Kicked out of SICU

[tarty/sweet, BSN, RN]

Hello I just recently completed a LPN to RN A.A.degree and started in the SICU fellowship. Unfortanetly I was moved to a neuro IMC because of my lack of confidence cited by my preceptors (SICU). Basically I had about 6 preceptors over a course of 9 weeks and the manager felt that by week 10 I should be ready to be on my own. Long story short my preceptors felt I needed more time to orient. But management budget could not accomodate more time in orientation. Ironically I got positive feedback from preceptors but was indeed nervous sometimes and I do not have a poker face. So I was wondering if anyone knows of classes or refresher courses offered to increase knowledge of patho/physiology, I think that my confidence issue is that my LPN program was accelerated and so was the LPN to RN bridge program. Also I took my prereq to be accepted into the RN program 10 yrs ago. So ofcourse there is independent study of which I do engage. I just love the SICU environment. Please help

[jjjoy, LPN]

The unfortunate reality is that there's not much opportunity for a graded entry to practice for nurses. It tends to be all-or-nothing, sink-or-swim, etc. So most places give you somewhere between 6 to 12 weeks to manage the same workload as any experienced nurse. If you can't get up to speed by then, you're dropped like a hot potato. And what can you do to help get up to speed? Are there any remedial clinical courses for licensed RNs to get themselves ready? No. There are few refresher courses here and there, but they don't usually offer much in the way of rigorous clinical experience. So what can you do? Apply again as a new grad, go through another orientation, and continue building on the progress you DID make during the first orientation... because you DID make progress the first time round, just not on the time frame that unit prescribed. If most new grads had no problem with the transition, I'd suggest you really reflect on why you didn't make it. But MANY new grads struggle to meet the expectations put upon them and MANY don't stick with their first job out of school for one reason or another. So far, with just one aborted attempt at SICU, there's no reason to doubt your potential as a nurse. Get back on that horse and try again!

[HouTx, BSN, MSN, EdD]

tarty,

So sorry for your difficulties - as an educator, I believe you have accurately identified one of the contributing factors. Accelerated programs speed up the content delivery but it's not so simple to speed up learning also. It's not like you can just flip a switch and throw your brain into overdrive.

In my organization, we use the PBDS assessment system - which pinpoints exactly what type of development is needed. Everyone has to live within their labor budgets so it's really important not to waste time. It's a much more effective process because we don't waste time on stuff that isn't needed & concentrate on what the nurse actually needs.

At any rate - I would suggest that you take a look at AACN's (www.AACN.org) eLearning programs. Their 'Essentials of Critical Care Orientation' is very comprehensive. It has a great neuro module. It's a bit pricey but it is all CE'd and I think you can deduct it from your income tax as business related continuing ed.

[tarty/sweet, BSN, RN]

Thanks jjjjoy and rbezemek. I appreciate your words of wisdom and encouragement. I was feeling a little discouraged due to the way things transpired and needed some direction. The web site is a great resource. I also got inspired to look into other options as I find the IMC a slower pace that is definately different than the pace of SICU. So.... how is this supposed to prepare me to reenter the SICU? Anyway hopefully I will get accepted into another fellowship. Im already looking!

[DaveCRNA]

Tarty, don't give up, just keep trying.

6 preceptors in 9 weeks doesn't sound like a very structured orientation to the unit. I precept on my unit and we try to keep orientees with two primary preceptors and occasionally they are with someone else during our 12-14 week orientation program.

With all that said, your experience is not unlike others I have seen. Unfortunately $$ dictate, imo, too many decisions in the clinical setting.

My advice, yours to take or leave, is to spend the time in the neuro IMC (intermediate Care I suppose??), to brush up on the pathophysiology and basic nursing stuff. Gain confidence in yourself, add skills, and work on you "poker face". I'm sure you will find challenge in your new unit and will be able to seek out future SICU opportunities. Once you do, you will be better prepared for the unit and orientation will be just a little easier for your experience and previous time in the SICU.

Good luck:up:

[sjt9721, BSN, RN]

My advice, yours to take or leave, is to spend the time in the neuro IMC (intermediate Care I suppose??), to brush up on the pathophysiology and basic nursing stuff. Gain confidence in yourself, add skills, and work on you "poker face". I'm sure you will find challenge in your new unit and will be able to seek out future SICU opportunities. Once you do, you will be better prepared for the unit and orientation will be just a little easier for your experience and previous time in the SICU. -- CVSICU_RN

I agree with the above. It sounds like you weren't ready for the SICU environment...which is not to be taken as a negative. Sometimes people are good nurses (or show the potential), but aren't a good fit at the time or need a slower pace for awhile.

Spend some time in this IMC Unit building your skills and confidence. You can always apply to transfer into SICU if that remains your goal.

Chin up! This is a learning opportunity to help you eventually reach your dream of SICU!

[TexasNurseEducator]

I agree with several of the other posters esp. about staying in the IMU to gain experience but, have one more suggestion. If they will allow you, would it be possible for you to spend some unpaid time to continue your orientation, i.e. on day off,etc. The AACN review is an excellent idea for knowledge but, you still probably need more hands on as well. Also, I am not sure of the size of your facility but, sometimes a smaller facility same type of unit may offer a slower pace due to less critical patients with fewer co-morbidites as they mighter send their tougher cases to the larger medical centers. Just some other ideas.

[tarty/sweet, BSN, RN]

Wow this site IS THE BOMB all of the replies are so helpful. Yes this is a large hospital/Med star....large city and lots to learn. So, I have considered a smaller hospital. I'll have to weigh my options. Anyway,I have been on the Neuro Intermediate Care unit for 2 weeks now and it's fine. I've been learning alot. This unit also gives me the opportunity to do nursing skills that I have never done before. I will be off orientation in 1 or 2 weeeks. Thank you the replies were insightful and encouraging. So now that my ego is recovered I'll look into whether or not I can shadow someone for free.

[barefootlady, ADN, RN]

Sounds like you found a good solution for now. Learn all you can on this unit and then decide if the SICU is still what you want. Sometimes we are clinging to an idea but we really need to recognize we are at a good place already.

Good luck.

[jjjoy, LPN]

It sounds like your current situation is working - yeah!!! If that's the case, why not focus your energies there for now and put the "what next" worries and plans on the back burner? Let us know how you do off orientation. Best wishes!!