Help me please! I need advice

Editorial Team / Admin · Dec 13, 2014

Hello,

Sorry you are having some hard times. Did you and your Manager go over any tips to help you with time management??

HouTx, BSN, MSN, EdD · Dec 15, 2014

You're right - Critical Care may not be the place for you. There is a much higher level of performance expectation - that's probably why your preceptors are 'rushing' you more than the ones in MedSurg.... patient needs are more urgent, so preceptors may be much more directive rather than letting your sort things out for yourself.

Time management can only be learned with experience. It requires an ability to prioritize - to deal with the continuous avalanche of 'things' during a shift. As you're better able to determine which things need to be done now and which ones can be delayed - it will become easier. Inexperienced staff are easily overwhelmed because they typically give the same level of urgency to everything that comes their way.

Gooselady, BSN, RN · Dec 15, 2014

It might not be the right place -- for a new grad! I know new grads need to start somewhere, but some residencies, I think, inadvertently set a new grad up for failure, at least feeling like one. If you stick with it, you feel like you've been run over by a backhoe.

It SHOULD be challenging, scary and anxious at times, but more that 50% fulfilling. We nurses are known for banging our heads on brick walls (we don't give up).

Since you had a great time on med surg, why not get a job there for a couple of years? Allow yourself to have a positive, supportive experience, especially when you are new.

I don't know if the ICU and CCU nurses are just poor preceptors or if you really DO lack some basic skills. The thing is, you don't have enough experience as a new grad to KNOW if what they are saying has truth in it or not. Like someone said above, go to your manager and discuss this with an open minded attitude. Be willing to consider that it is TRUE you lack some basics. Of course you do, you are a new grad. Your role in this is to learn, not call the shots.

If you are very motivated to do ICU, just can't imagine not doing it, then WHEN you go to your manager, go in there wide open and say 'teach me!' . When the goofy CCU nurse does her thing, take a deep breath, and ask for clarification, as if she were right.

BTW snatching things out of your hand, including the phone when talking to a doctor is UNACCEPTABLE behavior, and I've precepted some really unconfident new nurses and NEVER did that kind of stuff. I have manners. I don't care how 'stoopid' she thinks you are, she needs to go back to kindergarten and be taught to play nicely.

messymissy · Dec 16, 2014

Yes, it is normal to feel overwhelmed and anxious as a new nurse! I honestly can't say if ICU/CCU is the right place for you. I can tell you that I started out as a brand new RN in a very busy ED. I had a preceptor that was bossy, pushy, often making me feel as if I was a failure and that I was not meant to be a ED nurse. I cried to my dear hubby countless times...I did survive. We don't always have the best "teachers" to learn from. Not that I'm excusing your preceptors behavior.

The point I want to make is that, as a brand new nurse you are going to feel anxious,maybe scared, no matter WHERE you work. Real world nursing is so much scarier than clinical's as a student. You will learn so much the first year, and continue to learn as you progress through your nursing career.

Talk with the ICU manager, don't assume that they won't extend your training out a few weeks without asking first. They may not. You won't know unless you ask. Good luck to you! I wish nothing but the best for you.

Lev, MSN, RN, NP · Dec 16, 2014

I am a recent graduate nurse may 2014, I got accepted into a residency program at a hospital I interned at for critical care right after I passed the NCLEX. Our group consisted of 6 individuals .. We were placed on a med surg floor for initial training consisting of 6 weeks but with classes it ended up being only 4 weeks of actual on the floor training. We were then placed in the ICU for 4 weeks and then switched to CCU for 4 weeks. On the med surg floor I felt so confident that I was really understanding it and received compliments and all positive feedback. Now I finshed my ICU experience I never got any negative feedback but all of a sudden the manager told me I need help with time management and that the preceptor felt like she was prompting me too much ..

You are a new grad! They should cut you some slack. All new grads need help with time management and prompting. You need to ask daily for feedback. At the end of the shift, ask your preceptor what you did well and what needed improvement. Then you follow up with the nurse manager.

But honestly I felt that she was so aggressive and wouldn't let me do things on my own I just let her lead and that I am most likely paying for not being assertive enough.

Yes, you must be assertive. Especially in an ICU setting.

Now I am on the CCU side .. I have a crazy preceptor that is the only way to put it, she is very smart and knows more than some doctors but she expects so much from me .. She gets upset if I am not doing something fast enough in non emergent situations mind you and she will rip things out of my hand ..

Ripping things out of your hand is inappropriate. I had a preceptor who did that. Your preceptor having high expectations may be honest, but not necessarily realistic for a new grad. Has she precepted a new grad before? I have found some preceptors have a hard time being a preceptor for a new grad.

She says she believes I am capable but I lack a basic skill set which I agree there is so much I haven't done yet because I haven't been given the opportunity ..

You are a new grad! Again, the basic skill set is learned on the job. What are they expecting? Is this critical care residency program new?

But she is so dismissive of me and will just take control and talk to doctors without including it but then I get negative feedback that I am not taking on the assignment my self ?

That is wrong, but understandable. If the doctor is there and ready to go, she may not have time to find you. Have you spoken with her about your concerns?

At this point she has belittled me so much I hate coming into work thinking this was a terrible decision going to nursing school. Is it normal to feel this way ? I think the ICU may not be the place for a new grad .. I don't know what to do ? They don't want to extend our orientation and I don't even think the manger wants me .. The staff seem like they can't be bothered and make terrible comments about us .. Makes it difficult to stay upbeat while at work .. Please help any advice would help

I don't think it's you, I think it's this particular department. Ask yourself: Do you want to work on this unit? Is there any staff you feel you'd get along with? Maybe you can speak to the manager about switching preceptors.

Either way, I think you have to meet individually with the preceptor, manager, and educator, individually and as a group. Don't say anything about you not being cut out for ICU. Don't badmouth yourself at all. Say that you feel there are certain things lacking about your orientation and you need X, Y, and Z to be successful. This may included a new preceptor who has precepted a new grad successfully before and a couple more weeks of orientation. It's also very important to continuously ask for feedback and ways to improve. This shows that you are eager to learn and open to feedback. Lastly, ask the other staff nurses for help when needed. You don't necessarily need to be dependent on your preceptor for everything, but do know what she needs to supervise, so no one can get you in trouble for doing something without your preceptor. If it doesn't work out at the end of your orientation, see if you can go back to med-surg or maybe the ICU stepdown unit.

casrn5 · Jan 4, 2015

I just wanted to thank you guys for the feedback !! I appreciate it so much, I did as you guys suggested went to the manager and agreed that the program is overly ambitious with only 8 weeks of training and she would be unable to extend my orientation that it might not be the right setting. I truly didn't feel comfortable and I would never want to put patients at risk, so I accepted a position on telemetry I feel that I will get a good foundation and experience and maybe in time can go back to the unit. I appreciate everyone's advice and positive feedback, I am doing so good on telemetry and really feel more comfortable and confident. Thank you and happy new year !!

messymissy · Jan 4, 2015

Congratulations! I'm sure that you will learn and grow so much this next year on the tele unit. You can always apply for the ICU again, once you have mastered the basic skills that lay the foundation. Even if you decide to stay on the tele unit, you will learn something new everyday and never have a boring shift.

Good luck to you!