Dealing with emergencies

I definitely think that you can acquire this ability by immersing yourself in a more acute environment! Coming from med surg myself, I also was able to remain calm in emergent situations but would think back to what I should have done or could have done better. Then when I switched to ICU I felt like it was going to take forever to feel comfortable and to feel like I know what to do without feeling like I need to go get someone else who knows what they are doing lol. I've only been in ICU for 7 months. One of my preceptors said that it will take a good 2 years to feel really comfortable, and I definitely was super anxious and unsure if myself in the beginning. But I will say that in my daily practice I've definitely started to feel more confident/comfortable and feel like I know what to do in situations that previously I felt kind of frozen in. I still have a long way to go of course, but I definitely can tell the difference. My first day by myself I had a pt who was desatting on the vent and I remember going in and staring at the monitor like oh s***! And then I took a breath and was like you know what to do!! Suction, reposition, chest PT... that ended up fixing the situation but you might have to lavage, bag them, and always remember to get help, call respiratory, etc. Now when something like that happens I feel much calmer and just act on the situation right away. I work with an awesome team of ppl who are always willing to help me and answer questions. I remember my first code off orientation, I was not alone, there were already 3 other nurses in the room with me before it happened and were there helping me with different things. That's really important too, try to find an ICU that has a reputation for good teamwork! You'll do great!

It's about practicing what you know. Maybe you haven't had a lot of opportunities to practice the process of running a code. There's nothing that stops you from learning your institution's process and running it in your head, right? Look for scenario training. Can you shadow the RRT one day? And realize that just because everyone else looks calm, that doesn't mean it's true. Hang in there!

“We don't rise to the level of our expectations, we fall to the level of our training.” -Archilochus

Satisfactory performance in an emergency situation requires self-confidence, adequate knowledge, and swift application. This comes with practice.

In my experience, there are limited opportunities to practice in a safe environment and often education is focused on knowledge acquisition opposed to application. Even if an individual possesses adequate knowledge to deal with a situation, their actions will likely be characterized by hesitation and inefficiencies if they are not given the opportunity to apply their learning and hone their response.

My advice, in your current position, would be to get involved. Anytime there is a rapid response or code situation offer to help. Force yourself to be in the moment. Take everything in. Analyze the actions and decisions of others and yourself and grow from it.

If the ICU is where you would like to see yourself, then you should go for it! The rest will fall in place.

If you are interested, I recently wrote an article discussing my personal experience with high-fidelity simulation. It was an invaluable experience that has greatly boosted my confidence in taking charge during emergency situations. Best of luck!

http://criticalcareinitiative.com/preparing-for-the-worst-high-fidelity-training-in-medicine/