I think I'm gonna be sick.....

Carpediem1012, BSN, RN · Oct 1, 2014

There is definitely something to be said for just being "alright" sometimes. I think perfectionism can be just as dangerous as lack of caring sometimes. It causes you to second guess yourself too much and doesn't allow you to "dance", if that makes sense. You have the background knowledge; trust that, and be okay with moving to the music! (I speak from experience) :)

Tobi_RN · Oct 1, 2014

How is it that every time I ride the elevator to my floor, the gorge rises in my throat and my hands begin to tremor. All I can think about is what will today bring me. Will I be asked to perform a task I don't know how to do? Or will I miss something?
I finally reached the point last week where I would whisper these words inside my head..."they can't take away my birthday". Funny huh? My mom used to say that as a joke when I was a child and things seemed overwhelming. So now each time I have to call the doctor who is known for his terse replies, or try something new, or don't know the answer, I repeat those words. It gives me focus and helps take the pressure of performance off my head.
It also helps to think that as a new grad in the ICU, I now am striving for mediocrity. Funny to hear that coming from me. I have always been an overachiever, but not in this profession. My first year I KNOW NOTHING! I am reliant on getting hands-on experience and wise teaching from more experienced nurses. So this is my plan, I am going to strive to be mediocre this year, because no new grad nurse in the ICU is going to be stellar. So, I'm writing this post to encourage mediocrity and to let you all know, "they can't take away your birthday".

What a great post...love it! Thank you

HouTx, BSN, MSN, EdD · Oct 2, 2014

C'mon, I KNOW that critical thinking was a major emphasis in your educational program.... now is the time to apply those skills. When you are assessing something, the only valid benchmarks/comparisons are those that share the same characteristics.... e.g., you can't draw conclusions based upon a comparison of abdominal girth between a preggo lady and a cirrhosis patient -- even though their bellies may look similar from the outside, it would be ludicrous to compare them, right?

So - when you engage in self-evaluation of your own performance, you need to compare yourself to other nurses who are at the same place in their careers rather than those with more experience. If you do this, I think you'll find that you are doing just fine. I'll bet that your tenured co-workers would say the same thing. Experience is the ONLY pathway to expertise. You'll get there. You just have to 'pay your dues' ... we've all been where you are.

guest833402 · Oct 2, 2014

I started working in the ICU when I was in my mid-twenties and felt the same way that you did. Many of the older and more experienced nurses were extremely critical and very unwelcoming. They made me feel like a complete idiot. I was terrified during our yearly performance reviews and figured that my boss would rate me as mediocre. But guess what...I received an excellent review and was told to keep up the good work! I don't think there is a good excuse for ICU nurses to treat their newcomers like garbage. The focus should be on treating critically ill patients and not trying to belittle younger nurses to make themselves feel important. Nursing is a team effort. So on your next elevator ride keep your head up and remember all of the positive things you have done for your patients. Try to be the best nurse you can be but don't beat yourself up if you don't know everything. Experience will come over time. I'm sure that in a few years you will look back and realize all of the wonderful things you have accomplished. Then you can become a positive role model for other new nurses and hopefully boost morale on your unit.

PMFB-RN, RN · Oct 3, 2014

After the 9 month residency we pair our new grads to an experienced ICU nurse mentor. The mentors all go through our hospital's preceptor course and get some perks for serving as a mentor to a new grad. Choice of schedule, no floating, higher priority for vacation requests and $1/hour differential. As a result we always have plenty of experienced nurses willing to serve as mentors. Mentors and new grads work the same schedule for a year. The idea is to prevent the very feelings the OP expressed in our new grads and thus make them more likely to stay so that the unit can recoup the investment in training we made in the grads. It gives the grad an experienced nurse to come to with questions and guidance, a nurse who volunteered to be that resource and has an interest in doing so.

In addition to other objective and subjective measures, mentors rate the grads after periodically, and the grads also rate the mentors. Mentors who's grads under preform, and/or who receive low rating from the grads are not invited to be mentors again. In practice this has only happened once.

The other thing we do is keep the nurse residents together for the whole residency and make sure that several of them are working together after the residency. We find that very close friendships are formed between the grads in residency. We try to schedule the friends to work the same shifts so that they always have a friend / friends on the unit.

It all makes a real difference. Before we started this program our new hires were leaving in droves. Now (for the most part) stay. We used to lose most of our newly trained nurses to CRNA school and other hospitals (most of them). Now the number one reason we lose them in the first 3 years is to be stay at home moms after having babies (a few).

Pediatric Critical Care Columnist · Oct 3, 2014

After the 9 month residency we pair our new grads to an experienced ICU nurse mentor. The mentors all go through our hospital's preceptor course and get some perks for serving as a mentor to a new grad. Choice of schedule, no floating, higher priority for vacation requests and $1/hour differential. As a result we always have plenty of experienced nurses willing to serve as mentors. Mentors and new grads work the same schedule for a year.

That sounds like nirvana. On my unit, there's no such thing as a residency. New grads are given 16 weeks of orientation, but are rarely paired with the same person twice. They're "attached" to whomever has the most appropriate assignment - which is not based on any specific criteria - and neither party has a choice in the matter. The so-called resource shifts at the end of orientation often end up with the new staff nurse at one end of the ICU and the resource person at the other... or even across the hall. We're not paid more for precepting new employees, only if we're supervising nursing students.

In addition to other objective and subjective measures, mentors rate the grads after periodically, and the grads also rate the mentors. Mentors who's grads under preform, and/or who receive low rating from the grads are not invited to be mentors again. In practice this has only happened once.

Because the new staff nurse isn't paired with one or two specific preceptors, there's no serious evaluation of the new nurse's progress. The people the new staff nurses are usually paired with are often the most recent crop of newly on-their-own nurses who don't even know what they don't know. Those nurses tend to go to others from their cohort with questions and for help, which means they're both wandering around in the wilderness. And our administration wonders why there are so many sentinel events happening lately...

It all makes a real difference. Before we started this program our new hires were leaving in droves. Now (for the most part) stay. Now the number one reason we lose them in the first 3 years is to be stay at home moms after having babies (a few).

There are lots of reasons our unit has a revolving door on the staff room. Poor orientation is only one of them. Horrible schedules, unsafe assignments, inability to access vacation - those are some others. I've lost count of how many new nurses we've oriented in the past year. It's scary.

PMFB-RN, RN · Oct 3, 2014

That sounds like nirvana. On my unit, there's no such thing as a residency. New grads are given 16 weeks of orientation, but are rarely paired with the same person twice. They're "attached" to whomever has the most appropriate assignment - which is not based on any specific criteria - and neither party has a choice in the matter. The so-called resource shifts at the end of orientation often end up with the new staff nurse at one end of the ICU and the resource person at the other... or even across the hall. We're not paid more for precepting new employees, only if we're supervising nursing students.
Because the new staff nurse isn't paired with one or two specific preceptors, there's no serious evaluation of the new nurse's progress. The people the new staff nurses are usually paired with are often the most recent crop of newly on-their-own nurses who don't even know what they don't know. Those nurses tend to go to others from their cohort with questions and for help, which means they're both wandering around in the wilderness. And our administration wonders why there are so many sentinel events happening lately...

Throwing the new grads to the wolves like that what else do thy expect?

There are lots of reasons our unit has a revolving door on the staff room. Poor orientation is only one of them. Horrible schedules, unsafe assignments, inability to access vacation - those are some others. I've lost count of how many new nurses we've oriented in the past year. It's scary

The must be something good about working at such a rich hospital? I mean if they can afford to just thro money away like that you must work in a very rich hospital. Are you Magnet? Your hospital operates like every Magnet hospital I have ever worked in.

Pediatric Critical Care Columnist · Oct 3, 2014

Magnet status isn't a recognized designation in Canada. The thing about throwing money away is something I've pointed out many times. But in somebody's mind, recruitment is more important than retention. It's been this way for quite a few years but only recently has ti gotten this bad. One of our patient care managers (we've had quite a few of those over the last 10 years too) told one of our very senior (>30 years on the unit) that if she was unhappy with her evaluation (over the dress code - not her nursing care) she was very welcome to move along - she was not irreplaceable and her job would be filled in no time. As long as there's a name next to the line on the rotation who cares? With a mindset like that... it's no surprise that we're not treated well. We've got a dozen people on orientation right now.

PMFB-RN, RN · Oct 4, 2014

Magnet status isn't a recognized designation in Canada. The thing about throwing money away is something I've pointed out many times. But in somebody's mind, recruitment is more important than retention. It's been this way for quite a few years but only recently has ti gotten this bad. One of our patient care managers (we've had quite a few of those over the last 10 years too) told one of our very senior (>30 years on the unit) that if she was unhappy with her evaluation (over the dress code - not her nursing care) she was very welcome to move along - she was not irreplaceable and her job would be filled in no time. As long as there's a name next to the line on the rotation who cares? With a mindset like that... it's no surprise that we're not treated well. We've got a dozen people on orientation right now.

It would be simpler, more efficient, and more humane to simply burn their money in the waste incinerator.