Help!! ICU Nurse Needing Advice!

HouTx, BSN, MSN, EdD · Nov 8, 2016

It's excruciating to go from competent expert to rank beginner..... and that's what you've done by switching clinical areas. Really hard on the ego. IMO, it is much more difficult than the transition from student to practitioner as a new grad because your frame of reference is different. With this change, you distinctly remember what it was like to be fully competent - probably serving as a resource for coworkers who were less experienced than you.

I have no doubt that you will achieve full competency in your new setting .... if you stick it out long enough. Only you can determine whether the "juice is worth the squeeze".

In the meantime, I'd advise you to talk to your manager &/or unit educator to let them know that you are having doubts about your career switch. (No need to mention any names, because if you're being targeted by unit 'mean girls', there's a good change that they already know who these people are.) They may have some solutions to offer you. After all, your employer has already invested quite a bit in you & they certainly don't want to lose you.

Ingrambl89 · Nov 8, 2016

Thank you so much for your advice. And yes, that's a huge point of why I don't want to leave, because they've already invested so much time in me and I'd feel awful. I honestly feel like the docs have been giving me more grief than anyone though.

calivianya, BSN, RN · Nov 8, 2016

I'd advise you to get the heck out of that hospital system if it's the physicians that are the problem. Not just that job - that whole hospital system. It obviously has a very crappy culture. My first job was like that - the physicians were gods and they could do no wrong. I got cussed at, overheard a coworker called a c-word, and watched someone else get a chart thrown at her. It was bad. When physicians can get away with whatever they want with no consequences, things don't get better.

I feel like most places are not like that anymore. At my current job, if physicians are hard on us, we can go straight to the medical director who will rip the physicians a new one for us. I have seen multiple physicians lose their privileges to practice in the whole system when enough nurse complaints about their attitudes pile up, and believe me, they will straighten up and treat you with respect when their livelihood is on the line. It doesn't sound like your hospital is willing to take on the physicians for you and your colleagues, so IMO they don't deserve to be able to keep good nurses. Hit them where it hurts and vote with your feet.

Just remember - physicians are NOT in your chain of command. Your chain of command is your charge nurse, your nurse manager, and your nursing supervisor. Those are the people who have the right to talk to you about your performance. If you are getting comments about your job performance from physicians over and over again, especially if they are saying things with a nasty tone, that is not appropriate because they are not your bosses.

Been there,done that, ASN, RN · Nov 8, 2016

Hi everyone!
I'm really in need of some advice of people that have maybe been in my situation before... so here's the story..
I'm 26, I've been an RN since the summer of 2013. After I graduated I moved to Florida from the Midwest and started a night shift job in oncology. The unit was tele/med surg/neuro/chemo. It was a teaching hospital....yes I felt stupid at times when I was newer, but overall got a good bit more comfortable with time. I eventually was charge nurse. I learned a ton there. But everntally moved home because I wanted to be closer to family.
So my next goal was getting into critical care. I'm still very unsure of what type of nursing I'd like to do long term so I figured this would either be a great stepping stone, or something I'd like to stick with.
Well it's another night shift job... which I hate... but still thought it'd be a good plan. I started had 3 months of orientation.. and still feel awful. This month marks my month 5. It's not that I feel like my assessment skills are bad... or my patients are unsafe under my care... I just feel dumb constantly. To the point I've cried in the back at work and cry on my way home. I get scolded by doctors and nurses daily. Bottom line, I'm afraid I hate it. Absolutely hate my job. I feel terrible saying this but I want nothing more than to quit. No one seems to have respect for anyone there. No matter what I do or say it never seems right.
Its really taking a toll on me..on my confidence and my overall well being...I feel like a failure because I'm used to being good at what I do.. some people (nursing friends from old job) are telling me stick it out for 1 year. My boyfriend of years hates it, wants me to quit so badly because I'm always so upset.
I know I'm the only one that can make this decision and the only one who knows what's best for me, but I'd like some opinions on what I should do?
Bottom line im very unhappy there, but feel like it's best to stay and learn more..
Thanks for the advice guys!

You have 2 months experience , on your own. You have much to learn, but ICU leaves no room for mistakes.

What exactly are the doctors and nurses calling you out on?

By the way, unless your boyfriend is a doctor or a nurse, his input means squat.

Ingrambl89 · Nov 8, 2016

It's not that I'm even making mistakes... for example this weekend I called the cardiologist after obtaining an EKG on a patient because I thought I noticed ST elevation on the tele monitor.. sure enough EKG showed STEMI... the patient was asymptomatic... but to me, that did seem like a significant rhythm change and being that he was a few days post CABG thought that they'd want to know... well boy was I wrong! The doctor asked why I got an EKG and called him If the patient wasn't having symptoms in a very condescending "now why would we do that?"- type of manner...

Or this weekend when we had a patient from the ED come up receiving blood products and on levo (suspected gi bleed) ... not my patient but I was helping out a little with transfusions and what not... I called lab to get more FFP thawed and the lab guy made small talk and asked how the patient was... I stated he was becoming more stable...(we were going down on levo, 100% room air, heading in better direction to me)

well the doc heard my comment... when I walked in the room to bring the blood products.. in front of the patient and all the nurses on the unit she yelled "I heard your phone call! This patient is NOT stable! He's on levophed!" Okay yeah I get he wasn't completely stable by any means... but was it necessary to yell? It's not like we weren't all in there helping, getting kings done ASAP, and being serious about it. Ugh

AliNajaCat · Nov 8, 2016

Consider running the ideas of phone calls to docs past your charge nurse once or twice until you figure out what's significant to THEM. And I wouldn't waste time on chatting with the blood bank guy.

But I completely agree that it's very hard going from being a senior to a freshman :) Hang in, it will get better (I am assuming that you like the other aspects of critical care and want to learn more about it).

And gee, who uses Leave-'em-dead anymore?

TheCommuter, BSN, RN · Nov 9, 2016

Moved to the Critical Care Nursing forum for more replies.

calivianya, BSN, RN · Nov 9, 2016

It's not that I'm even making mistakes... for example this weekend I called the cardiologist after obtaining an EKG on a patient because I thought I noticed ST elevation on the tele monitor.. sure enough EKG showed STEMI... the patient was asymptomatic... but to me, that did seem like a significant rhythm change and being that he was a few days post CABG thought that they'd want to know... well boy was I wrong! The doctor asked why I got an EKG and called him If the patient wasn't having symptoms in a very condescending "now why would we do that?"- type of manner...

A 12-lead reading STEMI is always, always, always worth a call no matter what. You can bet your butt if that person was actually having a MI and you didn't call it, the physician would be the first person to throw you under the bus.

I have done 12-leads on asymptomatic people where I thought I noticed new elevation while watching the monitor plenty of times. A few of them were nothing. Several bought themselves nitro, morphine, and a heparin drip, and several went to the cath lab. You don't have to be having symptoms to have a MI. Any healthcare provider - nurse OR physician! - knows that there is such a thing as a MI with no symptoms, especially in women and diabetics. Your physician is an idiot.

MarisL · Nov 9, 2016

Hi everyone! I'm really in need of some advice of people that have maybe been in my situation before... so here's the story.. I'm 26, I've been an RN since the summer of 2013. After I graduated I moved to Florida from the Midwest and started a night shift job in oncology. The unit was tele/med surg/neuro/chemo. It was a teaching hospital....yes I felt stupid at times when I was newer, but overall got a good bit more comfortable with time. I eventually was charge nurse. I learned a ton there. But everntally moved home because I wanted to be closer to family. So my next goal was getting into critical care. I'm still very unsure of what type of nursing I'd like to do long term so I figured this would either be a great stepping stone, or something I'd like to stick with. Well it's another night shift job... which I hate... but still thought it'd be a good plan. I started had 3 months of orientation.. and still feel awful. This month marks my month 5. It's not that I feel like my assessment skills are bad... or my patients are unsafe under my care... I just feel dumb constantly. To the point I've cried in the back at work and cry on my way home. I get scolded by doctors and nurses daily. Bottom line, I'm afraid I hate it. Absolutely hate my job. I feel terrible saying this but I want nothing more than to quit. No one seems to have respect for anyone there. No matter what I do or say it never seems right. Its really taking a toll on me..on my confidence and my overall well being...I feel like a failure because I'm used to being good at what I do.. some people (nursing friends from old job) are telling me stick it out for 1 year. My boyfriend of years hates it, wants me to quit so badly because I'm always so upset. I know I'm the only one that can make this decision and the only one who knows what's best for me, but I'd like some opinions on what I should do? Bottom line im very unhappy there, but feel like it's best to stay and learn more.. Thanks for the advice guys!

In the hospital I used to work in, ICU was right down the hall from our unit. Several of our unit's (experienced) nurses eventually tried working there. Despite any level of prior experience, I never saw one of those nurses who did not find the first year in ICU to be profoundly challenging. Put another way, everyone seemed to have a really rough first year. There was a lot of drop out before that 1 year mark, as well. Maybe it was just the facility I was at, but I'm guessing not. Seems like "experienced nurse, new to ICU" is a place that can be very rewarding. It also seems like a place to put the seat belt on tight before starting, because it is probably going to be a bumpy ride. One of my nursing school classmates (top of our class) went the ICU route, and she was working very hard to stick things out. Bright side, she stayed in ICU for many years and has said it was one of the most rewarding parts of her life.

futureCRNA'20 · Nov 12, 2016

I started in a mixed Medical/Neurosurgical ICU as a new to practice nurse fresh out of school and it was extremely challenging. The difference is that I was the one being hard on myself and setting my expectations too high within the first year. It truly takes about 1.5-2.5 years to feel like a confident and competent part of the ICU team. The problem is that it sounds like you are not learning in a supportive environment at all. The experienced nurses and doctors I work with embrace new staff and serve as mentors for us all. I would definitely bring the examples of issues you've shared to your manager's attention and see how they respond to your concerns. If nothing is done about it and you continue to feel unsupported in your new role, it is an issue with the culture of the hospital system - NOT YOU! Keep your head up and keep taking good care of your patients. That's really all that matters at the end of each stressful day. Good luck!

nursealisha, BSN, RN · Nov 15, 2016

Your story is similar to mine! I have over 5 years of experience as an ortho nurse - received my med-surg certification, charged, and precepted new grads. I love ortho and feel extremely competent and comfortable there. I recently moved to critical care in June and was having a heck of a time during orientation. I was terrified of everything and all my years of med-surg seemed to do diddly-squat for me in ICU. ICU is a new ball game. It's like a seasoned football player making the switch to baseball. Are they athletic? Sure. Are they going to be fantastic players right from the start? Probably not. You've got the foundation but now you're building up and that takes time. Confidence will come. I already feel a heck of a lot more comfortable here but I'm still learning and I remind everyone that I'm new to critical care. Don't ever be ashamed to ask for help and admit what you don't know. Also, the two examples you cited just sounded like typical physician behavior. I missed a few orders with a DKA patient and the endo doc the next morning was pissed but I accepted the blame, admitted it was my error, learned from it, and moved on. Docs are under a lot of stress and though this doesn't ever excuse their piss poor behavior, let that stuff slide. Double check with your charge if you're questioning a change and ask them what they think your next steps should be. Some docs, especially cardiology ones are very particular about what they want done following patient changes but the big thing is always cover your butt, even if the docs don't think they need to hear it. It's your responsibility to report changes to them and if they're not interested, be glad you caught it, chart it, and move on. Good luck!