From school to ICU...What was I thinking?

Nurses General Nursing

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I graduated in August and was hired in October to a neuro ICU unit. How excited I was.

Now, in January, I wonder what I was thinking. I'm so nervous at work, on the way to work, on the way home, even at home. I realize I don't know even half of what I should to be effective. The other nurses on my unit keep telling me its good that I'm scared. I worry so much that either I'll do to wrong thing and my patient will suffer or I'll not notice something and my patient will suffer. I'm constantly checking IV pumps. Six IV's going at once almost sends me into a panic.

My poor husband does his best to comfort me but I know he's worried I'll give up.

I tried to leave the unit. I asked if I could transfer to a Tele unit to build my experience level. The ANM said yes but the manager said I was an ICU nurse and she wouldn't give me to a Tele unit with 11 weeks of ICU training. She said to give it 6mo.

I cried the other day during report when I realized I didn't make sure ABG's and Chest X-rays were completed. The oncoming nurse probably thought I was crazy. I thought I was crazy. Why is it like this? icon5.gif

I want to help people and comfort them, not be afraid to do anything for them.

Advice is greatly appreciated.

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Specializes in Telemetry, CCU.

Try reading some threads in the "First Year of Nursing" section; there are many stories similar to yours. From what I've been reading here (and will soon find out firsthand), the first six months for a new grad are hell. If you go over to tele, it will be the same issues: None of us are supposed to know everything right out of school. Almost every specialty has very sick patients these days, and the areas with lower acuity have higher patient ratios, so either way you will have that feeling of dread regarding your care and the patients safety.

BUT from what I've read, it gets a whole lot better. First off, be thankful you are in the ICU, because ICUs probably have the best orientation across the board (general statement, every hospital differs), so you are probably getting a much better orientation than a lot of other new grads and more so than you would get in a different unit (my tele orientation is only 8 weeks).

Good luck to you, this must be a very difficult time for you, but I know you can get through it. If you really feel after six months that ICU isn't the place for you, then maybe try to transfer. But I think that if you stick it out there, you will feel a lot more confidence as time goes by.

GOOD LUCK!!! :heartbeat

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Specializes in ICU, currently in Anesthesia School.

Repeat after me:

I am only human, I am only human.....

The experienced nurses in your unit weren't born that way, they went through a process just like you. Some may be stronger in some areas and weaker in others....just like you. You are 5 months into a new career, and the concern you express for your patients is admirable, if everyone was as vigilant, there would be no such things as errors in medicine.

You work in an ICU, a 24-hour a day 'bidness... if you could do it all in 12 hours, there would be no need for a night shift. Some nurses love to find fault in previous shift's omissions, regardless of how important or unimportant they are. (I had an a** chewing as a new nurse because my patients linen didn't get changed after we had coded him 3 times.... uhhh right... pt living doesn't matter, but the blood on the bed does...OK)

Look at the little things like lab checks and x-ray results you will never omit after an inconsequential reminder at shift change. Focus on the positive- even a bad day where the patient dies can be learned from. And don't forget, that even in an ICU, when everything was done correctly,promptly and with professionallism, people still die despite valient efforts.

Anxiety as new nurse is common, and I would bet that if you were honest with yourself, there are things you do now that used to scare the C**p out of you when you first started. Given further experience, you will look back and wonder what all the fuss was during this stressful time.

Study hard new things (School ain't out until your dead), try and understand the why's of what you are doing, and anticipation of events will start to come together. The basics (paperwork, pump programming, time mgmt) are probably routine at this point, now you get to figure out disease management. Welcome to Critical Care.:up:

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Specializes in Emergency.

Amen! I too have entered ICU straight out of school. All I do is work (which is really 8-10 hours of controlled panic) then come home and hit the books trying to better understand conditions that I did not have time to look up at work.

Must admit, was happy to see your post. After last nights shift, I am having a hard time slowing my HR in anticipation of this mornings shift. .... your panic gives me comfort- I am with you-- Surely we will laugh about this one day...

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Specializes in Med/Surg, Geriatrics.

You have received some good advice. I hate to tell you but new grads in Med-Surg, Tele, Onc., OB-Gyn, etc experience the same feelings. It is not easier on the other floors. It will get better, I promise. Good luck and remember, you are not alone in the care of your patients. Always consult that extra pair of eyes, ears, and hands.

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I, too, went straight to ICU out of school, and I absolutely love it. It's a place that is expected to keep you on your toes, and it really is a good thing that you're so observant and conscientious about what's going on. Over time, you will feel more comfortable with yourself, and you will feel more confident with your patient care. It just takes time.

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Specializes in Neuro/ Tele;home health; Neuro ICU.

i am also neuro ICU so i know how stressful it can be working this unit. the most important thing when you start is assess your pt so you have baseline to carry out thru shift, check your pumps and setting, go thru you report sheet and to see what wasa done and what need to be done; neuro has it that any change can happen anytime and it is nobody fault, you may assess your pt one minute then after next 5 minutes you may find him coded or at least changed so you run like crazy for CT, meds, labs ... and it is ok to ask for help. esp that you are new grad. you do not have yet knowledge and experience like other nurses who work years here and there... i transfer to my unit after 9 months of med-surg/ tele under same managment; till now i can tell you that i have days when i come and think if i did all what i supposed to or if something happen with pt i f i could catch it earlier if my assessment was good... but that is life and i just let it go after while because i have to ready for next shift and next pt to care about. i register with critical nurse association, also bought those unlimited CEE by advance nurses (i think it is about 25- 30 $ for a year), sign up for critical care nursing journals, i also have choosen my preceptor as mentor for me and any doubts or questions i have she always try to support me and help out. i learn every day from pt and situations. just remember we all are humans and mistakes happens and will happen; give yourself time and if you feel stressed stil then you will have to make decision what to do next... ICU orientations are very good, they put lots of time for you to prepare and of course money so that are also reasons not to let you go so quickly. you have your preceptors and other nurses to go to; do not give up, you will learn more and more and will see one day it was all worth it..

best luck, you can PM me if you want to.. :up:

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Specializes in ER/ICU, CCL, EP.

I am a new grad and orienting to SICU. I feel your pain, and I walk around for 12 hours each shift wondering what the heck I am doing here!

My co-workers are wonderful and really help to keep me informed of my progress, so I feel a little bit less like an asshat ;) I know that I am going to be petrified for the first year, and extremely cautious for the rest of my career.

You will get used to it....and then you will tell me how you did it! :)

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Specializes in CICU.

It will take you at least a year to begin to feel comfortable. If your co-workers are helpful then that makes things easier. I have to agree with some of your co-workers; yes it is good to be scared. Complacency inevitably leads to errors, even the most experienced ICU nurse needs to be alert to everything going on with their patients and constantly assessing and reassessing. This high stress and intense environment is why most nurses go into ICU, we love the challenge and love to be a part of looking after the critically ill. If I had to go back to a med-surg unit I would shoot myself, don't get me wrong, I have total respect for floor nurses who have 6 patients who want everything done at once, I certainly couldn't do it. I really enjoy critical care nursing and teaching. Teaching new grads I have found helps keep my skills sharp and I love to watch people learn and become more confident. I think you will do well. The stress level isn't going to change, rather you will become more comfortable dealing with it as your knowledge and experience base develops.

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Thank you. I am trying to remember that being human means I'm not perfect.

I really want to do things right. I'm learning that not all the advice I get from fellow nurses on my unit is the best. Some have no problem cutting corners. They seem to have less drive or I guess less concerned. It's hard for me to relate to right now. It makes me want to see everything in writing before I do it.

Thank you so much for all your wonderful guidance & advice.

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Specializes in NICU.

I'd give it more than 6 months ..... give it at least a year. That first year is incredibly hard. I was there not too long ago and I remember hearing this all the time, but trust me, it really does get easier. Just hang in there.

Do you feel like you need more orientation? 11 weeks really isn't that much. I got over 12 weeks with a preceptor and that's in NICU ..... we don't get the diversity that an adult ICU does, so I would think the orientation in adult ICU would be longer.

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Specializes in Telemetry, CCU.

I am very inexperienced myself, but one thing I learned (and need to keep reminding myself of constantly) is that if I rush through something, even just gathering supplies for a dressing change, I will have most likely forgotten something and have to go back for what I forgot. In other words, do it right the first time, don't have to do it a second time! Anyway, that and most importantly, patient safety, is what will keep my head straight when I get tempted to "hurry hurry hurry" to try and keep pace with the more experienced nurses. I know a faster pace will come with time :)

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