Who's afraid of the ICU?

After working three years in the ICU, I want to share my experience of starting out, and how I quickly realized how very little I knew about critical care. Hopefully my story can prevent some of the arrogant mistakes that I made. Specialties Critical Article

Who's afraid of the ICU?

I won't say that I always wanted to be a nurse, but it is a near thing. Even when life got in the way, and delayed my career for several years, nursing was always in the back of my mind.

When I finally did get into nursing school, I was ecstatic. It was grueling and stressful, but never scary. I breezed through tests and clinicals, and I knew I had made the right choice for a lifelong career. I was made for this!

I worked on a busy Med/Surg unit as a nursing assistant and unit secretary during school (which despite being an ADN program took four years due to an extensive waiting list for the nursing program). I believe the experience I gained from that job made me a better nurse, and I encourage all perspective nurses to be a nurse's aide first (trust me, you can tell the difference from those who don't have that prior hands-on care).

Needless to say, when I graduated and started orientation on that same unit, I felt well prepared for what was expected of me. I was nervous, but not scared. My education and previous experience did not leave any room for fear in me. I quickly got the hang of things and was soon comfortable in my new role. I had my time management skills well honed, and was never late with medications or charting. My patients were well cared for, and my call light volume was low, despite heavy patient loads. I just couldn't understand why it took some nurses so long to chart and get their tasks completed.

I completed one full year on Med/Surg before I wanted to spread my wings. I had always been very interested in critical care, and as luck would have it, a spot had just opened up in our ICU--not something that happened very often. I took a chance and applied. Happily, I was accepted.

I went into this job, one year fresh out of school, brazen and cocky. Of course I belonged there--I had done so well in school and out on the floor. This would be a piece of cake. Oh, how quickly I was knocked off my horse!

The ICU was worlds--galaxies--away from Med/Surg. Even though I felt like I knew everything, my coworkers wasted no time in proving me wrong. My preceptor, and ICU nurse for more than twenty years, bombarded me with questions constantly, about things I'd never had to think about before. Not just the "how" and the "why" of things, but the "what else", "what if", and "what do I need to do to change this". These are critical thinking skills that I thought I was using already, but clearly was not. It is hard to critically analyze your patient's care when you're busy completing tasks. I quickly learned that we don't do tasks in the intensive care unit, we manage patients. And it is an absolute must to know what you're talking about at all times. There usually isn't time to look up references when you're not clear on something. And I knew next to nothing.

I would leave every morning after a long and stressful shift in tears. I wasn't good enough, or smart enough, or fast enough for this job. Doubt started creeping in about my life as a Med/Surg RN, and I begun to fear that maybe I wasn't even as good at that job as I so arrogantly believed. There were many days during my orientation that I had to talk myself out of quitting. How could I be trusted with patients' lives?

Slowly, but surely, it got better. I immersed myself in critical care textbooks and journals every day. My eyes would go cross-eyed reviewing my patients' charts making sure I knew everything that could potentially go wrong with them. I asked questions. I practiced. I survived.

It's been three years now, and I look back on that time with embarrassment. It was my own over-confidence that made for such an awful experience. No brand new nurse would be expected to function on the same level as seasoned pros. And a 3.9 GPA doesn't prepare you to recognize minute changes in your patients as an impending disaster...only experience can do that. I still don't know everything, but the difference is, I know that now. I know more than I ever did, and I'm learning more every day, which is the beauty and the point of nursing--that endless supply of new knowledge. I am eternally grateful for my preceptor, who saw right through me, and believed enough in me to make me change and grow. I hope to someday be a tenth of the nurse she is.

My advice to prospective ICU nurses is to be afraid. Something's wrong if you're not scared, and you're most likely not ready. Learn. About everything. Listen to the nurses that have been doing it for years. Stick with it. Nothing is more exciting or rewarding than balancing on that thin line between life and death, and these patients need good nurses. Welcome to the club!

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Trissity

About Trissity, ASN, RN

I have been an RN for four years, and an ICU nurse for the last three. I love (almost) every minute of it!

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Great post! There is a great web resource for new ICU nurses at index. It goes through many of the subjects that you deal with as a new ICU nurse. It is a great place to start if you are just starting out.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Great post.....that site is icufaq's.org

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Very insightful post! Thank you for sharing your experiences. My mom's been a CCRN ICU nurse for many years now and she often tells me various stories of the so called 'drama/events' that go on there, especially with new ICU nurses or arguments with other nurses from med surg. What struck me the most about your post is when you mentioned how a 3.9 GPA won't thoroughly prepare you for what is to come with the challenges presented in ICU. It highlights a bigger issue how some people think learning ends when a program ends and the truth is you never stop learning.

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Specializes in ED, Telemetry,Hospice, ICU, Supervisor.

There is nothing like actual experience to humble someone.

all my experience in my previous career made the transition easier, but still humbling when I got in and started getting my hands dirty.

Yeah a 3.9 gpa is nice for school. But RN school is so different from RN work. I feel you on that

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Specializes in ICU.
...snip...

My advice to prospective ICU nurses is to be afraid. Something's wrong if you're not scared, and you're most likely not ready. ...snip...

I wouldn't say "be afraid" so much as "be paranoid." If you're part way through your shift and everything seems to be going too smoothly, consider whether you're missing something.

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Thank you for that post! I will take your advice to heart! I too want to be in the ICU as I believe that is where I belong. Thank you again for that insight!

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Specializes in Critical care.

It's an amazing place, and as much as I gripe and groan about it, I couldn't imagine being anywhere else. Good luck in your endeavors!

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Specializes in Pediatrics, Women’s Health.

I'm a new grad in a level 1 trauma center SICU. Some days I love it and can't imagine working on the floor, other days I feel like holy crap, I am in over my head. I am super paranoid about double/triple/quadruple checking my drips/critical alarms/restraints/etc. I feel very task-oriented at this point, but I'm assuming that things will all come together after some more time on the unit.

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You just need to remember, all we do is collect data, crunch numbers, and report anything out of the ordinary, and remember to chart the memo that said you notified the doc. Blue collar workers just like everyone else. In reality, hospitals don't pay us to sit there and think, but to follow orders and report anything out of the ordinary...I know we like to make nursing like some fluff and puff high and mighty calling...but it's not, it's a job, and that's the reality of it all.

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Interesting perspective dh07RN. I think that for a long time our profession has experienced this tension between an identity as task-oriented blue collar workers and skilled professionals who are constantly faced with the complex judgments of triaging, prioritizing and educating. Monitoring and assessing the patients, administering treatments and knowing when to call the doctor may sound simple and straightforward but these "tasks" require a fair amount of expertise and carry a high degree of responsibility.

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Specializes in Pediatrics, Emergency, Trauma.
Interesting perspective dh07RN. I think that for a long time our profession has experienced this tension between an identity as task-oriented blue collar workers and skilled professionals who are constantly faced with the complex judgments of triaging prioritizing and educating. Monitoring and assessing the patients, administering treatments and knowing when to call the doctor may sound simple and straightforward but these "tasks" require a fair amount of expertise and carry a high degree of responsibility.[/quote']

^This...our "tasks" have a meaning behind it...our skills in assessment/"investigating" and judgement help identify things missed and help prevent further complications. Each pt is individualized; there are no set rules...we may report issues to the providers, yet we have to assess, and MOST of the time, we are recommending actions and are guiding the plan of care by confirming whether to add, take away, or try an entirely different plan of care, with THOUGHT...not just action behind our clinical practice.

We have moved VERY far away from the "tasks" or "just doing what the doctor ordered"-in the many years I have practiced as a nurse, I have collaborated and many of times, guided care and decisions, especially when there is interdisciplinary team driven environments. Never in my practice has it been "whatever you say Dr." Blindly doing "tasks". :no:

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