HELP!?! New in a SICU... already cried... totally terrified

NewestRN_OnTheBlock · Apr 5, 2017

Oh my. It's as if I've written this myself.

I JUST completed a critical care training program a few weeks ago. Just like you, I cried and everyone saw me. Give your preceptors a chance. Ultimately, I was grateful to have the toughest preceptors because my training felt more solid. I would sometimes be switched around to other preceptors and they would usually tell me my charting is thorough, my clinical skills are good, and I ask the right questions. It was a good confidence boost hearing those comments, and I think the tough love from my preceptor really helped.

My first preceptor was harsh and made me hate my decision for going into critical care. I ended up contacting my clinical educator to tell her our personalities were clashing. I'm not one to stir up any hard feelings. But ultimately, when I realized that I was having difficulty learning anything of value from that preceptor, I had to do what was right for me. You only get 13 weeks to learn what you need to pass this program. Do what's right for you so you can learn what you need to learn. Do what's right for the patients that depend on you to know what you're doing...

Be careful what you say to your managers, as it may be too soon to jump to any conclusions. In fact, after two shifts it really is too soon. In my case, I spoke a bit too freely and the rest of my program was a nightmare. I can't complain too much though... I ended up getting the toughest preceptor and the toughest patients as a form of boot camp lol.

There are TONS of things that you're going to encounter and learn, as well as things that you won't come across before you're on your own. Learn what you can, study and review the content they give you. Take the initiative to read about things you see and try to understand them rather than waiting for the opportunity to see it during the next 13 weeks. I'm not sure how your schedule is... But whenever I had a day off, I'd spend time reviewing the didactic content and trying to understand things at my pace (even when our didactic teaching ended).

Don't give up so soon. You have an amazing opportunity! In the end, only you can decide if you need to stay. But work hard and be truly open to the experiences you have (both bad and good) before you decide. Observe your fellow nurses. Get an idea of who likes to teach and who is approachable or a good resource. Be mindful of all the patients around you... Not just your own. Offer to help!!! There's no better feeling than receiving a heavy workload and seeing your fellow nurses jump in and help you out. So return the favor and be involved. And remember to take a deep breath when things get tough. Collect your thoughts, apply your knowledge, and utilize your resources.

I realize this is long. Let me know if you need any more words of encouragement, tips, or anything else. I'm not that far ahead of you, but I've definitely felt all the feelings you're feeling since it's all so fresh and recent for me.

Workitinurfava, BSN, RN · Apr 6, 2017

That nurse is trying to toughen you up to the reality of the stress of the job. Before you are put in the numbers (on the schedule without a preceptor), figure out if the position is for you. Sometimes employers try to blackball you when you leave if you are in the numbers and fresh off orientation. Please don't cry in front of the preceptor. Go somewhere in private and do that. Lie and say you have allergies, but please stop crying in front of her. It is not helping you if she see's you breaking down all of the time. Good luck, I tried an ICU step floor and didn't like having to move faster, (heck do everything faster). I am where I want to be now (in mental health). I have never had a peace of mind like I do now. I did great on the ICU step floor, never got any complaints, heck when I tried to go they begged me to stay, but I just didn't like the pace. It is like med-surg on steroids.

BSN16 · Apr 6, 2017

but I feel like her expectations of me might be a little unreasonable.

Her expectations are that you need to be a proficient ICU nurse by the end of your orientation, which is not unreasonable. 13 weeks may feel like a large amount of time to be on orientation but in reality it takes soooo much longer to even be half way comfortable taking critical patients. I have been and ICU nurse for a little over a year now and i still nervous coming to work.

I am not trying to sound harsh but the intensive care unit is not for uncertainty and emotional weakness. There is a LOT going on and you need to always be sure of yourself. This is not by any means a low stress job. You deal with life and death situations, complicated family dynamics, and very complex and critically ill patients.

Honestly, it doesn't even sound like you really want this job? If you don't i suggest asking your manager to help you find a new, less intense floor....

If you want to continue in the ICU here is some advice:

Address to your preceptor you are essentially a new grad, ask LOTS of questions. Even stupid questions. A good question i liked to ask on orientation was "Ok, what are the MAIN things i need to look for during assessment? Are there any complications i need to watch for? etc..."

Don't ever tell anyone that you aren't ready for something or tell them no. You should always be looking for new things to help with or learn.

Lastly, you need to find some way to manage your stress and emotions. Patient's and their families will be looking to YOU for advice and reassurance so you need to be able to remain calm.

I LOVE being an ICU nurse. Although it is very stressful and fast paced, it also makes me feel like a total badass. I love having such complex patients and truly using the full scope of my practice. I love learning, working together with the team, and being able to make a difference.

NuGuyNurse2b · Apr 6, 2017

I know you're miserable, but think of how lucky you are. As a new grad, I applied to ER/ICU's, areas where I wanted to start, and the doors never opened. Take this as an opportunity to grow and be a proficient nurse.

JerseyTomatoMDCrab, BSN · Apr 6, 2017

I want to know where this hospital that hands out ICU jobs like free T-shirts at a minor league baseball game is located. I would have given my left arm for a new grad ICU position!!!

Amethya · Apr 6, 2017

Don't give up! Try your best! This is just the first 2 days! Keep your chin up and everything will be fine as long as you try your best and take risks. Take that mentality of no able to do it because I never done it before, and just do it. She's there to watch you and if you mess up, she can correct you. Try as much as you can, if you still feel that you can't after 13 weeks, then I say go find something else.

MelodyNelson, LVN · Apr 6, 2017

I feel really bad. Both for you AND for your preceptor. ICU is such a fast pace place. Everything can go hell in a hand basket in a matter of seconds. It is not a place to be insecure and second guessing yourself. We all have different abilities and personalities, perhaps you are better suited for other settings that do not need to you jump in action, take charge and make life or death decisions on the spot. I do not want to be mean. I hate to say it, but if you really want to be there, then you need to grow a thicker skin, pull yourself together, read up on all the meds and procedures and really step it up! 13 weeks fly by so fast! Or, if you feel that the setting would cause too much stress, find something else! If there is one good thing about nursing is the variety of places where you can work.

foggnm · Apr 6, 2017

You could probably search the allnurses forum and find 1000 posts of newer nurses expressing their fear, terror, anxiety, emotions/crying, feelings of overwhelmed, etc all related to starting a new nursing job (ICU or not). Equally the 'bad preceptor' probably also takes up 1000 threads. I say this to let you know your feelings are quite normal. However, there's a way to deal with them. For your fear or stress, utilize your normal coping skills. Whether that be exercise, talking with friends, spending time with family, spiritual pursuits, eating well, getting good sleep, etc....all those are things that you do in any job in response to stress. As far as your preceptor, as an adult entering a new profession you should take things head on and learn to be assertive. If the person is not a good fit for you, then request another preceptor. If the person is clashing with you then speak directly to the person about your conflicts and see if it can be resolved.

All that said, it is unfortunate that being a new nurse is such a stressful circumstances. I think a lot of it has to do with how nurses are trained in school. They are trained for fear rather than confidence and curiosity. Just know it is normal to not be competent in any new job, nursing is no different. Take each step in stride, take care of yourself, learn and ask questions. But whatever you do don't let fear and anxiety rule you because at this point you cannot be an expert and there is nothing wrong with that! Also know there are hundreds of different nursing careers, so your first is unlikely to be your last!

Ruby Vee, BSN · Apr 6, 2017

Hi All,
I just started a clinical care training program at a county hospital. It's a 13 week program with a mix of didactic and clinical time.
There are about 35 of us in the program. The majority of the people are new grads... some have a couple years or less experience in a different discipline.
I graduated in 2015 and started working in a chronic outpatient dialysis clinic in addition to doing some registry work. I've never worked in a hospital.
This job basically fell in my lap... I never had huge ambitions to work in a hospital and never ever imagined I'd want or be in an ICU. My self esteem is such that I would never think I have the competence or ability to do what I consider such advanced and sophisticated nursing (God, just disclosing this opens all kinds of invitations into my broken thinking). So while I am super grateful for the opportunity I have also entered this with a somewhat paralyzing amount of fear and trepidation.
I have just completed two days with one of my two preceptors (my primary preceptor).
First impressions: she absolutely terrifies me. She's fast, talks fast, does fast, moves fast, has a thick accent that is sometimes challenging. She's incredibly intimidating. She's abrupt, abrasive. She's a "take no prisoners and take no ****" kind of gal. She's knowledgeable, experienced, proficient. She is required to precept and she openly disclosed to me she avoided it for years. She's impatient, particular, and hard around the edges.
Yesterday, my second day on the unit, we were in conversation... I can't remember the exact content of the conversation, but whatever it was she told me I responded with, "I don't think I'll be ready for that." She quickly shut me down, told me that is the wrong attitude, told me I should reconsider if I want to be in the ICU, told me the NM would flip out if she heard me say that. I, in turn, began to cry. I felt so small. So embarrassed. So weak. So incompetent. So useless. And so incredibly lost. And I was thinking, "****, i'm the girl that cries. I don't have what it takes to be and ICU nurse... my second day and I'm already in tears. I'm too sensitive, too vulnerable....."
Now, in all fairness, while by and large her personality and mine clash, she does show me certain things, she pushed me into a room with a fresh heart patient straight from OR to see how that all looks (I didn't understand a thing about what was going on at all)... but I feel like her expectations of me might be a little unreasonable.
I don't do super well with the "tough love" method. I freeze. I buckle. I don't have enough of a foundation to feel confident and secure. When i worked in dialysis long enough to feel my footing I was not so sensitive to being challenged or yelled at.... but here, I just don't have a clue. I'm overwhelmed... I feel like a nursing student again. I feel like I'm being set up to fail. I don't know how to prioritize. I don't know **** about the meds, the procedures etc.... And I noticed today that we haven't gone exactly according to the orientation program schedule of what were supposed to be doing Day 1 and Day 2. She had me charting yesterday - in Epic.... my god, none of it is intuitive and she would yell at me for forgetting things or tell me I'm charting too little or too much and I don't really understand where I'm supposed to get into detail and where I don't need to get into detail. I 'm getting mixed messages.
I don't feel comfortable or "safe" with her.... I mean emotionally. I know she's not there to coddle me. And I can appreciate that I need to put in the work, too. I get that. But I look around at some of my peers in the program with me and their preceptors seem so much more gentle, more patient, soft spoken....
Should I not be expressing my fear? Should I reconsider the ICU? When is enough time to know it won't work?
She did suggest I write down questions/concerns we can discuss next time. I go back Saturday and will be with my other preceptor. I've met the secondary. Truthfully, she doesn't seem much better. .... but I'm open to see what happens Saturday.
I can't help but imagine the secondary will already know I've cried....
God, I'll take any feedback or guidance or help.

As others have wondered, why in the world did you apply for this job if you didn't want to work in a hospital, especially in an ICU?

You noted that you're in a class of about 35. With that many new people coming on board, the ICU was probably desparate for preceptors, forcing everyone who has ever had their license renewed to precept. You were incredibly lucky and got a preceptor who is knowledgable, experienced and proficient -- in short, someone who knows her stuff and from whom you can learn. (Notice I didn't say someone who can teach you -- she's made it clear that teaching isn't her thing. It's your responsibility to learn, anyway. You can LEARN from her.)

It isn't up to your preceptor to meet your emotional needs, bolster your self esteem or manage your feelings. Feeling safe with her emotionally is so much not a thing. You're an adult, an experienced nurse, and this is a job. You have 13 weeks with a preceptor to learn ICU nursing -- there isn't enough time to "feel ready" for everything that comes up. If you pass on a learning opportunity because you don't feel ready, it may not come up again until you're off orientation. You'll be figuring it out on your own -- will you be ready then?

You freezing and buckling because you lack self-esteem is a problem, but it's YOUR problem, not the preceptor's. Expressing your fear and crying at work is going to put a target on your back. Everyone will be watching to see how you handle the orientation, and they'll be predisposed to think that you can't handle things.

Two days is probably too soon to make any decisions, but someone who needs as much emotional support as you seem to in order to get through two days of orientation is probably not someone who will be a good fit for the ICU. If you want to work in the ICU, pull yourself together.

amzyRN · Apr 6, 2017

Keep a notepad and write down things she tells you. Learn about the patho of what conditions you are treating in your ICU. Ask what the priorities are for X, Y, Z patient. Learn the meds you use, the unit lay out, the equipment. Create a barrier between your feelings and the work you are doing. Your feelings should guide you, but not suck you in so that the overshadow the work at hand. Expect that you aren't going to be an expert for quite some time. As long as your preceptor isn't trying to sabotage you, I'd keep the one you have. "stick with the devil that you know". You can also respectful tell her how you learn best or what would be more helpful to you. She probably doesn't want you to fail because it will look poorly on her too. While you are doing your preceptorship on the floor, you do need to be studying outside of work so that you have the conceptual part of what you are doing and why. You should always know why you are doing what you do with a certain patient, what to avoid, what to chart and why. You will need to develop that barrier between your feelings and your work, not so much that you don't care, but that your "brain" is governing the process of your work and interaction.

Kooky Korky, BSN, RN · Apr 7, 2017

That nurse is trying to toughen you up to the reality of the stress of the job. Before you are put in the numbers (on the schedule without a preceptor), figure out if the position is for you. Sometimes employers try to blackball you when you leave if you are in the numbers and fresh off orientation. Please don't cry in front of the preceptor. Go somewhere in private and do that. Lie and say you have allergies, but please stop crying in front of her. It is not helping you if she see's you breaking down all of the time. Good luck, I tried an ICU step floor and didn't like having to move faster, (heck do everything faster). I am where I want to be now (in mental health). I have never had a peace of mind like I do now. I did great on the ICU step floor, never got any complaints, heck when I tried to go they begged me to stay, but I just didn't like the pace. It is like med-surg on steroids.

Forget about crying. It's over and you can't undo it, so just forget it.

What are you thinking ICU will enable you to do? CRNA?

Your preceptor sounds like a "rhymes with witch". You say she doesn't really want to precept. Heck of a place to be.

Good luck.

kaylee. · Apr 7, 2017

I totally feel for you OP! My preceptor was a less intense version of yours. Hopefully she mellows out when she gets to know you, because it is really tough for us sensitive types to learn from the type of person u describe. Give it a little more time before going to management.

But she SHOULD be walking you through things when they are new to u. Esp EPIC lol it is sooo non-intuitive. I laugh because the refresh button is hidden in a different spot on every page! *****

Start a list of things you have seen so far so you can go home and study about them. I swear this is an important part! Your first heparin drip for example...she will wiz thru it and she seems the type where she thinks she is teaching, but probably not well...and u go home learn all about it! What its for, why, how to etc.The second one you will feel empowered...You cant be expected to know what u havent seen, so a good place to start when there is soo much to learn is study the things u see in practice. Be a self-learner! Keep us posted!