Losing my mind

I'm a new grad orienting in busy ICU, and it has been four weeks. I feel really overwhelmed, and I feel like I've bitten off more than I can chew. Transferred patient to telemetry floor and forgot to print new medication reconsiliation. I feel sooo stupid:madface:!!! I am also with a super smart and organized preceptor and am feeling just a little bit intimidated. Preceptor is really nice and is good at teaching. I keep forgetting little things (mostly paperwork stuff, clinical skills are good). Will I ever get the hang of this???? Thanks for letting me rant!!!

Hello mdinelle,

Yes! Absolutely it will get easier with time. It sounds to me that you are comparing yourself..............a new grad with 4 weeks experience to a preceptor with at least 2 years (probably more) of experience. That is just not a fair thing to do to yourself.

Actually if you told me that you weren't somewhat overwhelmed............it would be much more concerning to me than hearing you feel overwhelmed.

Your orientation period is about YOU............so make sure you are getting what you need out of it. Talk with your preceptor about how you learn best, and things he or she can do that you would find helpful.

Even at the end of your orientation you are only expected to function at the level of a competent, safe, NOVICE critical care nurse, expected to know who and what your resources are and how to access them, as well as to continue to ask plenty, plenty questions and to seek out new learning opportunites as they are available.

In my experience..............it takes about 9 months to a year for a new grad in critical care to start really feeling like they have the hang of it............and about 2 years is considered to be the "advanced beginner" stage.

Things you can do to help yourself:

1. Develop a peripheral brain.........a notebook or place that you write down important information, resources, phone numbers, unit routines, etc.

2. Ask your preceptor and other RN's in the unit for tips and trick of how to organize your day.............maybe develop your own report sheet or time management tool.......something that works for you.

3. Ask PLENTY questions, get in the "learner" mode and seek out opportunities........nothing scares experienced RN's more than someone who is new and does not ask questions.

4. If you make a mistake..............like forgetting to print out a new med reconciliation. Accept that you are not perfect, and don't beat yourself up too badly. Choose one thing that you would do differently next time and figure out a plan for yourself so that you won't do it again. (Everyone makes mistakes...............the real problem is if you keep making the same one and not learning from them).

5. Pay attention to mistakes that others make..............not so you can feel superior to them.................but so that you can NOT make the same mistakes. Thank goodness, we can all learn from each other.

6. Learn the unit routines........get them down pat!!! Try to set yourself a timeline of when (by what time) you will have your initial assessment done and charted, by what time you will have AM care down, by what time you will have meds given, etc., etc. Challenge yourself to meet your timeline and keep trying to get faster!

7. If your unit has adult emergency protocols, or hypoglycemia protocols, or standing orders get a copy of them and commit them to memory..............know what you can and cannot do while calling a MD to see the patient.

8. Focus on EXCELLENT patient and family care. You can prove yourself to the other nurses in your unit by taking excellent care of your patients

9. At the beginning of your shift...........ask yourself what you think are the top 3 nursing priorities for each patient that you care for that you need to accomplish during your shift. Bounce your thoughts off of your preceptor and see if your ideas match up with theirs.

10. Make sure that you ALWAYS know the plan of care for each patient that you care for. If you don't get this information in report from the previous shift...........ASK!!! Because the next shift that you report off to, is going to hold you responsible for giving them the information.

11. Introduce yourself by first and last name to ALL of the staff who come through your unit. Housekeepers, RTs, PTs, OTs, residents, attendings, chaplains, social workers, nursing assistants...........EVERYBODY! Treat everyone with the same respect and insist that they treat you with respect. Over time you build rapport that makes your work life easier.

12. If you need a call a MD.............get all your info lined up, anticipate what questions they might ask you...........bounce ideas off of the charge nurse or your preceptor before you call............and then make the call. Use some type of succinct, concise communication method such as SBAR. (situation, background, assessment, recommendations) to get what you need. However, you should pretty much KNOW WHAT YOU WANT from the doc before you make the call.

13. If you take care of a patient with a disease process or pathology that you are not familiar with............go home and look it up. It really helps to tie learning in with a real patient. Helps it stick in your brain better.

Final note: The things that you are feeling and experiencing are NORMAL. Are you part of a New Grad class or Critical Care Course? Talk to some of your classmates............and if they are honest, they'll tell you the same thing. If not.........seek out some of your nursing classmates and see if they are going through the same thing.

Hang in there...........it does get better........... however it probably won't happen as fast as you would like it to. Nurses that are attracted to critical care are usually the type that want to know EVERYTHING!!!! and they want to know it YESTERDAY!!!!

I've been a critical care nurse for 22 years and I know plenty.........but I definitely do not know everything. And I'm not ashamed to ask questions or admit that I do not know something.............and the truth is I still learn new things almost everyday and I enjoy what I do.

IMHO...

There are probably worse things that you could forget than the med rec. Keep your chin up and don't be too hard on yourself. You're only human. Getting comfortable in an ICU setting takes time. As long as most ppl are supportive of your learning process, things will work out fine.

Don't be too hard on yourself. I too beat myself up over the little things that I forget because I am a perfectionist. Relax a bit, make a list of things you need to remember until they become second nature, and just be okay with being human...(It sounds so easy to say now, but it's soo hard to practice...however, I keep reminding myself....It's okay to make mistakes!! )