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Considering ICU.... among several other options

Nurses   (2,384 Views | 41 Replies)

Name9335 has 1 years experience .

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This sounds very similar to a situation I observed closely and was peripherally involved in.

Since I have not heard anything egregious, my bet on this (diagnosis, if you will) is "Failure to reassure."

Think about that. Being introverted is one thing; many people consider themselves such. But when you are new to those around you, new to the setting, new to the profession, etc., you certainly can fail from "failure to reassure."

It goes like this: Someone is inexperienced. They are prone to run-of-the-mill, not-too-disturbing ignorance and misunderstandings, like I did when I was brand-spanking new on orientation and thought that medication was to be removed from an ampule with a regular needle and then pushed into the IV line through a filter needle. In my case I asked a question (is it this way, a, or this way, b?) and got the correct answer and none of this affected a patient. But when people don't talk and want to get by on this idea that "I'm thinking though things, I just don't say it out loud" - there is no way for others to know that.

There are a lot of things that can act as pitfalls for new nurses, but one of the surest is a staunch, somewhat defensive determination to use introvert status as an excuse for lack of appropriate and necessary communication. Uncomfortable though it may be (for some more than others), this stage of your career requires a great deal of interaction.

Secondly, given the situations described, introversion/lack of communication often also affects other areas, such as the idea of being pleasantly assertive/asserting yourself in your patients' best interests (and your own).

The reason I think your lack of communication is the problem is because you haven't mentioned anything else that most new grads aren't prone to - and are usually easily coached through. On any given day they may struggle to catheterize someone, can't perfectly judge urgency vs. non-urgent vs. emergent, and might upset a nursing assistant by not immediately evaluating someone's chronic problem. In order to be coached, they simply cannot stay in their own world inside their own head.

Introversion will fail as an excuse for lack of necessary communication. You can teach yourself improved interpersonal skills.

Best of luck ~

 

Edited by JKL33

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On 11/20/2019 at 11:14 PM, Name9335 said:

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

You mentioned diabetes educator and I think that’s a great idea!  I do a lot of work with diabetes (T2) at my job. We do have a Diabetes Educator and from what I’ve observed, she is able to truly sit with a patient for as long as she needs to and “check all the boxes” with each individual patient.  She is not subject to the same time crunch and prioritization problems as a lot of other nurse jobs. It is something for you to look into at least. 

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Good news for you: you don't have to do bedside if it's not working out for you. Just like facultyRN mentioned, you can do occupational health, public health or clinic which is more task oriented and repetitive.

I was doing bedside for less than a year and I didn't like it.. And now by the grace of God, I'm working as a school nurse.

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TooManyCats has 3 years experience as a ASN, BSN and specializes in Critical Care.

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Having book smarts and being a great test taker are useful skills, but critical care requires a certain level of intuition and on-your-feet thinking that can’t be taught. It’s really not for everyone. 
 

there are lots of nursing positions that *are* task oriented. I would spend some time solidifying your resume with a repetitive, task oriented job (not bedside!).

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JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

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On 11/21/2019 at 10:11 AM, Name9335 said:

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

Essentially you were fired from ALL jobs for issues surrounding incompetency, and that forced resignation (also referred to as resignation in lieu of termination) versus termination is just a matter of semantics for HR/Unemployment purposes.

You have been offered some great advice on this thread.

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1. I also think you should look at your communication skills. The incident you mentioned with the orthotics sticks out to me. Pretty much every time I've had to help someone with an orthotic I've been totally confused by it. I usually have to ask the patient how to do it or often will put it on wrong and then have to take it off and do it again, but I've never had any patients or families upset by this. They usually walk me through it, or I ask another nurse, or we figure it out together, depending on the situation. Seems like the way you communicated in that situation must have put them off or made them feel unsafe.  The same thing was probably at play with the telemetry monitor tech and the CNA. They reported something to you and you somehow made them feel dismissed or like you didn't care. None of the things you mention seem completely egregious for a new nurse, there is likely something else at play here other than just your critical thinking skills. 

2. Also, just because you leave the bedside now doesn't mean it's closed to you forever. Bedside nurses will always be in demand. Taking some time to reflect and grow and mature as you work in another area of nursing might benefit you and build your confidence. Then you could go back to the bedside when you are ready.  I echo the others' thoughts that you should probably just apply to the positions open in your area see what options are available. Also, I think it's reasonable to ask to shadow for a few hours when you're considering taking a job. I think this is a common practice in many places.  

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