frustrated with transition to icu

Liddle Noodnik · Dec 18, 2014

I am an RN with 2 years of experience on a stepdown unit with a 3 to 1 ratio...
This autumn I took a position at a new hospital, relocated, and have been working in a fast paced ICU...

That is a HUGE lot of change in one bite. I wonder if 2 months was enough. This doesn't say anything about you being a good nurse or having skills, this is just saying you have had a lot of changes that are not easy to just jump into.

how is your relationship w/ the charge nurse or nurse manager? Do you think you could share some of what you've said here and ask for more orientation/preceptorship? In my experience orientation is often rushed and there is a sink-or-swim feeling.

Or is there a particular nurse you feel comfortable talking to there? Do you need some validation or encouragement as to how you're doing?

You don't necessarily need to "move backwards" but I can see why that might be a temptation.

Venting is DEFINITELY necessary and I'm glad you found a safe place to do it. Keep posting, would love to see how things are going. In any event don't give up - and I'm glad you know that you're not a bad nurse. It's just a big change that anyone else would be struggling w/, not just you.

commonsense · Dec 19, 2014

I am an RN with 2 years of experience on a stepdown unit with a 3 to 1 ratio, lots of PNA, CHF, COPD, MI, stable trach-vents, GI bleeds, AFIB/RVR, DVT/PE's, etc. I consider myself experienced and very proficient with Heparin, Cardizem, Amio, and some other drips, BiPap and stable trach vents, and putting the pieces together to look at the multi system issues of a patient. At my workplace I was known for problem solving and advocating strongly for my patients, as well as catching evolving emergent situations.
This autumn I took a position at a new hospital, relocated, and have been working in a fast paced ICU. I had 2 months with a preceptor and have been about two months on my own. I am frustrated. My preceptor and I did not get along that well, and I don't feel that there is a strong team atmosphere with my coworkers until there is an emergency -- very different from where I came from where you had a lot of backup from charge RN and those working around you and we always had each others backs.
Additionally the learning curve is hitting me hard. I don't like, and don't feel confident with, a lot of the drips in the ICU setting, and I don't really like my patients to be ventilated. I live in fear of a doctor wanting to do a bedside procedure because I don't feel confident enough to know what they will need me to do and when and what medications to have on hand. I dont feel like I have all of the knowledge of the pathology I need for my patients -- we get a fair amount of oncology, for instance, which is totally new to me. I feel like I'm not able to put pieces together fast enough to intervene or notify doctors, and I feel like my entire core set of nursing skills are being negatively affected by me trying to concentrate on all the new processes/tasks that I'm trying to learn.
I don't know if its the change to a new hospital and having to learn all of their procedures on top of jumping into an ICU, or the fact that I might just not be cut out for ICU, or is this really the same as when I was a new nurse and with time and experience everything will get better? I don't exactly want to ask to go to a less critical unit because I feel like the whole move would have been wasted. I took the job because it was a step into a more critical enviromwnt and I thought it would be a move up.
Instead I find myself sorely homesick for the people and the hospital and the pt acuity that I left behind. If I try to get into a stepdown unit where I would be more comfortable with pt acuity, it will feel like giving up and going back to the same old same old but without the friends and coworkers I had at my old job.
At the same time, I am very stressed out at my new job. I'll have some days that are OK -- pts pretty much sick but stable, I get everything accomplished and get out mostly on time - and those days aren't so bad. Then I have train wreck days that leave me getting out late feeling like I missed a thousand things and second guessing myself and crying the whole way home because I just hate it and don't want to go back. Just sitting here writing this I'm feeling frustrated that I have to go back there. When I think about asking to get to a leas critical environment, I feel guilt for failing in ICU,but I also feel a lot of relief.
A lot of this is me venting and I'm sorry it's long winded. I just don't know what to do, except to take it day by day, but how long should I be miserable to see if it improves? Especially when I feel like a bad nurse and my confidence plunges with every bad day I have. I don't know what to do. Some days I feel like I should be yelling "I'm not a bad nurse" to the world, because that's what I feel like everyone sees when they look at me sometimes, and logically I know its ridiculous, but I have had my confidence broken down after being totally profocient and a resource person at my previous hospital, to here at my new place being looked at funny every time I ask a question...

It does get better, but a transition to the ICU does come with a pretty steep learning curve. I agree with Liddle Noodnik on speaking with your nurse manager, possibly more orientation is needed. I believe the individual you orient with does more for your learning than how long you orient. I've learned more from some people in two days than I have from others in months. Keep studying and try not to be too hard on yourself.

SierraBravo · Dec 29, 2014

I 100% agree with the previous posters. Take comfort in knowing that working in a step down environment and the ICU are two related, albeit, still different environments. Your step down experience is very valuable, and undoubtedly has eased your transition into the ICU, but there is still a big learning curve to overcome. One day at a time... :)

zzbxdo · Dec 29, 2014

With 2 years of prior experience, the transition is gonna make you feel like a new grad again. Give yourself 6months to a year and the jitters will subside. I started in a burn ICU as a new grad but when I float to sicu the population and and acuity is different so I get butterflies all over. Be aware of what you don't know and ask for help or someone to eyeball an assessment with you real quick early on for new things.

CriticalCareRN1 · Jan 1, 2015

Thank you for your post! From reading this post, there appears to be a learning curve from one ICU unit to the next, and the learning never stops. So the question is now, does it matter where a new grad begins--MICU, SICU, CCU, NICU--because each unit has a unique learning curve all of its own. Of course, if the basic theory isn't there for that unit, there would be too much of a learning curve to handle, which is why hiring managers should test the knowledge base of these new grads, instead of asking "where do you see yourself in five years, why did you pick this hospital, and how do you handle stress," because of course the student wants to increase their critical care skills, and they probably applied to several different hospitals knowing how competitive it is to get a job as a new grad, and the stress will be there if you don't know basic principles of certain disease processes, which helps determines the appropriate nursing intervention. I know people who have beliefs on both end of the spectrum. My belief is, if the new grad has a strong theory base, let them enter.

zzbxdo · Jan 5, 2015

I think most new grads have the same potential for theory base. I think success lies in the support system within the unit. Strong preceptors, strong designated educators, strong orientation, support and help from all peers. Helps with preventing a high turn over rate, but some units like ultra busy and complicated sicus can't be helped.