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.

[BelgianRN]

Without any kind of disrespect towards the OP but it is a one-sided story. I would like to start by saying that under no circumstance anyone should send you away from a patient without providing a reason. But not the entire context of the situation is known.

I'm intensely involved in the training of newer nurses in our ICU and the thing I find most difficult is managing them in an acute situation (code, crash etc.) where they are in charge. (And managing them the first day when you have to explain to them how a three way tap (not sure if this is the correct medicoenglish term) works.)

I don't agree with the way you were sent out. But I can think of situations where it is more beneficial to the patient to ask a nurse to take his or her hands off. A good relationship is key here. The times I told one of my "charges" (for lack of a better word) I wanted them to stop working bedside or stop doing that particular thing they would respect my choice and follow my direction. They know I tend to have good reasons behind my choices and actions. But I would make it a priority to talk to them as soon as possible and explain my reasons.

Again without any disrespect intended towards the OP, but are you absolutely sure you were doing the right things at the right time? I've met nurses that want to help but they end up being in the way. In an effort to make things go smoother they actually form obstacles at the bedside. And some of those nurses have way more experience than I do.

What I try to teach the nurses I'm responsible for is to talk about what you want to do. It provides insight. When one of the newer nurses that work with me want to do an admission and "run" the bedside show they usually tell me which areas they are unsure about or if they want to run it all by themselves. And I can tell you when they run the show I have to reign myself in and not comment on things because you spot a million things you would have done differently (not saying better here). But it is their call and unless they are make grave mistakes I'll let them call the shots and stick to the "boring" administration or follow their lead bedside.

So the only advice I would like to give when working with a more experienced colleague that you know isn't known for letting loose control, talk about it before it becomes a problem. Usually you have at least a few minutes before the patient arrives or have some time at the beginning of your shift if you have to run RRT's outside the ICu. I can see no harm in just explaining you want to be the one that manages the patients. Tell them you might do things a bit different than they would, but that you would like them to provide feedback to you afterwards about how you did things. This way you don't take all control away from her because she is still the one "supervising". And in the meantime you get to do your thing with your patient. It also increase the treshold for her to comment because she is made aware that things might go a bit different this time.

Without knowing your situation of course she could just as well be a bully that picks on you. In which case it is good you are starting over.

Anyway my five cents.

Greetz Marco

P.S. Apologies for any English mistakes as it isn't my first language.

[Sanchez RRT]

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.

OOPS!!

[AllAngelsRN]

So finally I am here in my new position & settled doing fresh open hearts. I feel great and more confident in my skills and patient care than ever.

Thanks to everyone who replied. I know that there is nothing that can erase the experience but writing what I have experienced and having you write me back words of wisdom was very therapeutic.

After going to the new hospital and seeing how different nursing is, I know that I was working with bitter people who haven't really learned how to help others to grow. I remember the director of that unit was very close to me and she used to tell me that it is the "worst unit" that she has ever worked for. She knew her staff were just a bunch of angry beavers. I know that she didn't like that but had little control over changing that culture.

It's good to see different and it was a good experience to learn from. I have no regrets :)

[ukstudent]

I am so glad that you took the time to update your post. So often i wonder what happens to the pople posting.

I remeber that I was worried that you would end up in yet another toxic enviroment and I am so glad that worry did not materialize. Everyone should have what you have now found, a caring and supportive enviroment. As you get more expereince and start precepting, remeber those toxic nurses and strive never to become like that.