Experienced nurse, but new to trauma ICU

Published

I am a nurse and I'm going on having 5 years of experience. Two of those years were in a SNF as a wound care nurse and two were in an LTACH. In LTACH, I worked with vents, trachs, ET tubes, tele and some medicated drips. The nurse to patient ratio was 5 to 1. To make a long story short, in March the LTACH I worked for closed (also, nicely, right when I was in my last semester for my RN to BSN) and luckily I was able to pick up a job in what I wanted to work in since graduation: a neuro/trauma SICU in a teaching hospital. I love it there, but I've found out that because I had experience, they are trying to give me a faster orientation. I was not told how long of an orientation I would have specifically, but after only 5 weeks of pure floor orientation (because I was being scattered between classroom and floor orientation the first 3 weeks), I was told I was not as far as expected and possibly moving me to a step-down or med/surg unit (however they still want me to do the required critical care/trauma education). Honestly, I think this is a bit much. I found a neuro/trauma ICU to be a completely different world than LTACH. I needed to learn a new hospital and charting system, learn a new way of thinking, even a new way of giving hand off report, etc... (honestly, even our vents are completely different than what I have worked with in the past). I've received an action plan of what I've expected to improve in and to improve on that in three weeks. If I do not improve, it will be discussed if I should be moved to a lower level of acuity. I am really improving on things currently, however recently I've been pressured by my preceptor to not stay late to finish up charting like care plans or teaching records, which are required. That I should have all this charting finished in addition to charting the hourly full-assessments on my two trauma patients. I really really love this job and I am willing to learn and improve, but I feel so pressured to get this new floor and hospital system down perfect and do it fast. Is it just me? Or am I really not cut out for this? I've been so depressed and stressed out over this. As I said, I love the floor and I love the hospital I work for and am willing to learn and improve, but I constantly feel like I'm not doing "good enough".

Up Vote Up Vote ×

Hey Susie, sorry to hear about this :( Sounds like you're working really hard and doing really well! Honestly though, there is a LOT to learn in the ICU, particularly in the neuro trauma specialty.

From my experience, if your educator does not want to give you a longer orientation time, then you could always ask your manager to let you go to a step down unit or something for say... 6 months, so you can adjust to the hospital, acute care nursing, charting, report etc. THEN to transfer back to the ICU. Step down is stressful in its own way, but it can make this transition a little easier on you.

Up Vote Up Vote ×
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

LTC to ICU is a difficult transition. You have to alter your way of looking at patients, goals and outcomes as well as learning the new policies and procedures, charting system, heirarchy, etc. It's not unusual for a nurse to have difficulty making the transition from LTC to ICU, especially an ICU as specialized as the one you're in. Work as hard as you can on improving, but if they offer to move you to a less acute unit, take the opportunity. Sometimes the jump is just too great and you'll be better off for taking it a bit more slowly. Some of the best ICU nurses I know failed their first ICU orientation and went to a less acute level of care of a year or two before trying it again.

Up Vote Up Vote ×

Update: I did improve in all areas needed in the alloted time, however they still did not feel I was ready for that ICU and HR would not allow for more orientation time. They asked me to resign from my position today, which I did in my best interest. The good is that I can apply as an internal candidate still. I plan on applying for step down, get my foundation there and work my way back up. It was a rough decision, but I defintely feel less pressure right now. I will get there!

Up Vote Up Vote ×
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Sorry to hear that you've been asked to resign. I hope you land a position in stepdown! Good luck!

Up Vote Up Vote ×

Sorry to hear they asked you to "resign"... that word sounds so punitive!! I'm glad that you're taking the stepdown route, I know personally it was stressful but not as taxing as the ICU and you'll be able to build a wonderful foundation. Good luck and I can't wait to hear what experiences find yourself in!! :)

Up Vote Up Vote ×

Applied for tons of jobs. The only interview I got was with an ICU in a smaller hospital in the network. Thought the interview went well and thought it would be a "better fit" (smaller unit with less patient acuity), but didn't get the job. The manager of the unit I interviewed for told me to continue the ECCO course, since it was still good for a year (my previous manager told me to not continue with it since at the time they were paying me to do it), but I found out after my interview my membership was cancelled! I really want to feel like I'm doing something to become a better ICU nurse because I thoroughly enjoy ICU nursing! I've applied for med/surg and step downs in the network, but haven't gotten any calls! So, still applying. Also applying to other hospitals and put an app in for another LTACH. This is so frustrating. I fear that I'm going to end up going backwards or nowhere at all.

Up Vote Up Vote ×
Specializes in SICU.

It's not easy to find a job. It might take a couple months even. Stick with it and don't get discouraged!

Up Vote Up Vote ×

Got offered a position finally after close to 2 months of applying! It's at a different hospital (it's actually a Magnet hospital) in their rehab hospital. They have a great critical care course and when I interviewed with the unit manager she encouraged me taking the hospital's critical care course after I get myself settled in the network. They also have a TNCC course I can take. I think it's a better fit to start in something I'm comfortable with in a new hospital and work my way up. I def learned that with my last position. Very very pleased right now :)

Up Vote Up Vote ×
Specializes in Pediatrics, Emergency, Trauma.
Got offered a position finally after close to 2 months of applying! It's at a different hospital (it's actually a Magnet hospital) in their rehab hospital. They have a great critical care course and when I interviewed with the unit manager she encouraged me taking the hospital's critical care course after I get myself settled in the network. They also have a TNCC course I can take. I think it's a better fit to start in something I'm comfortable with in a new hospital and work my way up. I def learned that with my last position. Very very pleased right now :)

Congrats!!!! :up::up::up::up:

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.

Congratulations!!

Up Vote Up Vote ×

That's a good decision. Maybe you've been shocked of the situation. anyway, starting your way down going up is a lot better. Don't feel down hearted, there is always a reason. and remember to never lose your compassion, many patients will benefit from you. :)

Up Vote Up Vote ×
+ Join the Discussion