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

[jlv613]

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.

[SaltySarcasticSally, LPN, RN]

I think this preceptor may actually be good for you. I say this because I lacked a lot of confidence like you in the beginning, very sensitive (not a bad thing!!), and spooked easily. I then worked a job in a rough part of town, with no **** taking kind of women and it scared the crap out of me. They pushed me out of my comfort zone, were never like "mean" to me, but honest and abrasive. It was awful at first. But they toughened me up, made me push myself to be better, and once I dug in, worked hard, and refused to fail, they were like my second family lol. That was nearly 7 years ago and I am still grateful to those ladies because they made me a better nurse as rough as it was.

You got this, keep your preceptors, let them push you, feel your nervousness/anxiety, soon you will be able to ignore it. I help my anxiety by making sure I know absolutely what I am doing with a patient before I do it. I ask questions but write down the answers so I do not have to ask twice, any new job i start I have a small notebook that fits in my scrub pocket with all of the items I do not want to forget. I think if you stick with this, you won't regret it. GL!

[chiromed0]

Huh? Well, my general advice is NEVER CRY AT WORK! NEVER, EVER, EVER, EVER. At least not out in the open, go into the supply room, bathroom, etc. Heck, I bet everybody here has gone into the "room" to decompress. I HAVE!

Now, specifically ICU. I did step down or IMC in a rural hospital which at times was basically ICU lite. In other words when they need an ICU bed they shipped them down to me even though they probably still met ICU criteria and I was 100% total care. So yeah, I know terrifying (if you don't have support). Support is everything-I was scared but the patients were safe b/c they supported me if I needed it and I seldom needed it b/c I'm an idiot sometimes and don't like to bother people. If this is your first hospital gig then going straight to ICU is a bit ambitious. I would suggest do med surg and see some variety. The main thing in ICU is you HAVE TO PAY ATTENTION the whole shift-no blanking out b/c the patients don't have that much variance. This, in itself, is exhausting until you become numb to it. And yes, the nurses there are superstars and a little bit more intense. Usually not because they are jerks but because they are on edge A LOT.

You CAN do ICU but it will take some confidence and I think that's what your mentor was driving at. The patient and their family can't afford for you to not know what you're doing. In med surg...ehhh, there's a little more room. ICU is just that "INTENSIVE". So don't be surprised by the reaction, theirs or yours. It's natural. Just be clear about what you're trying to do--it's a bigger leap. Good luck!

[Greenclip]

Two shifts in is way too soon to judge. Give yourself a little time. You won't have every shift with her, and if your orientation is anything like ours, you'll have some time doing critical care modules and other classes. In other words, your brain will be challenged to work in different ways which will give you time to assimilate what you need to work ICU. Coming from dialysis, you'll already have a good understanding of fluid balance and kidney disease, which will be so helpful in the SICU (probably more so in the MICU, but even so).

I think your preceptor sounds like the kind you can learn a lot from. I had a very tough preceptor. It made my orientation to ICU very hard, but when I look where I am now, I'm so grateful for her. The nurses in my residency group who had the easier, kinder preceptors are the ones who have made sloppy mistakes, and that exacts its own price. Also, after I had been out of orientation about 4-6 months, I realized that because I had made it through with my preceptor, she really had my back. She is a very strong nurse and to this day I can go to her with questions, requests for help, anything!

Towards the end of orientation, people were saying to me, "We wondered if you were going to make it with xxxx. She's so tough, that's why they never give her an orientee if they can help it...but looks like you've done ok!"

If you get midway through and you are certain that there is a serious personality conflict, then I'd encourage going to leadership and asking for a different preceptor. They want to see that you've genuinely tried. Good luck and keep us posted!

[LovingLife123]

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!!!

Many ICUs offer jobs to new grads and have for many years. In my opinion, it's the best place for a new grad to learn.

[JellyDonut]

SICU moves fast and taking it easy on you will not do you any favors. granted maybe a day or two of shadowing may have been helpful, but 13 weeks will go fast. I do think it is a good idea to write down your questions and pay attention to how your preceptors organize their day. ICU nurses have routines for time management and its good to pattern yourself after an experienced one. If you do not know the meds - learn them. You do not understand a procedure, look it up. Ask questions and ask why a lot.

When I precepted a million years ago I always liked the newbie who was not afraid to jump in and see and do things. Practice being fearless once in a while and push yourself to do the things that scare you (i mean like jump in on a code or go to the rooms where all the action is and try to help).

I would not quit or seek out the manager just yet. Give it 4 weeks, ask questions and tell your preceptor about some of your concerns. Crying in your car or the bathroom is okay just never ever in front of a patient.

Good luck!

[AK1975]

(1) Don't worry many ICU preceptors are over confident, cocky, abrasive, and abusive. It's part of ICU culture. Your going to have to decide if you want this job, and not because you want to work with any of these people or be their best friends. Don't decide that, " oh I am not qualified to work here because someone just verbally abused me", or " that if someone insults me I cannot do this job". Only you can decide if its worth it to you. Once you decide that you do want to be an ICU nurse, it doesn't matter what your preceptor says about you, just take in only the pertinent information you need to do your job. All people are human and make mistakes and have to learn. Even your preceptor on how to be a good preceptor. We are not born knowing everything. Any nurse who thinks you need to know everything and be on top of everything when you first walk in the door to orient, especially if she one of those that sits on her bottom checking Facebook on her cell phone while you work is ridiculous. Forget the demeaning comments. Remember the lessons learned. Move forward. You will do fine. I was once in your shoes as so was your preceptor. Just remember, you won't be on orientation/ training forever and the comments and cattiness will subside and your confidence will increase. what your feeling now is not forever.