

-Telephone triage nurse - only if scripted guidelines and a decision tree are available for directing patients

-Obtaining a teacher certification to teach health sciences to high schoolers since you do well with the academic side of things

I was going to say home health, but I don't think that would be a good fit since you'd be practicing without supervision and don't know what you don't know. (<Which I don't mean in a bad way! True of most inexperienced nurses)

I'm sure you feel frustrated, and I'm sorry you've had such a difficult start in your nursing career. I think looking for a routine, low acuity, task-based position would be your best bet... And that's ok! You'll still be a nurse, and we are all gifted in unique ways.

[ihavealltheice]

I totally understand the book smart vs street smart. I graduated with straight A's, but struggled my first few years out of school. It took me a while to realize that textbook and tests are not the same as real life. Here are some specifics to try and help. I copied and pasted your situations and bolded my advice to try and help you.

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.

Even though you thought that you assesed the situation and used your nursing judgement, you didn't. With this situation, you can't use your nursing judgement if you don't go and assess the patient yourself. Your aide was obviously fantastic enough to come to you with their concerns (believe me, that doesn't always happen) and it was interpreted as you blowing them off...and you did.

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.

Then you need to start thinking out loud, whether you're a quiet person or not. No one knows what you're thinking so no one can help you. Maybe what you are thinking is not accurate (and that's perfectly OK!), how are they to know if you don't tell them what you're thinking. I'm a quiet introverted person too, but to think/plan/question out loud when you have the luxury of a preceptor, someone who is dedicated to helping YOU, you need to take advantage of that.

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.

Yep, same goes for IV sticks, NG insertions, anything. When I worked in infusion, we had a max 2 stick rule. Even if you're the BEST at it, you can still have an off day. Get someone else. Don't be afraid to ask for help, don't be afraid to advocate not only for yourself, but for your patient. BUT, don't give up. Maybe you didn't get this one, but you'll get the next one.

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.

Again, DON'T GIVE UP. You'll never learn if you do. You want to be at the bedside, you better believe you'll be inserting foleys and if you refuse, you're going to make yourself look bad. Every nurse has their weakness and that's OK to admit that and then ask for help. I HATED starting IVs before I took the infusion job, guess what, I was one of the best before I left there. I've been gone for 5 years now (switched to school nursing to spend more time with my kids), and I always say I miss starting IVs the most!

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!)

Doctors aren't the experts, nurses are ? Never assume that the doctor knows. Different brands of braces can be different and different doctors order different stuff. I'm sure your facial reactions indicated your confusion and that may not have gone over well either. You say you would have learned, but did you show them that you were taking the time to learn? Again, saying "I'm pretty new at this, I don't know your answer, but I'll find out." will go a long way. But if that situation happened the way you describe it, I would have been concerned as well. Put yourself in the patient or family member's shoes, would that situation make you comfortable?

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.

OK, 2 issues here....

1. I don't care what specialty unit you're on, you need to take into consideration the whole patient-ALL systems of the patient (neuro-yes, but heart, lungs, GI, whatever as well). Maybe this patient had a heart condition that lead to a stroke, the stroke is the primary reason he's there, but that doesn't mean the heart condition is not a factor. THAT kind of nursing knowledge and assessment skill does not come right away, but it will come with time. You need to learn from that and ask questions. Ask yourself-what did you do miss and what can you change in that situation so that it doesn't get missed again?

2. If central tele calls you, you get up, go in right away and you assess the patient, you don't have time to plan. By you writing that you were planning on getting it leads me to believe you didn't act fast enough to assess your patient. And I don't even mean getting vitals, you know his heart rate already-go LOOK at him yourself. (The delay of physical assessment seems to be a common denominator since it was brought up in the SNF as well).

I hope this helps. Good luck and please don't give up!

[Name9335, BSN, RN]

4 minutes ago, ihavealltheice said:

I totally understand the book smart vs street smart. I graduated with straight A's, but struggled my first few years out of school. It took me a while to realize that textbook and tests are not the same as real life. Here are some specifics to try and help. I copied and pasted your situations and bolded my advice to try and help you.

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.

Even though you thought that you assesed the situation and used your nursing judgement, you didn't. With this situation, you can't use your nursing judgement if you don't go and assess the patient yourself. Your aide was obviously fantastic enough to come to you with their concerns (believe me, that doesn't always happen) and it was interpreted as you blowing them off...and you did.

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.

Then you need to start thinking out loud, whether you're a quiet person or not. No one knows what you're thinking so no one can help you. Maybe what you are thinking is not accurate (and that's perfectly OK!), how are they to know if you don't tell them what you're thinking. I'm a quiet introverted person too, but to think/plan/question out loud when you have the luxury of a preceptor, someone who is dedicated to helping YOU, you need to take advantage of that.

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.

Yep, same goes for IV sticks, NG insertions, anything. When I worked in infusion, we had a max 2 stick rule. Even if you're the BEST at it, you can still have an off day. Get someone else. Don't be afraid to ask for help, don't be afraid to advocate not only for yourself, but for your patient. BUT, don't give up. Maybe you didn't get this one, but you'll get the next one.

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.

Again, DON'T GIVE UP. You'll never learn if you do. You want to be at the bedside, you better believe you'll be inserting foleys and if you refuse, you're going to make yourself look bad. Every nurse has their weakness and that's OK to admit that and then ask for help. I HATED starting IVs before I took the infusion job, guess what, I was one of the best before I left there. I've been gone for 5 years now (switched to school nursing to spend more time with my kids), and I always say I miss starting IVs the most!

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!)

Doctors aren't the experts, nurses are ? Never assume that the doctor knows. Different brands of braces can be different and different doctors order different stuff. I'm sure your facial reactions indicated your confusion and that may not have gone over well either. You say you would have learned, but did you show them that you were taking the time to learn? Again, saying "I'm pretty new at this, I don't know your answer, but I'll find out." will go a long way. But if that situation happened the way you describe it, I would have been concerned as well. Put yourself in the patient or family member's shoes, would that situation make you comfortable?

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.

OK, 2 issues here....

1. I don't care what specialty unit you're on, you need to take into consideration the whole patient-ALL systems of the patient (neuro-yes, but heart, lungs, GI, whatever as well). Maybe this patient had a heart condition that lead to a stroke, the stroke is the primary reason he's there, but that doesn't mean the heart condition is not a factor. THAT kind of nursing knowledge and assessment skill does not come right away, but it will come with time. You need to learn from that and ask questions. Ask yourself-what did you do miss and what can you change in that situation so that it doesn't get missed again?

2. If central tele calls you, you get up, go in right away and you assess the patient, you don't have time to plan. By you writing that you were planning on getting it leads me to believe you didn't act fast enough to assess your patient. And I don't even mean getting vitals, you know his heart rate already-go LOOK at him yourself. (The delay of physical assessment seems to be a common denominator since it was brought up in the SNF as well).

I hope this helps. Good luck and please don't give up!

Thank you for your comments. This helps a lot, but unfortunatly too many people, including my parents, and others have recommended that I no longer go back to bedside nursing. I am a believer in Jesus (yes, I understand that many are not and wouldn't understand what I am about to say), but we are believing that for some reason, He has closed the door to the bedside..... When you have three different facilities essentially say the same thing, perhaps in different ways, there must be an issue there.... Wether it is the way that my brain is wired or something else? I don't know. It hurts immensely to consider the possibility that I will never return to my dream, but I also want to be a SAFE nurse and protect potential future patients. If that means that it is not possible for me to return, then i will find a way to come to the acceptance of that....Might take some time, but I will get there.

[beekee]

20 minutes ago, Name9335 said:

Thank you for your comments. This helps a lot, but unfortunatly too many people, including my parents, and others have recommended that I no longer go back to bedside nursing. I am a believer in Jesus (yes, I understand that many are not and wouldn't understand what I am about to say), but we are believing that for some reason, He has closed the door to the bedside..... When you have three different facilities essentially say the same thing, perhaps in different ways, there must be an issue there.... Wether it is the way that my brain is wired or something else? I don't know. It hurts immensely to consider the possibility that I will never return to my dream, but I also want to be a SAFE nurse and protect potential future patients. If that means that it is not possible for me to return, then i will find a way to come to the acceptance of that....Might take some time, but I will get there.

Just want to throw out that you are doing your black and white thinking. Yes, the ICU is a bad idea. Low acuity nursing with some heavy self reflection? Probably something you can manage, but ONLY with some serious work on your part.