Do I stand a chance at being successful?

[AesthesiaSeeker]

(This is a cross post previously posted in the careers section. Idk if I'm breaking the rules by doing this but I just wanted to post this and apologize ahead of time in case I am).

Hi Y'all,

So I seriously need help.

Long story short, I was accepted into a critical care program with a renowned hospital system in the DFW area. But for a month my recruiter was sending interviews, phone screenings, etc to [email protected] to [email protected].

There is no @ICOULD.com. For a month he just assumed I wasn't interested and never even bothered to call. I had to call his department in order to get a hold of him. By the time I contacted him he told me that all the positions had been filled. He asked me if I would be interested in going to the Central Texas area and I said yes. So I contact the recruiter who essentially tells me all the positions I wanted had been filled. BUT I found a challenging unit that I thought if I did well in would impress the ICU management once the time came. I started on the unit, my orientation was HORRIBLE and I learned close to nothing during that time, and then when I got on my own I tried to go into work and do the best I could with everything I had every day.

That was 5 months ago.

Three days ago, I was called into my director's office where my manager was. They told me that over the past two weeks my rating during pt rounding was low. There was also an incident where (I screwed up on this one) during a pt. assessment a nitro patch came stuck to the inside of my pt's gown but the paste was still on his body. He had suffered a lot of trauma and the paste on his body was right where a wound was. I told the night nurse that he was refusing all medications and that 'he stated he wanted to die' and was put on hospice. Why she put another nitro patch on him is beyond me but I'm the one that had to take the bullet for it.

They told me I didn't have the time management skills to excel on this floor OR in the ICU

Tbh I HATED this job. Each day I had 5-6 stroke/epilepsy/brain injury/total care pt's that were on my own. It was hell. I truly hated it but at the end of the day I got the job done. The unit was a revolving door, each pt stayed approximately two days and between everything that was going on with all the patients, all their families, for 5-6 people...it was hard.

It was very different from my last experience. For my preceptorship I did 90 shifts at a Neurosurgical ICU. While I was there with my preceptor I worked up to taking total care of not ONE but TWO of her patients. I learned how to titrate drips from her, I spent 4 shifts with following a respiratory therapist learning all about ventilators and looking at breathing waveforms. I loved it and the staff on the floor said they loved me.

Anyhow in January a new nurse critical care orientation group starts and I am debating applying. But I want to make sure that I'm ready for it.

Please give me your thoughts and your opinions.

[MDMBSNRN]

If you're really dedicated to it, and you really want to do ICU, then I think the critical care orientation group is something you should consider. With you having no ICU experience as a bedside nurse, I would be interested to know how long the program lasts, if you will also be receiving critical care education in a classroom setting, and how long you will be percepting on the unit you are assigned to. Having just two patients in ICU does sound much easier than having 5-6 patients in a step-down setting, but, in reality, it often isn't. As you saw during your time in ICU, we only take two patients for a reason.

Also, as you stated, time management is important in ICU, but flexibility is also key. You can have your day planned out nicely, and, suddenly, one of your patients decides to become acutely hypotensive/code/have an acute mental status change/experience a dangerous arrhythmia/desaturate/any number of issues. Before you know it, your nicely planned hours turn into a central line insertion, an intubation, an arterial line insertion, a trip to CT, drawing numerous labs, adding five new drips, and actively working to stabilize your patient. When you finally get out of the room, you realize you haven't personally seen your other patient (who probably isn't the picture of stability) in two to three hours, and you have multiple new orders/meds to give/labs to draw.

I find that this need to have a formulated, well-organized plan for the shift, coupled with the frequent, and sudden, deviations from said plan is often what frustrates new ICU nurses. Experienced ICU nurses are by no means immune to this, but I feel like it is quite the shock to those who have never worked in a critical care setting.

Also, I have never worked in an ICU that employed CNAs/techs. This means that in addition to all the nursing tasks you are worried about, you also have to find time to turn your patients every two hours, perform oral care every four hours, empty all drains as indicated, and bathe your patients. If you have patients that are able to eat/walk, you are also looking at ensuring they get three meals a day (on day shift), and ensuring that they are up in the chair/walking, and tolerating the activity.

I love critical care, and it is definitely my favorite of any area I have ever worked in. With that being said, there are still nights that I feel as if I'm being pulled in a million directions at once, and wonder how I will ever get everything done. If you are truly passionate about critical care, then I say go for it. Time management is something that we as nurses, no matter how long we have been working, should strive to improve each day. More and more responsibility is being placed on bedside nurses, and, unfortunately, staffing often doesn't reflect these additional responsibilities.

[AesthesiaSeeker]

MDMBSNRN

Thank you very much for your input. You make a lot of very good points. I've had a bit of experience to that, not to the degree of which you're stating, on my unit now when a pt's NIH stroke scale changes and then has to be rapided or if one of my patients turns septic.

You have really given me a lot to think about and I have many decisions and things, weighing the pros and cons.

As I find out more details about the program I'll post them and let you know!