Are some people just not cut out for ICU?

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morte, LPN, LVN

7,015 Posts

If she thinks dig is an antihypertensive, are we sure she is a nurse?

sunnycalifRN

902 Posts

In answer to your question, yes, some people are not cut out for ICU and your orientee is one of them. She should be given the boot before she kills someone!!

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ghillbert, MSN, NP

3,796 Posts

Specializes in CTICU.

Yes, some people are not only not cut out for ICU, but are dangerous. I think it's a stretch for you to say she's looking after patients "independently" if you have to put things on her desk and remind her etc. Her knowledge deficit is less scary to me than her lack of insight into her shortcomings and lack of initiative to improve them. Time to quit the softly, softly approach and get tough. This isn't daycare... shape up or ship out. It's not fair to subject critically ill patients to someone who not only doesn't get it, but doesn't care that she doesn't get it.

opossum

202 Posts

Specializes in ICU/CCU, Med Surg.

I'm a new nurse and just got off a two-month long orientation in ICU; when I started to read your original post I thought you were being a little too harsh and impatient with her but by the end of your post, I can see that she is lacking some of the qualities required for ANY kind of nursing, not just ICU. Chronic tardiness is NOT good!

It sounds like you are a great preceptor - it's clear you're concerned and want her to succeed...but what makes you good is recognizing what her weaknesses are. And the hard part is communicating what those are to her. It might be time to sit down and have an honest conversation with her about what you're telling us. Despite the horror stories of more experienced nurses "eating their young" I believe most nurses do not want to hurt the newer nurse's feelings...and fear their constructive criticism could be misinterpreted as bullying.

In my two months of orientation, I've often worried if I'm cut out for nursing PERIOD, not just ICU. I've made stupid minor medication errors, made idiot "rookie" mistakes as well as downright illogical where-did-they-teach-her-that kind of moves. But I've also been told it takes time and that I'm doing a "good job". I've had one experienced preceptor pull me aside one particularly hectic (for me) shift and say that she wants me to understand she's not trying to set me up to fail or leave me hanging, but she wants me to get a feel for what it's like once I'm on my own...e.g., having all my linen and stuff ready before asking help when changing sheets. Or she'd ask me why I programmed the pump to deliver 150mL for a 100mL bag :uhoh3: (I SWEAR I was thinking of something that happened in clinicals once...). She was trying to kickstart that critical thinking and ability to see the big picture and think logically...

Anyway, my point in all this is...keep doing what you're doing and when you "light a fire" under her, do it with compassion and tell her what your concerns are and what you'd like to see her accomplish. Maybe she'll surprise everyone...

Specializes in NICU.

I want to thank everyone for you posts. Opossum, thank you for sharing your experiences. I'm going to continue to work with her and try to be supportive and educational. I'm also going to try to refrain from venting to coworkers about my frustrations. This isn't helpful and just causes them to look at her in a negative way.

We are going to try to do 2 more weeks of orientation on day shift and then she is to go to nights for a few more weeks with a different preceptor.

Like I said I cannot complain about her bedside manner. I'm hoping time management and prioritization kick in soon. She is improving slowly. Thanks for your support. I don't think we will really know how she is going to do until she is on her own.

emilyBABSNRN

49 Posts

This is a little off-topic, but what do you all think are good qualities in an ICU nurse then, besides having good bedside manner? I have over one year as a tele RN but had to move to a new state and take a job in a universal care unit. Is it better to go back to tele and then to ICU or straight to ICU? I don't wanna drown like all the others...

Specializes in NICU.

Not everyone drowns. You just have to be able to see the big picture. Understand basic physiology. Know how each organ effects the other organs. Be able to pay attention to details. Labs, vitals, urine output, neuro assessments. You have to be able to pick up on subtle changes before they become emergencies.

Know why you are doing what you are doing and the benefit it has on the patient.

ICUenthusiast

54 Posts

Specializes in ICU.
I'm a new nurse and just got off a two-month long orientation in ICU; when I started to read your original post I thought you were being a little too harsh and impatient with her but by the end of your post, I can see that she is lacking some of the qualities required for ANY kind of nursing, not just ICU. Chronic tardiness is NOT good!

It sounds like you are a great preceptor - it's clear you're concerned and want her to succeed...but what makes you good is recognizing what her weaknesses are. And the hard part is communicating what those are to her. It might be time to sit down and have an honest conversation with her about what you're telling us. Despite the horror stories of more experienced nurses "eating their young" I believe most nurses do not want to hurt the newer nurse's feelings...and fear their constructive criticism could be misinterpreted as bullying.

In my two months of orientation, I've often worried if I'm cut out for nursing PERIOD, not just ICU. I've made stupid minor medication errors, made idiot "rookie" mistakes as well as downright illogical where-did-they-teach-her-that kind of moves. But I've also been told it takes time and that I'm doing a "good job". I've had one experienced preceptor pull me aside one particularly hectic (for me) shift and say that she wants me to understand she's not trying to set me up to fail or leave me hanging, but she wants me to get a feel for what it's like once I'm on my own...e.g., having all my linen and stuff ready before asking help when changing sheets. Or she'd ask me why I programmed the pump to deliver 150mL for a 100mL bag :uhoh3: (I SWEAR I was thinking of something that happened in clinicals once...). She was trying to kickstart that critical thinking and ability to see the big picture and think logically...

Anyway, my point in all this is...keep doing what you're doing and when you "light a fire" under her, do it with compassion and tell her what your concerns are and what you'd like to see her accomplish. Maybe she'll surprise everyone...

I agree with this post a lot.

During my orientation period, I had personality clashes with a preceptor. She wanted to tell me what I'd do, at all times, and it was very demoralizing as I felt I couldn't learn well and what knowledge/skills I had were not "good enough" for that one preceptor. Unfortunately, for some ppl, this backfires and they almost regress, because all they are not being allowed to think for themselves, and if they do, they don't receive recognition for it. This is what happened to me! When I had another preceptor, it was completely opposite, and I was independent w/ exception of emergencies. I felt like I was able to show I knew my stuff, and at the end of the day, they'd tell me things like, "You did very well overall. As you progress, try to improve on x points." And if I made a dumb mistake (like why isn't this suctioning--oh it's not hooked up), I appreciated that people could say "Yeah, I make some of those mistakes still," where as the preceptor I didn't get along with attacked me for them. So what that came out looking like was one person only had negative things to say about me while everyone else on the unit I knew and worked directly with me praised me and welcomed me to the unit. That made my first eval hell too.

Regardless of that, I still always showed up to work on time, was trying to expand my knowledge base, and could tell someone dig was an inotrope............ I feel those are just basics to showing you even want to be a nurse regardless of specialty!

RNChristy

64 Posts

Specializes in Telemetry, ICU/CCU, Specials, CM/DM.

OMG. This nurse is not cut out for ICU. And 14 weeks and she is still showing up late and not reporting off her patients when she leaves the floor? Also, she does not know about medications like Digoxin after 14 weeks? That would have never been tolerated in the ICUs that I worked. Your director needs to make a decision on whether this nurse should be terminated or placed in another unit.

nitronymph

17 Posts

Specializes in ER, MS, ICU.

She must be part of the social set. Believe me, I have also seen nurse like this in my years, but they are kept because the no someone in the upper crust of the hospital or the small town. Therefore, in spite of there lack of belonging in ICU, the remain because of who they are or who they know. Very sad. If this nurse is not getting to work on time and does not seem to be interested in attempting to learn her drugs outside of her job, she is definitely not an ICU nurse!

funkywoman

32 Posts

Specializes in ICU.

Some people are just not cut out for ICU, nothing wrong with that. Sounds like she is not, and not really applying herself to 'make the grade'. I would definitely sit down and talk to her, very straight forward about the situation. You mentioned she does not take criticism well, so do her the kindness of sitting down for this discussion : in private, at the end of the shift, when she does not have to come in the next day. In my experience, most nurses figure it out by 14 weeks that they don't belong and are more than happy to leave. Only seen a few that just don't get that they don't get it.

Barbr93

6 Posts

You sound like a GREAT Preceptor, one who wants to teach!

I just came out of an 8 maybe 9 1/2 week orientation in the ccu. ( NEW GRAD, new at all of this!) First off, I was hired to work icu nights, but was never scheduled in that department. Second, my preceptor expected me as a new grad to know everything right off the bat, and although I knew a lot, there is SO much to learn! I know my pressors from my anti hypertensives, and my anti arrythmics... Gave all meds ON TIME, was never late, and always always reported off!! What your preceptee was doing sounds like bad nursing period. In my opinion it takes time to develop the skills I needed, which was learning more about med titration, and getting faster on my charting. I was basically asked to leave, and they would find me another unit. Some of the folks before me had 4-6 months to train.

.The preceptor I was assigned to had to leave, and I got handed off to whomever on the unit, on any given day which was insane to me. Some nurses were great, one guy in particular had a great knack for teaching, and was good with IV's, and could tell you lots about hearts, but he only worked there 2-3 days a month, so I could not be with him as a preceptee. I think it is one's willingness to learn and work hard, as well as the quality of your orientation that helps prepare a critical care nurse. I feel that in my case, they failed miserably. I will be willing to go back, but not until after I can ensure that I get quality training in the future.

I enjoyed every day in critical care. I wish I had had the preceptorship I needed, and the classes I needed, which were not provided. I hear some hospitals put you through a short course on critical care, and then let you go with someone. THAT would have been great

I would love to start over, and get another preceptor, but with this place being as crazy as it is, I have decided to go to a specialty area, possibly the OR.

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