I am having problems with being "task" focused while trying to develop ICU critical thinking and clinical skills. I have been in the SICU for 4 months and still struggling. At first I was told that I was struggling with completing task and using critical thinking skills and now I am being told that I am "task" focused; lack knowledge and do not use critical thinking skills.
I have been trying to figure out where I am going wrong without having any constructive criticism or examples whereby I am exhibiting these behaviors. What I have been doing is reading the Pass CCRN book that has been mention so much on this site and reviewing disease processes; interventions and outcome to improve my knowledge base in hopes of improving my critical thinking and clinical skills. Being "task" focus I think is due to my ER background and that is why I wanted to be in the ICU because I have always thought I lacked critical thinking and associated this with lack of knowledge that in ED our main goal is to stabilize; treat and street our patients but in ICU I have observed that it's about understanding the patho and what am I going to do to keep this pt stable and fix the reason why they are in the ICU.
I have PCU experience and just realizing I did not utilize my time to help my transition into ICU and now I am playing catch up with pressure of being moved out of ICU and I really need some advice as to how to show that I am improving and capable of becoming a competent and safe ICU nurse. I don't want to go back to PCU because I don't feel like this will help me because I already have been in this setting. I just feel like I need more time but not sure how to improve faster and get up to speed because I am so behind as I have been told on my unit. I feel very overwhelmed when I am at work because I do focus on the "task" that I need to complete like : I need to assess my pt; I need to chart my assessment; I need to pass my meds; I need to change IV tubing; dressing changes; bathe my patient; chart VS: chart my q2's. I find that I run out of time and always charting 30-45 min after my shift is over which is viewed bad in my unit because of overtime.
I find myself not being able to grasp the whole picture as to why my patient is here and why am I doing these "task." I also feel like my time management is lacking and that I am not always so organize even though I use a brain sheet to help keep me on track. I have tried different ways to organize my time but nothing seems to work. For example; I get report; look at my orders then assess my pt; try to chart; bathe pt; give meds then when I look up it's about 11 and I don't even really have the full picture of my pt; have not read in detail the MD not or what has been written on my pt and then am not able to communicate when the CN comes to ask about my pt. I feel like I am just running the whole shift and not really know what's going on with my pt. I have asked some co-workers how they plan and in theory I have the same plan but I am not executing the plan that I have in my head when I start my shift.
Please give me some advice no matter how simple or harsh as I am trying to expedite and get to where I need to be so I can stay in ICU. Any suggestions will be helpful with time management; organization; planning my day; how to have the whole picture and move away from being "task" focused.
Go for it! That is a LOT of prep time! I've been a nurse for a year now, working on a medical floor with a high acuity. I just got hired for an ICU position and I'm only getting 8 weeks with a preceptor. That's it...and classroom time. Leap and the net will appear!
Hang in there! It is a lot starting out in the ICU as there are so many things to wrap your head around. I agree with the suggestions to read through the doctor's notes and h&p in free time pre/post work. It was so helpful to me when I first started out to do that so that I really got an idea of what the big issues were for the patient.
I agree that Critical Thinking skills take time to develop. It is a hard skill to build, especially when there are so many tasks around to distract your time. I would suggest bringing up things you don't fully understand to other nurses. Nobody knows everything! I ask questions of my brethren all the time. You can learn so much from it! Also when you have the time, get in on bad situations so that you get a picture in your head of it and can hear everyone trying to reason it out.
Something that helped me time-wise when I started and was running around trying to get everything done like a chicken with my head cut off(inevitably getting behind), was my preceptor telling me to check both patients quickly to make sure there was no emergency, set your alarms in those rooms and trust them to alert you if something is wrong, and then give yourself an hour in each room to get the big stuff done. That helped so much because it stopped my mind from wandering all over the place thinking of things I needed to get done. I was able to focus on one patient at a time.
This book called Notes on ICU Nursing is written in a very conversational tone and was huge for me when I first started out. They explain so many things in a very understandable way which was a good way for me to get a base to work from. They tell you some stories from their experience as well which really help drive the message home. This was invaluable to me.
Keep pressing! Every day you get more comfortable in the ICU.
@Henrica80
You can definitely be fine in the CCU! The program you are going into sounds great. I would recommend using that classroom time well to get a good understanding of the processes you will be seeing. If you are able I would start studying big processes in your free time in those weeks too, again that book above was great for me. Remember, they hired you and they wouldn't have if they didn't think you could do it! I say take the opportunity!
hey midnitej. I am in a similar situation. I am in my first month of preceptorship with 2 more to go. ( I have 1.5 years on a med/ tele floor and feel like a new nurse) I am doing my reading and following my preceptor. Saturday I start my second month and second preceptor (3 months, 3 preceptors) and I still feel lost. I have been reading and reviewing all of these new ICU related drugs and revisiting disease processes and reading on topics that I am unclear on. It is immensely overwhelming and you can at times feel like an outsider on the unit. Have faith and keep pushing. That is what I am doing. Curious to know how you are doing now as it has been a few months since this thread.....
Henrica80 if you are interested in CCU go for it. You have some good experience behind you. I am starting to see the going to CCU is a growing experience. Along with that comes some bumps and bruises but in the end, if you really want it and work for it, you will succeed. The program sounds great. I am only getting 3 months of preceptorship and had 7 classes. GO FOR IT!
I know this is an old thread, but I wanted to mention that I too am struggling with developing critical thinking skills as I am focused on tasks in a busy ICU on day shift. I'm still on orientation and I have until Christmas till I'm on my own (I get 12 weeks since I have a year of floor experience). The tips in this thread were great.
I'm having the same situation and was wandering if you are willing to share your experience with this issue. Where are you now professionally. What did you do? What helped you?
I'm having the same situation and was wandering if you are willing to share your experience with this issue. Where are you now professionally. What did you do? What helped you?
Thank you you very much
Get a medical (not nursing) pocket critical care handbook or phone app and use it at work. Get a good medical critical care textbook and read about your patient's problems and therapy for that day.
Nursing, by and large focuses on the what and when, as is totally appropriate. Medicine focuses on the "why and how". With all of the stuff that nurses have to do, the "why and how" frequently gets left to the folks writing the orders. Start learning about that, and you'll change the way you think about your patient's problems.
Get a medical (not nursing) pocket critical care handbook or phone app and use it at work. Get a good medical critical care textbook and read about your patient's problems and therapy for that day.
Nursing, by and large focuses on the what and when, as is totally appropriate. Medicine focuses on the "why and how". With all of the stuff that nurses have to do, the "why and how" frequently gets left to the folks writing the orders. Start learning about that, and you'll change the way you think about your patient's problems.
back when i worked as an np in the hospital setting i bought a copy of Massachusetts general hospital critical care review. reading that along with some moderate physiology text would work wonders
they have physiology books for USMLE step 1 that are pretty readable. 300 or so pages of diagrams and explainations. many of the books for medical school exams are more readable than some of the nursing texts i used back in school... some nursing authors i swear with their writing could confuse a top rate physics teacher if they wrote a calc 1 book
ataymil8
13 Posts
Go for it! That is a LOT of prep time! I've been a nurse for a year now, working on a medical floor with a high acuity. I just got hired for an ICU position and I'm only getting 8 weeks with a preceptor. That's it...and classroom time. Leap and the net will appear!