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Distractions & interruptions: ICU vs. other units?

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by Lemon Bars Lemon Bars (Member)

3,648 Visitors; 133 Posts

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I could use some advice, please. I am a new grad BSN who has had to resign from my first two nursing jobs. I have non-hyperactive Attention Deficit Disorder, so distracting environments and frequent interruptions kill my productivity and my sanity. I have been in the ICU three times with my preceptors. Each time that I arrived on the ICU from another unit, I felt a great sense of relief. It is quiet in the ICU. Each nurse has only one or two patients. Each patient has vital signs displayed on a monitor right in front of the nurse, and all necessary equipment is in the room, not scattered throughout the hallways like on the other floors.

 

I know that the ICU and similar units are considered more advanced care, and I know that the patients are often unstable. I've been told that one must gain experience in other units before advancing to critical care, but I think that the ICU (or maybe an operating room) might be the only place in the hospital where I can focus and get my work done. I see that there are some new grad training programs that place new grads into the ICU setting. Does anyone have experience as a new grad in an ICU or experience precasting a new grad in an ICU setting? Thank you for any information or advice on this topic. 

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4,871 Visitors; 386 Posts

Critical care units absolutely have distractions and unpredictability. We constantly rotate through new admits and transfers out, patients have rapid changes in their presentation that require immediate intervention. There also isn't equipment for everything in every room. We still only keep one ultrasound for the nurses and providers on each unit, one bladder scanner, and so on.

I don't mean to sound rude but if you can't prioritize in a SNF or step down unit then you really shouldn't be in an ICU where there are critical patients.

If you really believe that your ADD is keeping you from being successful then maybe you need to manage it before getting back into nursing.

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4,771 Visitors; 297 Posts

Point:

It may be unwise of me to disclose this information here, but I also have non-hyperactive ADD, and I personally have found that the ICU environment is the environment most well-suited to my particular psyche. I get to dig deep into individual patients, treatments, and disease processes and develop an understanding of what I'm treating and why, rather than just being blind-sided by a mountain of competing demands and priorities that come with med-surg and other areas of nursing. At the same time, I get to work on my feet on a fairly absorbing task - which is why I got into nursing and out of desk jobs in the first place.

Counterpoint: 

Don't be dishonest with yourself about the difficulties you've been having. They need to be addressed, and a switch to intensive care is unlikely to fix all of your problems. I worked in med-surg for years, and the transition to ICU was difficult for me - it will not be any easier for someone with little nursing experience at all. The ICU still has many distractions. The ICU still has big personalities, competing demands, frustrating and boneheaded administrative initiatives, etc. As ADD goes, I've been building a kind of system and habits that work for me in the profession for over 10 years - the right environment helps, but it's only one small aspect of finding how to best function in your career. 

You didn't explain enough about exactly the kinds of difficulties you've been having in your prior jobs for me to comment intelligently on them. Feel free to do so or not as you'd prefer - but if you don't, I encourage you not to chalk them up solely to a single simple problem like constant interruptions in your prior jobs. You'll always have interruptions. The main reason why intensive care works best for me is that I find it more interesting than other areas of nursing, not because it's the perfect environment for my disorder. 

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CampyCamp has 18 years experience as a RN.

572 Visitors; 115 Posts

Cowboyardee's experience is not everyone's but it is mine. I'm not hyperactive (not by a long shot) but I have difficulty with time management. I also have tenancies to hyperfocus. Having 2 severely sick patients is much better for me than 6 med-surg level patients. Even 3-4 in step down cause me to frazzle. If they have roommates, forget it. I'll try to do anything for them that the roommate's nurse isn't. I can't do my charting while someone's needs are unmet. Charting? That's where I'm at my most distracted. I have a lot of trouble focusing on computerized flowsheets because I'd rather pitch in with any other unit activity whether it's a code or turning a 350kg pt to change a Pseudomonas infected dressing. Just get me away from the flowsheet! I did find that it was best for me to chart in the room where I was less distracted and could easily peak over my shoulder because I forgot *again* if the PIV/dressing/pulse ox/art-line/etc is on the right or left. Know your weaknesses and work on them. Mine were worse if I was tired and I sometimes set buzzing alarms on my phone for meds or precisely timed I/O and CRRT checks. I also knew how to prepare my room for max efficiency at the start of shift and lay out my report sheet consistently and check off complete tasks. Remember, you have more info displayed right in front of you but you are also expected to remember more labs, fluid balance, when the last lab was, etc off your head when doctors ask. With my hyperfocusing, I thrived there. 

I was not a new grad in ICU. I actually went there from OR. I did precept many new grads though and work with them. Regardless of where you come from, you will do some kind of critical care course with computer modules and plans on increasing hands on skill. Ask in interviews what to expect and don't take a job where they don't have a consistent proven program. Do a shadowing interview and ask how new grads are doing. Just remember, pt safety is more important than pride (and a lawsuit is very damaging to pride) so if you don't fit, bow out gracefully. No shame. Many nurses do, for many reasons. In the end, I did for my own reasons that kept me from being as successful as I wanted to be. 

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Regardless of where you work, time management is one of the most important things to master.   I have found (and most experienced nurses will agree) that one of the most helpful tools is a form that you create, of the tasks that you have to do everyday.  You can look up templates on line, or create your own. But it entails sort of a chronological schedule of things you have to do.  Scheduled meds, lab draws, dressing changes, checking sugars, etc.  As you get report you fill out the pertinent stuff about your patient, and fill in the tasks.  Check them off as you go.  Meds and blood sugar checks are usually done at specific times, so you can put dressing changes and other stuff at less busy times.  It is extremely difficult (if not impossible) to time manage in your head. Every unit has its distractions.  Wait until your in ICU and the occlusion alarm starts going off every two seconds because the confused patient keeps bending their arm.  Or the same confused patient tries to get out of bed every 5 minutes.  There are quiet days, but you WILL go home hearing the call bells in your head all night long.  

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3,648 Visitors; 133 Posts

8 hours ago, CampyCamp said:

Cowboyardee's experience is not everyone's but it is mine. I'm not hyperactive (not by a long shot) but I have difficulty with time management. I also have tenancies to hyperfocus. Having 2 severely sick patients is much better for me than 6 med-surg level patients. Even 3-4 in step down cause me to frazzle. If they have roommates, forget it. I'll try to do anything for them that the roommate's nurse isn't. I can't do my charting while someone's needs are unmet. Charting? That's where I'm at my most distracted. I have a lot of trouble focusing on computerized flowsheets because I'd rather pitch in with any other unit activity whether it's a code or turning a 350kg pt to change a Pseudomonas infected dressing. Just get me away from the flowsheet! I did find that it was best for me to chart in the room where I was less distracted and could easily peak over my shoulder because I forgot *again* if the PIV/dressing/pulse ox/art-line/etc is on the right or left. Know your weaknesses and work on them. Mine were worse if I was tired and I sometimes set buzzing alarms on my phone for meds or precisely timed I/O and CRRT checks. I also knew how to prepare my room for max efficiency at the start of shift and lay out my report sheet consistently and check off complete tasks. Remember, you have more info displayed right in front of you but you are also expected to remember more labs, fluid balance, when the last lab was, etc off your head when doctors ask. With my hyperfocusing, I thrived there. 

CampyCampRN you are describing experiences similar to mine. I think my brain must work in a similar way to how your brain works. Thank you for your comments. 

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3,648 Visitors; 133 Posts

"Regardless of where you work, time management is one of the most important things to master.   I have found (and most experienced nurses will agree) that one of the most helpful tools is a form that you create, of the tasks that you have to do everyday.  You can look up templates on line, or create your own. But it entails sort of a chronological schedule of things you have to do.  Scheduled meds, lab draws, dressing changes, checking sugars, etc.  As you get report you fill out the pertinent stuff about your patient, and fill in the tasks.  Check them off as you go.  Meds and blood sugar checks are usually done at specific times, so you can put dressing changes and other stuff at less busy times.  It is extremely difficult (if not impossible) to time manage in your head. Every unit has its distractions.  Wait until your in ICU and the occlusion alarm starts going off every two seconds because the confused patient keeps bending their arm.  Or the same confused patient tries to get out of bed every 5 minutes.  There are quiet days, but you WILL go home hearing the call bells in your head all night long."

 

I appreciate you taking the time to reply, nursy. However, I have already been operating using the types of schedules, checklists and notes that you are suggesting. Under no circumstances would I ever try to keep track of everything just in my head. Staying organized definitely helps and keeps me from forgetting many important tasks now that I understand the routine of how a nursing shift works. But even when I'm organized, I find that it takes some time to recover from interruptions and hard to be efficient in my work with distractions. Forgetting tasks is no longer my biggest issue; it's recovering from interruptions and getting work done despite distractions so that I can finish all of my tasks in a timely manner that is the biggest obstacle now. 

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4,118 Visitors; 339 Posts

I was going to post the same thing about having a checklist for your tasks, but I see that you mention that it doesn't help fix the root of your problem. 

I also have ADHD and working in the ICU is the best environment for me. I started in ICU as a new grad. However, keeping myself organized and embracing the crazy of the ICU has worked for me. A very large part of working in ICU is managing distractions. Whether it be alarms, family members, patient needs, critical changes, frequent meds/labs, etc. It is by no means a low distraction unit. And if you're ever lucky enough to have a simple, straightforward night, I can pretty much guarantee that one of your neighbors will need help with their patient load. Maybe an outpatient type of setting would be easier for you to start out in?

Are you on meds for your ADHD? Taking meds really helped me a lot, especially as a new grad. It helped with my hyperfocus issues. 

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3,648 Visitors; 133 Posts

Thanks everyone. I have a couple of applications in progress for outpatient clinics. I was trying to get the recommended hospital experience before branching out, but I might have to skip the hospital part. I'm already on medication for ADD and I do my best to be rested and ready for every shift, but apparently it is not enough.

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787 Visitors; 38 Posts

Hey I'm also thinking if I might have similar problems with getting distracted and having to "recover" vs. being able to hyperfocus (when I really know my patients, I really know it and can recite things from memory pretty well and be surprisingly accurate). 

Someone I interviewed with today said I sound like I might be suited for the ICU with less patients. I also wondered if outpatient might be the way to go. Anything where it's not like more than 4 or more patients seems to work for me. I can handle 3 or 4 stable patients, but throw in 2-3 acute patients and if they're total care it becomes completely insane. 

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CCU BSN RN has 7 years experience and works as a Staff RN.

4,088 Visitors; 239 Posts

I absolutely have inattentive type ADHD and mild autism, and I find the ICU to be the best setting for me. I also find that about half of my colleagues have fairly severe ADHD as well, which should absolutely tell you something. 

A lot of the pros/cons have already been said, but additional things I have to offer:

1. The ICU has a lot of strong personalities. This is usually looked upon as a negative thing. But it also means that your co-workers are used to working with quirky and sometimes difficult people. I love the tolerance/acceptance that I get from my colleagues, and I do my best to give it right back to them when they're being difficult. In ICU you NEED to work together as an effective team to keep everyone alive. You need to know that while you're holding pressure from an oozy sheath you just pulled, someone will titrate your levo on your other patient. So if you help out your colleagues like this, and generally don't kill people, they'll overlook the fact that you suck at giving report because your Adderall has worn off before shift change, or that your room is mildly untidy, or whatever.

2. There are still distractions/noises/interruptions, sure, but they're different and many of them you have more control over. We have a policy allowing us to change all our alarms on monitors to +/- 20 percent of patient's baseline. Some of my colleagues aren't meticulous about this, but most don't mind if I change their alarms for them (with permission/notifying them, obviously). Much of what I'm interrupted with on a typical day is actually important to the patient's well-being. For me the worst on less acute floors was patients constantly yelling out, televisions blaring, and prioritizing the needs of 7-9 patients who all want/need SOMETHING. There's less yelling out when half the floor is intubated, and you have a better chance of being able to medicate problem behaviors because agitated patients can easily de-line themselves, pull a chest tube, render your telemetry useless with constant motion artifact, etc. Think about what specific types of interruptions make you crazy, and which ones you don't really mind. That's probably where you'll find your answer.

 

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