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Considering ICU.... among several other options

Nurses   (2,388 Views | 41 Replies)

Name9335 has 1 years experience .

2,231 Profile Views; 99 Posts

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

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Rionoir is a ADN, RN and specializes in Neuro ICU.

591 Posts; 3,326 Profile Views

I mean, why don’t you even see if you can get a job offer from an ICU before you stress out too much about whether you want it or not.  They are competitive positions. 

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Name9335 has 1 years experience.

99 Posts; 2,231 Profile Views

Just now, Rionoir said:

I mean, why don’t you even see if you can get a job offer from an ICU before you stress out too much about whether you want it or not.  They are competitive positions. 

I don't even want to pursue it if it is not going to come close to fitting my strengths.

 

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Rionoir is a ADN, RN and specializes in Neuro ICU.

591 Posts; 3,326 Profile Views

Just apply for anything that interests you at all and see if you get an interview so you can go talk to them about the job that’s how careers work.  Every interview I’ve done I’ve been able to shadow so I really don’t know why you think that’s a HIPPA violation?  
 

If you look realistically at your resume at this point do you honestly think there’s a reasonable expectation that an ICU is going to feel like you would be a safe hire?

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1 Follower; 764 Posts; 7,187 Profile Views

You have been terminated from three positions.  With each termination, you have been given the same feedback. You haven’t worked as a nurse for six months. Realistically, getting any job is going to be difficult.   And, unfortunately, any bedside position is likely to lead to the same outcome.

While the bedside may not be the best option for you, if you wanted to try it again, I would definitely not recommend an ICU.  You may only have one or two patients, but that one or two patients have a myriad of issues going on that will require you to critically think and prioritize. 

Other than being a good test taker in nursing school, what are your strengths?  Try to capitalize on those. 

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Nurse SMS has 9 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

4 Followers; 6,095 Posts; 48,178 Profile Views

The ICU isn't realistic for you at this point.

There is definitely a difference between "book smart" and "street smart", so to speak. If you can't apply what you know but do well on paper, you are book smart but lack in your application abilities. It sounds like you already know this.

I think pre-op may be a good fit, particularly in an ambulatory setting where all of the patients are elective day surgeries. However, I suspect you won't really be seen as hirable by most of those.

I think a methadone clinic or other outpatient clinic may be realistic for you, depending on the specialty and job duties.

An infusion clinic requires the ability to critically think in a very fast paced, often high stress environment and would not be a good fit.

You aren't likely to get a position as a diabetes educator.

 

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11 Posts; 145 Profile Views

I'm a new grad too, 5 months experience in step-down. To me it doesn't sound like you aren't cut out for bedside, rather you haven't had a solid base of experience with good support. Are their any details you left out? Is their some incident that happened? Because a lack of critical thinking, delegation and prioritization skills sounds pretty standard for a new grad. I'm confused why you've been getting such negative feedback. 

Neuro med surg/step down is a really difficult unit! Did they offer you more orientation time? 

My opinion is that you should get a solid year of experience in a lower acuity unit (like med surg, telemetry) before going to ICU. This isn't because of the feedback you've gotten, or because I think you're dumb or not good enough. It's because if you go to the ICU now, when your confidence is shot, you just aren't going to make it. There is SO much critical thinking in the ICU, trending labs and vitals, checking complicated equipment, managing several drips, monitoring hourly I&Os, thorough assessments. On top of this, the patients are often total care and you don't have a CNA. You will be asked a lot of questions about your patient from other nurses and docs and expected to be an "expert" on your patient. It's really hard, there's a reason there is a ratio of only 1:1/1:2. It's because each patient you have is very time consuming. Even experienced nurses feel overwhelmed by the ICU.

If your dream is acute care nursing don't give up on it yet! You can do it. And when you get comfortable with that, you can move onto ICU confidently. You just need more time. Try to apply to some teaching hospitals! You'll probably get more support. The hospital I work for is constantly training new grads and is really good at supporting them. And sometimes one new grad finishes orientation early, sometimes they need a couple more weeks. Nothing wrong with that!

Some tips!

-if you aren't sure about something just ask another nurse or your charge nurse. even if the question is really basic or you feel like you're annoying people. ALWAYS ask. I call my CN every single shift. 

-if you are running out of time, take a second to make a list of things you absolutely have to do. then ask your colleagues or charge if they can do some of the things on your list so you can focus on the bigger tasks.

-after a shift write down the things you did well, and things you would do better next time. and then try to move on and do something to distract yourself from thinking about your job and obsessing about your mistakes all the time (something i'm guilty of!)

 

 

 

 

 

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Nurse SMS has 9 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

4 Followers; 6,095 Posts; 48,178 Profile Views

6 minutes ago, misha said:

I'm a new grad too, 5 months experience in step-down. To me it doesn't sound like you aren't cut out for bedside, rather you haven't had a solid base of experience with good support. Are their any details you left out? Is their some incident that happened? Because a lack of critical thinking, delegation and prioritization skills sounds pretty standard for a new grad. I'm confused why you've been getting such negative feedback. 

Neuro med surg/step down is a really difficult unit! Did they offer you more orientation time? 

My opinion is that you should get a solid year of experience in a lower acuity unit (like med surg, telemetry) before going to ICU. This isn't because of the feedback you've gotten, or because I think you're dumb or not good enough. It's because if you go to the ICU now, when your confidence is shot, you just aren't going to make it. There is SO much critical thinking in the ICU, trending labs and vitals, checking complicated equipment, managing several drips, monitoring hourly I&Os, thorough assessments. On top of this, the patients are often total care and you don't have a CNA. You will be asked a lot of questions about your patient from other nurses and docs and expected to be an "expert" on your patient. It's really hard, there's a reason there is a ratio of only 1:1/1:2. It's because each patient you have is very time consuming. Even experienced nurses feel overwhelmed by the ICU.

If your dream is acute care nursing don't give up on it yet! You can do it. And when you get comfortable with that, you can move onto ICU confidently. You just need more time. Try to apply to some teaching hospitals! You'll probably get more support. The hospital I work for is constantly training new grads and is really good at supporting them. And sometimes one new grad finishes orientation early, sometimes they need a couple more weeks. Nothing wrong with that!

Some tips!

-if you aren't sure about something just ask another nurse or your charge nurse. even if the question is really basic or you feel like you're annoying people. ALWAYS ask. I call my CN every single shift. 

-if you are running out of time, take a second to make a list of things you absolutely have to do. then ask your colleagues or charge if they can do some of the things on your list so you can focus on the bigger tasks.

-after a shift write down the things you did well, and things you would do better next time. and then try to move on and do something to distract yourself from thinking about your job and obsessing about your mistakes all the time (something i'm guilty of!)

 

 

 

 

 

1. This person isn't a new grad anymore.

2. They have been fired from three independent employers for the same issues. Yes, it is normal for a new grad to have some difficulty with time management, critical thinking, prioritization etc, but most of the time, they are able to improve enough to function during their orientation time. This leads me to believe, given three places have said the same things and terminated employment for the same reasons, that the OP has a struggle that is not typical in its scope.

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11 Posts; 145 Profile Views

Just now, Nurse SMS said:

1. This person isn't a new grad anymore.

2. They have been fired from three independent employers for the same issues. Yes, it is normal for a new grad to have some difficulty with time management, critical thinking, prioritization etc, but most of the time, they are able to improve enough to function during their orientation time. This leads me to believe, given three places have said the same things and terminated employment for the same reasons, that the OP has a struggle that is not typical in its scope.

You're right she's not a new grad, but she's had less than a year experience in both of her acute care jobs. I'd say it's pretty normal for her to be struggling with a lot of the same issues a new grad does. And at the time of her first job where she got negative feedback, she was a new grad. 

I acknowledge that it is concerning that she's gotten negative feedback from all three of her employers, but without more details about what she's doing wrong I fail to see anything she's doing is fire-able. It may be she's struggling more than the average nurse, but without more info imo it sounds like she hasn't been getting proper training either. 

Her first job she worked from July until October before she resigned, she wasn't fired. And it sounds like that ruined her confidence, which then affected her performance in her next job. The second med-surg job she didn't clarify if she was terminated or resigned.  

There are plenty of new grads I work with that need extended orientations because of similar concerns, they get it, and then they do fine and are now good nurses. She only worked July through October in her first job before resigning!! If OP is able to practice safely and ask for help when she doesn't know something, I don't see why her employers have these issues. I feel like i'm missing some information. 

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RNNPICU has 13 years experience as a BSN, RN and specializes in PICU.

1,057 Posts; 12,333 Profile Views

OP:

I  think you really need to look at what your three employers have said to you. If after a year and a half at the nursing home providers were still having issues with your performance, you need to really think about what has been told to you. I do not think ICU would be a good fit, it is extremely fast paced, you sometimes need to make split-second decisions, and there is an expectation to move quickly. 

Even out-patient setting such as a clinic, you will see volumes of patients quickly in a short period of time.  

Since you have worked in three different settings and there is a common theme, maybe talk out what the underlying problem is.  I don't think this is just a new grad taking more time. 

Could you tell us what the common theme was? Working with your counselor/coach is a good idea. 

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1 hour ago, misha said:

My opinion is that you should get a solid year of experience in a lower acuity unit (like med surg, telemetry) before going to ICU.

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. OP I don't know what to tell you. Do you have an ex-coworker that you trust who you can sit down with and have an honest, albeit difficult, discussion about what your exact failings are? Once you are able to identify the specific issues you may be able to work on them or find a position that can work around them. For now I think ICU is a terrible idea and I'm sorry to say all your other ideas aren't much better because they all require the ability to critically think on your feet. Maybe an evaluation by a mental health or job counselor might help you figure out where it is you are falling short of the mark. I wish you well.

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RNNPICU has 13 years experience as a BSN, RN and specializes in PICU.

1,057 Posts; 12,333 Profile Views

1 hour ago, misha said:

There are plenty of new grads I work with that need extended orientations because of similar concerns, they get it, and then they do fine and are now good nurses. She only worked July through October in her first job before resigning!! If OP is able to practice safely and ask for help when she doesn't know something, I don't see why her employers have these issues. I feel like i'm missing some information. 

Misha:

the OP worked Job #1 July - October

                         Job # 2   1 month

                        Job #3 (Nurinsg home job) 1.5 years

She wouldn't be eligible for any new grad position, especially with the 1.5 years of work there. I too wonder what the issue was unless it is safety.

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