I'm struggling in Critical Care


I'm in my 4th semester of nursing school with one more semester to go until I graduate with a BSN and can take the NCLEX test. My grades in the program are excellent, but it always seems to take me a lot longer to get my work done that most of the other students. This semester we are studying critical care and the material is more complex. I am really struggling with my critical care clinical logs. Each week, a detailed critical care report will take me 12 to 15 hours to complete, and I'm not including time taken for rest breaks. When I discuss this with my instructor or with other students, they think I'm greatly exaggerating how much time it takes to write these reports. I only wish that I were exaggerating.

I am also having quite a lot of difficulty now that we are expected to understand the medical conditions and care for three or four patients simultaneously. Listening to morning report is a nightmare due to the volume of information I am expected to understand and keep track of in a short period of time. I can't even write it down the information in my notes because the nurses coming off shift are speaking so quickly.

Will I be able to adapt and get up to speed once I gain more experience, or am I destined to be fired from my first hospital RN job?

Part of the picture is that I have non-hyperactive Attention Deficit Disorder, which makes sustaining concentration more difficult. I am already on the maximum dose of methylphenidate for this condition plus I drink two coffees per day to keep my energy and attention level high.

What can I do about this? Thanks for any help!


243 Posts

Maybe try cutting out the caffeine? I find I can't focus when I have any in me. What are these critical care clinical logs? What do you need to do for them? Are you focussing on the need to knows or going off into the nice to knows?

It gets better as you get more experienced and develop a system. I still encounter medical conditions I need to do a quick research on but generally, at this point, you should be able to recognize common patient conditions, common complications and potential care requirements and assessment points you need to cover. I've developed my own short hand, and having a cheat sheet that works for you really helps. I personally have never liked the ones they gave out in nursing school and just use a blank sheet of paper with a small subsection for each major system per patient.

You will never know all the details about a patient. The key is to know what the important Thingsto listen for/ look out for.

I'm more Than happy to go through one of your logs with you if you want some help on focussing your assessments/ interventions. I love critical care for its complexities and intricacies but can't imagine being able to put it all together as a student. Message me if you want some help

Specializes in Med Surge, Tele, Oncology, Wound Care. Has 11 years experience.

i wish I had more information to help.

If you can fill us in what your instructor requires of you in regards to the paperwork it will help us to help you.

Take a breath! It will all make sense once the "real" nursing starts and the paperwork turns into patients.

Most of us are hands on learners, is that your learning style?

If so it's hard to put that knowledge to pen and paper so to speak- I had trouble this way too. Hang in there!

practice practice practice. find videos on youtube of lectures and short study snippets so that you gain more familiarity of common disease processes,.

also, i would really suggest asking you classmates to give you mini reports throughout your non-clinical days. you dont have to be prepared to take care of a full patient, but just talk with the classmate about that imaginary patient's status. then work your way up to telling them expected findings, treatments, and medications.

you'll get it with practice kiddo

Lemon Bars

141 Posts

Thanks for the encouragement, folks. Although the work is a bit more complex than in previous semesters, I think I've figured out what is really going on in my brain. I think I've developed some tolerance to my methylphenidate, and it is no longer helping me concentrate as well as it did a few months ago. My provider just added another medication for me to help me finish up the semester. After this semester ends we are going to talk about switching medications, maybe doing Adderall for three months then rotating back to methylphenidate. Or something like that. I think my ADD symptoms just crept up on me. I thought perhaps I was burning out on school, losing my self-discipline, my self-confidence, and my desire to succeed. But after analyzing my symptoms, I feel similar to the way I felt before I started taking medication for ADD. I think I can get back on track now. Thanks again for the encouragement! :)

Specializes in Critical Care and ED. Has 34 years experience.

It's normal to be overwhelmed. You're not expected to know it all right off the bat. What I suggest is firstly to learn all the abbreviations you can. For example...for heart failure write HF. For pulmonary disease write COPD. Then all your vitals: BP, HR, SP02, RR and then lines: A-line, CVP, PIV etc. Then drugs: Dop, Epi, Levo etc. Use things that make sense to you. Then do a Google search for ICU report sheet and print off a few, so that every shift you already have a template to work with. When the nurse gives report just jot your notes down on that. One for each patient. On the back I would draw a section for each hour and then I'd write on that hour if a med was due or when I had to check a lab result. That gets you organized like a calendar or desk diary but it's by the hour. Here's an example:


Often the key to being a successful student or new ICU nurse is organization. Once you get that down you can start to learn new things. You can also use this sheet to give report to the next nurse. I've been an ICU nurse for 25 years and I still use these sheets. The good thing is if you have the same patient two days in a row you already have everything written down. If your instructor asks you something you just have to pull it out and look and everything is on there.