Feeling wiped out, overwhelmed, etc.

Trauma Columnist · Oct 13, 2007

Hi there...please take a deep breath and relax! Your frustration is so evident in your post. Please don't give up. You have to give yourself a break. If you knew everything before you started a position, there wouldn't be a need for orientation - lol. And then what would preceptors do?

Seriously, doing critical care is hard work. It can be mind-numbing at times. However, it does get easier. In six months, you will be able to handle these babies with ease and just KNOW what lab tubes are for what test. Have you asked for some hints from some of these experienced nurse? Have you spoken with other new grads? I would bet they are in the same boat - frustrated and sad.

I see that you are 30, so you probably have done other jobs in your life too. Were you an expert the first day on the job? Did you feel frustrated and perhaps sad during orientation? These are normal feelings when we get out of our comfort zone.

Please hang in there - it does get easier.

crazybusyRN · Oct 13, 2007

OK, I was thinking about your post, and had to reply. You sound like you could be one of my orientees, so I'll tell you what I tell them...

Do you feel that your preceptors think you're too slow because they said something, or because you can't do things like they can? They have been doing this for years (hopefully). It's OK to not be like they are, and if they are good preceptors, they don't expect that of you. The goal of orientation is to help you become a competent, safe, NOVICE nurse. It's a learning curve LONG after orientation (actually, forever).

And OK, maybe carrying around a binder of key info isn't feasible, but why not notecards? Or take a look at how your labs requisition slips look... odds are it tells you right on there which tube to use. The key for the information overload of learning in a critical care environment is, don't memorize what you could look up. Can't imagaine a situation in which you can't take a minute to look that up... focus on things that are need to know, like how to deal with emergencies.

And the last thing is... try to breathe. Critical care IS hard, especially with babies. It's easy to feel overwhelmed about such a lot of tubes and wires in such a small body, and managing all of it is hard! Trust your preceptors, and ask for feedback, so you don't just hear that voice in your head saying, you could have done that better. Hear THEIR voices saying, you've come a long way! You did great with X, and next time we'll work more on Y.

Hang in there!

bubbly · Oct 14, 2007

Chero, I am in exactly the same boat as you are! I just graduated nursing school in May and have started working on the NICU floor in July. I just finished my 12 weeks of internship today and fortunately will get 12 more weeks in Level 3 as an orientee. Everyday I try real hard to keep up, but it is very difficult sometimes to keep ahead of everything. I have had many stupid and incompetent moments being a newbie, wondering if I would trust myself taking care of my own baby (if I had one that is :) ). I have had really wonderful support at my hospital and my preceptor has been great. Even today, I almost forgot to feed my baby on time because I left it off my cheat-sheet and I still have trouble with those heelsticks! Vent babies are very difficult to turn! I actually dread turning them because I know I am slow with them and hate how fast they can destat while I try to get them repositioned and untangled from their wires. And they are so delicate, I worry so much about hurting them. But, it does get better. You can learn so much from your mistakes. Practice does help! I am nowhere near perfect, but my preceptor who has a lot of precepting experience and 20 years of NICU experience thinks I am right on track. Just keep hanging in there. The most important thing is that you care about your babies and you have motivation to learn. My preceptor still has to remind me somethings because I feel like I am on information overload a lot and it can take some time for everything to sink in. Good luck with your internship and feel free to PM me about your experiences or need any advice or tips from another NICU newbie!

Kate :)

cherokeesummer · Oct 14, 2007

Hi there...please take a deep breath and relax! Your frustration is so evident in your post. Please don't give up. You have to give yourself a break. If you knew everything before you started a position, there wouldn't be a need for orientation - lol. And then what would preceptors do?
Seriously, doing critical care is hard work. It can be mind-numbing at times. However, it does get easier. In six months, you will be able to handle these babies with ease and just KNOW what lab tubes are for what test. Have you asked for some hints from some of these experienced nurse? Have you spoken with other new grads? I would bet they are in the same boat - frustrated and sad.
I see that you are 30, so you probably have done other jobs in your life too. Were you an expert the first day on the job? Did you feel frustrated and perhaps sad during orientation? These are normal feelings when we get out of our comfort zone.
Please hang in there - it does get easier.

Thank you so much for your post. Yes its easy to see/feel/hear my frustration in my post. Thankfully I felt better today and not so dramatic about the whole thing. I keep reminding myself that I was put here with purpose. I guess for me its hard to go from being really good in nursing school and accomplishing such a big task to now being...duuuuuuh again! LOL!

Yes I have done a few things before nursing, I was a fast food worker, a callcenter employee, administrative assistant and then human resources and recruiting coordinator LOL! So done a few things and they were all different. I did feel new and somewhat overwhelmed with those jobs but not nearly like I do now, though I guess that could be why it takes more education to do what I do now LOL huh?! :):)

Thank you again for the kind words of support, I will keep coming back to this post when I feel overwhelmed.

cherokeesummer · Oct 14, 2007

OK, I was thinking about your post, and had to reply. You sound like you could be one of my orientees, so I'll tell you what I tell them...
Do you feel that your preceptors think you're too slow because they said something, or because you can't do things like they can? They have been doing this for years (hopefully). It's OK to not be like they are, and if they are good preceptors, they don't expect that of you. The goal of orientation is to help you become a competent, safe, NOVICE nurse. It's a learning curve LONG after orientation (actually, forever).
And OK, maybe carrying around a binder of key info isn't feasible, but why not notecards? Or take a look at how your labs requisition slips look... odds are it tells you right on there which tube to use. The key for the information overload of learning in a critical care environment is, don't memorize what you could look up. Can't imagaine a situation in which you can't take a minute to look that up... focus on things that are need to know, like how to deal with emergencies.
And the last thing is... try to breathe. Critical care IS hard, especially with babies. It's easy to feel overwhelmed about such a lot of tubes and wires in such a small body, and managing all of it is hard! Trust your preceptors, and ask for feedback, so you don't just hear that voice in your head saying, you could have done that better. Hear THEIR voices saying, you've come a long way! You did great with X, and next time we'll work more on Y.
Hang in there!

Hi there, I LOVE your user name! :):) Thanks for all of your kind words of support. No I haven't had anyone say that I was being too slow yet, just reminding me as needed that I have x or y or z to do and that we need to do it in x amount of time and to be quick at some times or take my time at others. So never anything other than supportive and gentle reminders. I've been lucky to have some very patient and kind preceptors. But I do know that I'm slow and it is hard to not compare to others but I know most of the ones I work with have been nurses for a loooooooong time so it will definitely be a while before I get that fast and controlled.

Thank you for the support. Yes I think note cards would be a good idea, maybe I can compile a few tidbits here and there of important stuff to know. I have a few days off in a row next week before I start night shift so maybe I can get that done then. Though from what I understand I will be doing a lot of new stuff on night shift too! More to learn! :monkeydance: :uhoh3:

cherokeesummer · Oct 14, 2007

Chero, I am in exactly the same boat as you are! I just graduated nursing school in May and have started working on the NICU floor in July. I just finished my 12 weeks of internship today and fortunately will get 12 more weeks in Level 3 as an orientee. Everyday I try real hard to keep up, but it is very difficult sometimes to keep ahead of everything. I have had many stupid and incompetent moments being a newbie, wondering if I would trust myself taking care of my own baby (if I had one that is :) ). I have had really wonderful support at my hospital and my preceptor has been great. Even today, I almost forgot to feed my baby on time because I left it off my cheat-sheet and I still have trouble with those heelsticks! Vent babies are very difficult to turn! I actually dread turning them because I know I am slow with them and hate how fast they can destat while I try to get them repositioned and untangled from their wires. And they are so delicate, I worry so much about hurting them. But, it does get better. You can learn so much from your mistakes. Practice does help! I am nowhere near perfect, but my preceptor who has a lot of precepting experience and 20 years of NICU experience thinks I am right on track. Just keep hanging in there. The most important thing is that you care about your babies and you have motivation to learn. My preceptor still has to remind me somethings because I feel like I am on information overload a lot and it can take some time for everything to sink in. Good luck with your internship and feel free to PM me about your experiences or need any advice or tips from another NICU newbie!
Kate :)

Thanks Kate, yes we definately sound like we are in very similiar boats! Did you always know you wanted to do NICU? I decided to try NICU after my son was born in 2005, in the middle of nursing school and he was in the NICU, only for one day for low blood sugars but it made a difference to me to see the nurses care for the babies and how they treated me and my son. It was very important for me.

Thanks for the support and kind words, I hope that we both find a good realm of comfort in the NICU soon. :):) :lol2:

Imafloat, BSN, RN · Oct 14, 2007

Cherokee, please be gentle with yourself. You sound a lot like me, in that you are your own worse critic. I used to pick myself apart on the way home, and then go to work the next day and say something to my preceptor about how I could have done things better, etc. My preceptor would just look at me and say honey, you are doing just fine, I didn't even think twice when you did this or that. I have been in the NICU since January. I didn't turn a vent baby all by myself until I was on the unit 9 months (just a couple of weeks ago). I always called respiratory to help me, and I usually turned in conjunction with suctioning. Also, if a baby extubates, it isn't the end of the world.

I told my previous preceptor that I made a big stride in my nursing practice, by turning a vented baby by myself and she told me that she never doubted me, because I ask for help until I am sure I can do something safely. That made a lightbulb go off in my head, you know, maybe I am slow at some things, but I am safe, and when you are new being safe goes further in the NICU than being fast. Sometimes I might not leave until an hour after my shift is over, but all my babies have been safely cared for, are clean, fed, and tucked in. I have learned over time that some people that are efficient aren't extremely thorough. Many of my coworkers have been nurses on this unit for 20+ years, there is no way I can even compare myself to them. It would be like comparing my daughter who just started gymnastics to an olympic gymnast.

As for the notebook, who says you can't carry one? I have a little pocket sized one that I wrote things down in that I needed to remember. I don't use the notebook anymore, I did lend it to one of our new orientees and it is in my locker in case something new comes up or someone else needs to borrow it.

Don't leave your job, what you are feeling is normal. Being a nurse is like riding a rollercoaster, and when you are in the valley you just need to remember that what goes down goes up and things will be better again. Just hang in there.

You can PMail me if you ever need to.

bubbly · Oct 15, 2007

Thanks Kate, yes we definately sound like we are in very similiar boats! Did you always know you wanted to do NICU? I decided to try NICU after my son was born in 2005, in the middle of nursing school and he was in the NICU, only for one day for low blood sugars but it made a difference to me to see the nurses care for the babies and how they treated me and my son. It was very important for me.
Thanks for the support and kind words, I hope that we both find a good realm of comfort in the NICU soon.

I started nursing school not really knowing what specialty I wanted to go into. After spending my clinical rotation day in the NICU during my second semester, I knew I had found my calling. I love working with the babies and the environment and educating the families. It was kind of funny since I had never really been around babies much growing up and don't have any kids of my own yet. I think we work with the cutest patients ever and I love how we are able to make such a difference. I was so happy to get my first choice job in the NICU at a very large teaching hospital. Even though orientation is rough, I have never regretted my decision to be a NICU nurse because I can't see myself as happy in any other nursing field. I take everything I do, even the mistakes, and turn them into learning experiences. This site has been so helpful to me since before I started nursing school because it makes me realize my feelings are completely normal! Thanks for your posts because it just restates what other people in your position are thinking as well! I love reading the support people give each other here! :)

NewEnglandRN, RN · Oct 15, 2007

Hi there,

Another new NICU RN feeing very overwhelmed here!

In August, I started my position in a level 3 NICU after one year of Med-Surg nursing. After the last few shifts I have worked, I am wondering if I am cut-out to do this type of Nursing. I dread having to attend emergency deliveries and I have not had a vented baby yet.

Every time I drive to work I want to turn around and go back home! The stress is overwhelming. So many things can go wrong instantly. I just pray I will be able react quickly with the appropriate interventions.

I tell myself I will wait one year to feel comfortable in the NICU, but I hate leaving work feeling incompetent.

Pediatric Critical Care Columnist · Oct 16, 2007

Going from adult care to NICU is about the steepest hill you'll ever climb. You might not ever reach the summit either, because neonatology is one of the fastest changing fields there is, with an enormous knowledge base. (Oh, and by the way NOBODY knows it ALL!) As the previous posters have said, being safe is far more important than being fast. Competence comes with experience, and you can't get that if you don't do the job. An OT told me that it takes a minimum of 1000 repetitions for a task to become automatic. Turning a vented baby six times a shift will take 167 shifts for it to be familiar enough to be considered automatic. Maybe you could cut yourself some slack? Worrying about having to attend emergency deliveries right now is about the same as worrying about the supply of fossil fuel drying up. It will happen someday, but not today. Keep your ABCs in mind and you'll get through. Airway, breathing, circulation are essential. The rest is less immediately important. You can find a way to deal with the stress you're feeling. Maybe you could do a little debriefing at the end of each shift with your preceptor. Tell her how you feel about the events of the shift, how you feel about your responses to them and see if you can pick out one triumph every shift. There will be at least one! Ask for guidance on what you could be focusing on for your next shift. It will get better... and it won't take 1000 repetitions, either!

Imafloat, BSN, RN · Oct 16, 2007

Also, if a baby extubates, it isn't the end of the world.

Cherokee, I thought of you today at work. I went to a baby's bedside because he was alarming. I lifted the blanket off the isolette and lo and behold, little baby bug's neobar was not attached to one side of his face. This kid was on the big oscillator, which practically used to give me hives just looking at it.

I grabbed the bag and mask, took the neobar and ET tube the rest of the way out and began bag and mask ventilation while I called for someone to grab the respiratory therapist. When respiratory and the resident arrived, they got the baby reintubated, I even knew to ask if they needed cricoid pressure. We tucked the baby back in, they went on their merry way and I charted the incident.

Five months ago I had a baby self extubate and I handled it, I appeared calm on the outside but was panicking on the inside. We got the baby reintubated, but I made another nurse stay with me while the respiratory therapist got his reintubation kit. I mulled over the incident the rest of my shift and almost called in sick the next day. I decided that this job was too stressful, too much could go wrong, and I was going to need to quit and find a less stressful job once my year was up.

Flash forward to today. I saw the neobar off and did what I was supposed to do, without even thinking about it. I didn't stress out during the incident and I didn't even think about it, until I came to allnurses, because I wanted to share with you that things will be different in 6 months for you. I am by no means trying to say that I have arrived as an expert NICU nurse in less than a year. What I am saying is that every shift you work will expose you to so much. I learned what to do by watching other nurses and learning from my mistakes last time a baby self extubated.

There is no way I am leaving my job when I hit the year mark, I can't imagine having to start over (or leaving my babies). We joke around on my unit that the learning curve in the NICU is so steep it is a vertical line. Hang in there, before long you will be posting encouraging words to the next batch of new nurses.