How to grow backbone in ICU?

[AllAngelsRN]

Hello,

I have been an ICU RN for 3 years. In the hospital I am at, I came to them with limited one year experience from a community hospital. My current hospital is a trauma hospital. They get all sorts of cases including fresh hearts and they teach the nurses many skills. I am giving you background about me and the hospital because, I feel a little unsure of self. When I joined them first, I didn't know jack S%#@ about much of the real ICU. So I had lots of times when I got corrected and got told off. It was alright for me to get this correction until I was able to stand on my 2 feet. Now 3 yrs in ICU and I still get told off by senior nurses. I got a rapid response the other day & the RRT and another senior nurse told me to step outside of the room to chart on MY patient while they get lines, BP stable blah blah blah.....so I did because I didn't wanted to cause any trouble besides, I was like if they want to do my work, let them- I didn't care. To make story short, I got a job at another hospital to do fresh open hearts; & today was one of my last few days at my current place, so I peaked my head into my supervisor's room and told her that I am excited about the opportunity but I am saddened to leave; she said well, just you must learn to act & stop over analyzing things especially in serious situations. I didn't know that she was hinting about that day with the RRT and that patient. So after probing, she told me that the RRT said that I didn't know how to handle the situation and that I was asking questions that were irrelevant about the case (like bolus amount) and that's why they sent me out the room to chart. I was taken by this because, this is not the first patient I had with such situation and many drips. I am capable of handling such patient. I worked with many septic patients in the past and in this hospital. She told me that I should have taken charge of my patient care and directed them to what needs to be done. I said that I didn't do that because, I didn't really care. If they want to do it, let them knock themselves out.

I need an honest feedback on how to handle such situation? Was I wrong by letting them care for my patient? Should I have told them to step aside and stop helping me and that I can handle it- how could I have delivered such a message without causing any friction. I knew that I couldn't handle the patient on my own. He was going to die if I didn't have lots of help. There were 3 people in the room- not one. I can't see that one RN can handle such situation alone- I don't care who you are, when a patient comes with no lines, no foley and no OG, help is needed. Please tell me where I went wrong. I want to learn to avoid future mistakes. Thank you for your input in advance.

[ukstudent]

Is sorry but with three years expereince your manager is right, your should not have been outside the room charting while others stablized YOUR pt. You make it sound like it is an all or nothing situation. Either they all helped and you stayed out or you had to do everything by yourself. You said a couple of times above that you "didn't care" and was ok with stepping away. You need to care about your being part of your pt's actual care.

[AllAngelsRN]

Thank you very much for your honest input. I posted this so I can LEARN from my mistakes. I am looking for constructive criticism like yours. I hear you and I wanted to be by my patient's side but I was asked to go chart. Leaving on time is very important to my hospital. They frown down on overtime. The nurses who were at my patient's side are capable nurses. I didn't worry that my patient's care was not going to be up to bar- that's what I meant by "I didn't care". The bottom line is that I was asked to leave the room and go chart because obviously my questions about the pt's history and what has happened P**sed them off and therefore I was "cast away"; what my reply should have been? I could have said "no I want to be by my pt's side" and caused some sort of friction or I could have just left and get told that I shouldn't have left..... I feel like damned if I do and damned if I don't.

[CVmursenary]

sounds like some "bullying" type stuff.

[ukstudent]

Yes, next time say no I'm staying. Who cares if you p..d someone off. However, if your were asking questions needed for charting and not directly relevant to the acute situation at hand I too would have been a bit annoyed too. If the charting needed to get done then one of the helpers in the room could have helped with that. I understand that you were not concerned about the standard of care your pt was getting, but again it was your pt. Your in charge (and legally responsible) for what occurs and doesn't occur.

Hopefully should be able to multitask and get relevant information from the transferring nurse and at the same time direct the care of the nurses in the room helping. Such as hearing that the pt possibly aspirated prior to coming to you and then directing the others to put in an NG/OG and getting it to suction.

It's good to learn from things. In the future don't let anyone chase you away from your pt.

[ProgressiveActivist, BSN, RN]

You should have said: DO YOU WANT TO TAKE THIS PATIENT?

I think they are out to make an ass out of you. Step it up a notch a tell THEM what to do. And since your leaving this place have fun with it. Take every messy patient and tell these petty women what YOU want.

[Sirapples]

charting does not save a patients life. appropriate actions to critical situations does.

I am also a new icu nurse, Ive been here for a little over a year and a half.. some very tough nurses here as well. Especially I think because I am a male nurse. I use the phrase alpha female because a lot of very strong intelligent women work here with more experience than I thought any nurse could have. Very strong personalities.

When I started here, and when a patient crashed, other nurses would come in and help my patient, and I would act as the go get this guy. I was afraid I was in the way and I honestly was scared of these situations. I realized that I would learn nothing doing this and changed how I acted.

Any time a patient crumped in the icu I made sure I was there to help and to see and do what I knew how to do. That could mean chest compressions, ambu bagging, starting iv lines, or whatever was needed that I knew how to do, and observe how others acted in each role.

I made it an effort to go to every rrt with a seasoned nurse and learned how to react to situations that occured and how to handle the stress of a crashing patient. I asked the charge nurse to let me be open so that I could take the first admission. I let her know that I may need her help but I wanted to learn.

Anytime someone was about to be intubated I would make sure I was present. to at least watch and if it was the right group, I would ask questions right away, or would ask questions after. Anytime anyone needs help with a bed change I help, or a call light or bed alarm or a vent alarm or iv beep goes off I check it out.

Doing this, I believe I am earning the respect of my coworkers. I do not have the knowledge that everyone here does, but I am trying to learn.

when I started the thing that always made me in awe of seasoned icu nurses was a patient that was from ed, crashed here, intubated, assisted with a line placement, and tons of pressors put up. About 4 months ago I went to an rrt by myself and the patient had no iv access at all, no foley nothing and sats kept dropping and bp was in the toilet. I helped the anesthesiologist intubate the patient, I asked someone in the room to page surgical resident for some kind of line and we brought the patient to the icu.

It made me very satisfied to of done that. Never would of happened if it was not for me stepping out of my comfort zone and starting to attempt to edge into the world of critical care by actually doing and observing and challenging myself.

gluck!

[GoldenFire5]

You have a great opportunity for a fresh start. You should receive some sort of orientation at your next hospital to learn the flow of how things work and how the RNs interact as a team.

>She told me that I should have taken charge of my patient care and directed them to what needs to be done.

I would take this advice to heart and become more assertive and directive at your next job. You're presenting yourself as having 3 years of experience... the nurses at your next job will expect you to know what you're doing.

And take the phrase "I don't care" completely out of your vocabulary. It will almost always be misinterpreted.

Good luck.

[Biffbradford]

Maybe I'm reading this wrong, but if you get assigned a train wreck rolling through the door, then you're in charge. Let others help you out and get lines in, hang blood, yell at pharmacy to get your drips STAT. You're the conductor to make sure everything gets done. You're on the phone (maybe TWO) with the attending and all the new consults, gathering orders and making sure they are all getting done. Cripes, I've seen 20 people in a single room, all doing something different, 3 phone lines stretched to the breaking point. If that's your patient, then by all means get out of the way! BUT everything goes through you and you chart your little fanny off!

[NCRNMDM, ASN, RN]

I'm still in nursing school, but I want to do surgical/trauma ICU when I graduate, and I've had experience in the ED prior to beginning the nursing program. My problem with your entire post is that you wrote, "I don't care," WAY too much. If you don't care who helps your patient, if you don't care to let other staff do your work, and if you don't care to just step out of the room and leave your patient in someone else's hands, then why are you a nurse, especially an ICU nurse? In the situation you mentioned, you are in charge. It is your patient, and you should run the show. This doesn't mean that others can't help you, it means that you utilize the skills of others, but you call the shots. You should've been saying things like this: "you, start at least two IVs, I'd prefer at least an 18 gauge if you can manage that." "You, get this patient on the monitor, get me a set of vitals, and tell me what the rhythm looks like." "You, hang IV fluids and medications." At the same time, you should've been telling someone else to get medications out of your Pyxis/Omnicell, or whatever you use, and getting someone on the phone with the physician. If someone else couldn't call the MD, you should've been on the phone to him/her. When a patient is that sick, it is a team effort to stabilize them and get them settled in the unit. However, when it is your patient, you are running the show, and you should be utilizing the talents of each member of the team. Having an indifferent attitude, and being content to let others do your work, are not good traits for an ICU nurse, especially one with three years of experience.

[rn/writer, RN]

What I get from your post is that you say, "I don't care," for two reasons. One is that you don't want conflict, so you take the path of least resistance and back away. The other is that you really do care, but you don't know how to step up and take charge, so rather than feel frustrated and possibly say things in anger, you turn off the caring function and detach yourself from the situation.

Neither of these thought patterns are going to serve you well in a fast-paced, critical care environment like ICU. But, fortunately for you and your patients, both are fixable.

Changing your outlook will not be easy, but it is doable.

The first thing you need to do is stop viewing yourself as a novice. You are now an experienced ICU RN with three years under your belt. Look at yourself as someone who is always willing to learn but not someone who is wet behind the ears anymore.

Second, decide that you are your patient's nurse and, as such, you are the gatekeeper for anything or anyone who wants access. Of course, others will be assisting you, especially during an admission, but you are the one in charge.

This might sound odd, but on your days off watch TV shows that show people being assertive. Law & Order SVU is a good one. Cops don't ask; they tell. Mariska Hargitay as Det. Olivia Benson is a good one to observe. She's sensitive but definitely not afraid to take control of a situation. I also like House. The medical stuff is whacked (I've never in my nursing career seen a doc draw labs or hang an IV) but watching House's team members fumble and stumble around before standing up to him is a good lesson in developing your own confidence. I'm sure there are other good examples out there.

Remember that people read each other for good or ill. If you don't start taking yourself seriously and feeling like you're in charge of your patient, you will telegraph the message that you're not to be taken seriously.

We all have times when we feel uncertain and off kilter. That's just part of being human. But you can still be certain that you deserve respect for yourself and your boundaries.

You don't have to change your personality and become a "force to be reckoned with." You just have to decide that it's more important to get the job done and take care of yourself and your patient than it is to be "nice."

Here are some handy phrases to use when someone's trying to walk over you (whether they're being rude or just being inconsiderate):

ExCUSE me?

What are you doing?

What did you just say?

Thanks, but I'm going to do it this way.

These phrases buy time, but they also say to the other person that they need to stop and take you seriously. You don't have to be nasty. Just firm.

Practice role playing with a trusted friend. Or just get used to saying these phrases (and others like them) so they etch a pathway in your brain. Then, when the time comes, you'll be ready.

How wonderful that you get to make a fresh start where people won't see you as the new grad. Make the most of this opportunity and walk in there with your brand new backbone.

[wanderlust99]

Sounds like you started off in the ICU as a "newbie" and some of the nurses are still treating you that way. I wouldn't tell someone to go outside and chart. Unfortunately there are some aggressive nurses, who think they know it all. That's not necessarily true. You don't have to be an ******* to be a good ICU nurse. I'd never tell the primary nurse to go outside and chart. That's rude. Hang in there. Maybe a different unit will do you good and no one will still think of you as the newbie. And remember, even if you're lacking in confidence, YOU know more about that patient than anyone else,more than the doctor and more than the know it all nurses who pushed you out of the room. Don't forget that.