ICU - Should I stay or go?

[OahuRN]

Hi all,

This is my first post but I have read posts for over 2 years. I am having some issues in my new job and need your advice. I graduated in Dec 2004 and began working on a Med/Surg Trauma floor. I was there for 8 months and gained great experience but applied to the hospital's CVCC since I would eventually like to apply to CRNA school. Anyway- I have been there for almost 4 months and about to quit. Here are some of what I have gone through:

1.I was told I would have 1-2 preceptors during orientation - I am now on #7.

This creates issues b/c each preceptor has their own way of doing things and I am constantly corrected (ex- one preceptor writes her VS, etc on notebook and then transfers to chart, she said to do this b/c taking the chart in the pts room is an infection control issue- when I did this with another preceptor- she acted like I was a moron and actually wrote a bad eval on this).

2. I was told I could remain on my Tues, Fri, Sun shift like on my original unit ( I need this schedule due to babysitting issues) but instead I am on Sun, Tues, Thurs. (My husband had to drop out of nursing school in order to accomodate this)

3. I was told on orientation, I would start with one stable patient and over 12 weeks build up to taking 1-2 more critical. I have always had 2 critical pts and the first few weeks my preceptor was so busy I might as well have been on my own.

4. I met with my mgr 3 weeks ago to discuss getting off orientation and she told me that one of preceptors said I was not SOCIABLE enough b/c on my down time I prefer to catch up on the hours of required computer training instead of chatting with the other nurses! ( I am not making this up!)

5. At my latest meeting with administration, 2 days ago, my preceptor said I had improved 150% in the last 2 weeks ( I have been taking 2 patients on my own, talking with every nurse I see on the unit, and improving my time management, etc.) then she says that what concerns her is that she does not see the PASSION she is looking for. She stated that we had a lung transplant come back from surg and I did not come over to "get the scoop" on what was going on like the other nurses. Sorry- I was too busy taking care of my own 2 fresh post-op pts.

At this point I am on orientation for at least another 2 weeks when we will all meet again and discuss my PASSION. I am about to give up. Since I have been there I have seen a nurse hang a bottle of insulin for one pt in another pt's room b/c she did not order the other pt's med in time, one nurse give a pt so much pain meds she had to give Narcan only to find out his real problem was that his O2 was not plugged in, I come in at least 1 shift a week to find that the off-going nurse has not charted a single thing all day but I am in trouble for a lack of PASSION. So my ? to you all is Am I crazy to stay on this unit? I know there are issues everywhere but this is making me miserable. Any advice?

[Gennaver, MSN]

Thank you all for your posts! I am sorry I have not replied earlier than now but my plate has been full. As for the ICU I was in - I did make the decision to leave. I will float to another unit starting this week and will also look at other ICU positions. The final straw this week was when my preceptor told me that she had deliberately set "traps" for me. ...

Hello OahuRN,

Was it your husband's post I read then when a poster said his wife's preceptor disconnected a chest tube for four hours!? As a test?

Wow! What ever became of that?

Gen

[Gennaver, MSN]

Don't go quietly. Establish yourself as a critical thinking, caring, safe RN who's willing to argue their case without emotion. I mean, whenever something ridiculous presents itself and you are certain about your facts - represent yourself, demonstrate that your not a push over. Challenge their *judgements* of you. ...:)

OahuRN,

The sentiment above resembles what my response to the disconnected chest tube situation, ( I thought that maybe it wasn't really disconnected but, rather that the test was to see your reaction to hearing that it was!) From possibly your husbands posting about the legal ethical issues surrounding that situation.

I do agree that speaking up for yourself and your patient rights is a necessity.

Best wishes

Gen

[Town & Country]

This is what I meant..................

Don't go quietly. Establish yourself as a critical thinking, caring, safe RN who's willing to argue their case without emotion. I mean, whenever something ridiculous presents itself and you are certain about your facts - represent yourself, demonstrate that your not a push over. Challenge their *judgements* of you. Who are they to judge your passion. Good grief. Bunch of little primadonas... and they're a dime a dozen so might as well practice the art of deflating their hilarious notions with evidenced based practice and theory in a unit you may leave cause you'll be faced with this again and again. Become your own advocate without seeming arrogant. Keep to objective non-emotional responses. Don't allow them to bait and hook you. It's all fun and games for the tenured staff. So NEVER let them see you sweat

Just said it a different way but this is what I meant......

[suzanne4, RN]

Removing suction from a chest tube is actually done all of the time, for example, if the patient needs to go to CT scan or for an MRI, or even some x-ray that cannot be done at the bedside. The chest tube is still to water-seal, it is not left open the the air. So, in those terms, there is nothing that is life threatening about that. Chest tubes are always put to water seal before they are actually removed to begin with. We still do not have all of the facts to make a judgement call on this. And they do get disconnected when a bed is moved, or for any other thing. It happens.

The issue is why it was not being checked every hour. Documentation in the chart in an ICU, states that you are checking it each hour. That is standard procedure in any facility.

[flashpoint]

A lot of what goes on in a hospital (nursing home, assisted living, etc) is pretty hard to believe. I can honestly see someone turning off the suction to a chest tube to see if someone notices, but I find it shocking that someone would do so. How dare anyone jeopardize a patient's recovery (and life!) simply to see if someone else is on the ball!

When I was a new nurse, I worked in an LTC that did things to "test" the CNAs to see if they were actually doing their job...the nurses were directed to leave notes under residents with a date and time to see if the CNAs were toileting residents...if the note wasn't brought to the nurse within two hours of it being placed, the nurse was to assume that the resident had not been toileted. Nurses would also mark their initials on soaker pads in beds and go in a couple of hours later to see if they had been changed. I found a lot of this to be a bit excessive...personally, I tried to pay close enough attention to the residents to know what was going on with them without the "tests." But...these "tests" NEVER put a resident in jeopardy.

Personally, I would get myself out of the environment...sometimes no matter how much you want it and no matter how good you are, you just don't fit in with the personalities on the floor. Learn from it, lick your wounds and go on...you know what kind of a nurse you are and what you care capable of.

[Bipley]

I'm not getting what going to a Med/Surg floor has to do with anything here.

It is all about politics and social issues on that floor, nothing to do with skills or patient care issues.

Not socializing properly enough as a reason for being punitive or keeping someone on orientation longer is a sign of a toxic, clique-ish ICU that is more concerned with potlucks and hen-clucking than actual nursing ability and performance.

Hear hear!

[rnmom3153]

Hear hear!

:yeahthat: :yeahthat:

Wow, what a bizarre place!

[nicholrwalker]

I'm not getting what going to a Med/Surg floor has to do with anything here.

It is all about politics and social issues on that floor, nothing to do with skills or patient care issues.

Not socializing properly enough as a reason for being punitive or keeping someone on orientation longer is a sign of a toxic, clique-ish ICU that is more concerned with potlucks and hen-clucking than actual nursing ability and performance.

Once upon a time.....nurses (at least where I worked) needed a strong med-surg background before going into ICU. I think the thought was to promote strong well rounded nursing knowledge as well as skills. My personal thought is new nurses would be better served obtaining a med surg background first. I am an acute dialysis nurse and I cant tell you how many times I have worked in ICU dialysing a pt. being cared for by a nurse who has only worked ICU and wasnt familiar with "med surg stuff". I dont hold it against the nurse..but AI rather be more knowledgable about other things beside just critical care...just to be more well rounded. I also run into this with dialysis nurses(all they have ever done was dialysis) not being familiar with "med surg stuff" either. I think it limits you as a nurse...but that is just my two cents, please dont think I am trying to offend or put anyone down. Good Luck:balloons: :balloons:

[RN34TX]

Once upon a time.....nurses (at least where I worked) needed a strong med-surg background before going into ICU. I think the thought was to promote strong well rounded nursing knowledge as well as skills. My personal thought is new nurses would be better served obtaining a med surg background first. I am an acute dialysis nurse and I cant tell you how many times I have worked in ICU dialysing a pt. being cared for by a nurse who has only worked ICU and wasnt familiar with "med surg stuff". I dont hold it against the nurse..but AI rather be more knowledgable about other things beside just critical care...just to be more well rounded. I also run into this with dialysis nurses(all they have ever done was dialysis) not being familiar with "med surg stuff" either. I think it limits you as a nurse...but that is just my two cents, please dont think I am trying to offend or put anyone down. Good Luck:balloons: :balloons:

I respect your opinion, and it still remains a popular one, however, I think that the old rule about working Med/Surg first as a new grad is outdated.

A new grad should have the very basic concepts of med/surg down upon graduation and, should they choose to work in Med/Surg, expand and grow on the med/surg knowledge base from there.

IMHO, prior med/surg experience is extremely helpful when entering ICU, however, not necessary.

[nicholrwalker]

I respect your opinion, and it still remains a popular one, however, I think that the old rule about working Med/Surg first as a new grad is outdated.

A new grad should have the very basic concepts of med/surg down upon graduation and, should they choose to work in Med/Surg, expand and grow on the med/surg knowledge base from there.

IMHO, prior med/surg experience is extremely helpful when entering ICU, however, not necessary.

I have been unfortunate enough to run into a few new grads(not all) who do not have a solid med surg background..it is one thing to learn med surg concepts in school..but to actually see and practice those skills and concepts...PRICELESS. But again that is just my opinion......:) :) And you are right know it is not necessary to have a med surg background but I think for the nurses sake it is better. I like to know what I know or dont know..and I think prior experience can give you this confidence.

[DidiRN]

Not sure I'd use the word outdated...if the nursing shortage was to end tomorrow, I personally believe it would be required again. I've only seen the recent trend of hiring new grads in ICU and other speciality units because they couldn't find anyone else. I doubt hospitals would be willing to spend the $$ training new grads extensively, when they could get someone with experience up and running much cheaper. And we all know how much hospitals are wanting to save a buck :)

And back the the OP...you've already got some great advice here. Unfortunately in nursing and I'm sure in other fields too, there are toxic work environments such as these. Been there and done that myself. I think it would be good to notify anyone higher up, but I certainly wouldn't stay at a facility like that if you can help it.

I was just talking with someone last night who had THIRTEEN preceptors in a large CCU. Ridiculous. She is no longer working there either.

I respect your opinion, and it still remains a popular one, however, I think that the old rule about working Med/Surg first as a new grad is outdated.

A new grad should have the very basic concepts of med/surg down upon graduation and, should they choose to work in Med/Surg, expand and grow on the med/surg knowledge base from there.

IMHO, prior med/surg experience is extremely helpful when entering ICU, however, not necessary.

[caroladybelle, BSN, RN]

Sometimes it pays to go somewhere that nurtures you more, and allows you to develop more self confidence for a while. That way, manipulative wretches like this preceptor will not feel that they can behave that way and get away with such as this. They feed off of good and well meaning coworkers, frequently. And they are found in every career field, we just like to think that nursing is above that..and are saddened to find that perception wrong.

Working in role that may be less stressful will allow you to become stronger than them, when/if you return to the ICU. It is much harder to breakdown someone with good solid experience, and that knows it.

While you may choose to just go to another floor for time, eventually it would be good to go to another facility. Sometimes it is good to prove yourself a bit and then go on to be fabulous at another facility.

I was eaten as a student nurse - chewed up and spit out by a couple of nurses on the floor that I wanted to work on. I ended up on an ID ward, full of BKAs from diabetic sores, decubes and liver failures, just the dregs of the hospital. I worked my butt off, for 18 monthes and then transferred to another facility. When I returned a few years later, the nurses that were evil to me were considered the bad nurses and I was the sought after one (and they also didn't even remember what they did to me).

About 4 years ago, I was being treated badly by my nurse manager. No matter how much my coworkers respected me, how my patients, MDs raved about me, she called me in for the most trivial things. I finally quit because I could not even get up for work without feeling sick and nauseated at the thought of going in. I was going to quit nursing but took a traveler position to give me time to figure out my next move.

Virtually every manager that I have worked for since has wanted to hire me, made me really good offers and invited back. I have references from 3 hospitals listed in the nation's top 15. I have worked with published MDs that are tops in the field. And when I got ill in Manhattan, one of the attendings at Cornell immediately saw me as a patient.

The problem sometimes is the Workplace.

Give yourself the time and a chance to gain the confidence that you need so that in another year or two, or three, you can set the world on fire.

And remember that G-d has a plan for us. It might not be what we would like it to be. Sometimes bad things happen to guide our footsteps onto the right path and in the direction that we need to go.

My thoughts and prayers are with you.

Carolina