From Tele to CSICU - lacking the "ICU hustle"?


I'm an RN with 3+ years of telemetry experience and recently accepted a position in a very large CSICU. I went into this field because I love cardiology, enjoy focusing on a few patients rather than 7-8, and so far am enjoying the kind of work I'm doing, but I fear that I might not be a good fit for this unit after all. The unit is extremely fast paced and my preceptors and educators are concerned that I am not working as fast as I should for this level of acuity. I tend to be very careful, double check orders and drips, etc. but they need me to work even faster than that and have an almost instinctual work ethic.

Personally I think the jump in acuity, working with a new system (ex. new IV/PCA pumps, vasoactive meds, ventilators, an entirely new computer system, etc.), and a sudden increase in autonomy are all factors that are slowing me down and require getting used to. I'm not sure if I am just not a good fit for the unit, or if I simply haven't had enough training.

When I accepted this job they told me it was going to be 13+ weeks of orientation, but as it turns out 4 of those weeks are used for classes (2 weeks were not even ICU-related, they were on hospital policies and general hire education). At this point I have worked 13 shifts so far and am working mostly independently with 2 patients or 1 patient with VAD/CVVH/TAH with my preceptor as a reference usually, but they still think that I work too slow especially in emergencies. I only have 1 more week where I get to work alongside a preceptor, and after that I am expected to admit patients and work independently with a preceptor only as reference.

And if it matters at all, the unit has extremely high turn over. I think about 10 out of 70+ or so nurses quit this year, so they are hiring in droves and hoping to fix the staffing as soon as possible. One night nurse who was leaving told me "F*** this place".

Does anyone have any tips for working faster in ICU, or about time management in general? Is 5 weeks for an experienced telemetry RN enough orientation?

Lev, MSN, RN, NP

8 Articles; 2,803 Posts

Specializes in Family Nurse Practitioner. Has 10 years experience.

Short answer, 5 weeks on the the floor is not enough orientation.


366 Posts

Specializes in Ambulatory Case Management, Clinic, Psychiatry. Has 16 years experience.

I am not a cardiac or ICU nurse, but based on the info on your post; this doesn't sound like an adequate orientation.


6 Posts

The new normal is shorter orientations, with orientation continuing of sorts after you're out on your own by slowly ramping up acuity. Are you taking stable pts or will you be required to stabilize fresh open hearts/interpret PA catheters on your own right away?

allnurses Guide

ghillbert, MSN, NP

3,796 Posts

Specializes in CTICU. Has 27 years experience.

Ask for more specific feedback. "Get faster" is not helpful. Do they have specific concerns as to how quickly you are putting things together, or reacting to an emergency, or is it charting issues, not giving meds on time etc?

What is your gut feeling? Do you like the environment, or feel like you are drowning? Are you excited to learn more, or feel like you made a mistake?

Things definitely improve over time, and with adequate support. If staff are leaving in droves, it's usually a unit based problem. What does your director say about the orientation? Are they taking you off because they think you are ready, or because they don't have staff to support it any more?

I don't care if new staff are "slow" in general. If I have concerns about their critical thinking, that's a different thing.