new grad having trouble w/ icu personalities

Ruby Vee, BSN · May 10, 2007

i am a new grad icu rn in training and am finding the most challenging part to be interacting with the nurses on my unit. granted some are nice, friendly, and helpful, but the majority of them are unfriendly, condescending, and outright mean to us. i have heard of nurses eating their young but this is ridiculous. it makes me dread going into work everyday. i have been nothing but friendly and professional and am getting glowing reviews at my evals. i am wondering if anybody else has gone through this and if these nurses are being so nasty bc i am new and on orientation. i hope this passes. i really do like all other aspects of icu nursing.

you've gotten a lot of very helpful and very supportive answers. i have one more suggestion. communication is a two way street. take a look at your own behavior and try to figure out what, if anything you have been contributing to these negative interactions. i doubt very much that you're perfect and all these other nurses are just being nasty for no reason. it's possible, of course, but unlikely. when you figure out what you may be doing to irritate these folks, take control of the situation and stop doing it. the only behavior you can change is your own.

suanna · May 26, 2007

I'm one of the mean old timers in the ICU. I wish it was different but with the responsibility level for critical care I dont have time to teach a newbie how to start an I.V., why levo not dopa, how to suction, extubate, intubate, code, etc.... It takes a great deal of study and commitment to do a good job in critical care over and above orientation.Give me a new staff member who shows she is trying to learn and is making the effort to polish her skills and I will to anything to help her. A new ICU nurse who is going the extra mile to learn the job will earn a place of respect on my unit very quickly. Most new people we have hired seem to think since the have "R.N." on thier name badge they know all they need to know. Unfortunately for patients a newbie's lack of skills can be lethal. How do I decide which patients get the nurse with no experience and is likely to miss changes in her patients condition until it becomes a crisis? Do I watch my assignment, your assignment, and still act as a walk up help center for every question that pops into your head. Before I had the nerve to go to critical care I spent a year on a tele floor, took ACLS, studied for my CCRN and read a lot. I may not have been fully versed in everything I faced in ICU but no one had to constantly look over my shoulder to keep me from killing someone. If I am mean to the new people it's just that I hate to see patients get short changed in nursing care. Bad outcomes reflect on the whole unit. No family has ever said to me the ICU at so-and-so hospital does great care except the nurse that let my dad die-they say the nurses at so-and so are lazy and stupid and don't care--they should all lose thier licences. I can even live with a few dissatisfied family members, I can't tolerate a few lost dads or moms so a new nurse can learn the job.

Lisa CCU RN, RN · May 29, 2007

being new, I think you're unprepared for the dynamics of personalities in any unit, let alone and ICU, so you didn't give enough background to your unit.
Are new grads hired regularly? Is there a critical care program to teach you this transition? What is the mix of new and old nurses?
That info speaks volumes for units. Mine is a turn over unit to anesthesia school, we have an extensive critical care school that trains new grads,12 weeks of didactic and clinical... so they come out fairly comfortable and confident... needing situational and policy questions answered... as well as some help with time management if a patient becomes challenging... We start off , off orientation with the two easiest... while in critical care school with a preceptor they take the sickest.... It's to build confidence, time management and skills.
If your unit is "throw you to the sharks".... you'll get nothing but... she can't swim". This is a loose-loose for everyone. If your 1/2 way inbetween, then you must work your orifice off to gain respect.
suggestions- don't ask what you can find. "what color tube does a bmp go in" daily. (call lab, check the reference book), Utilize staff to say... hey listen to these lungs, I think he needs lasix.... Anything you can find, and the finding gets quicker with practice do it! Ask how to find the info... not for the quick answer. If you have down time... your short cutting. No new grad ever sits for months... it's exhausting, strenuous and makes you want to cry and quit..... NORMAL for one year to `18 months.
Want to know how to organize? Find the smoker on the floor and emulate their organization.... it takes great organization to leave the unit 4 times a shift to smoke.
ON a good day and you really HAVE down time, after meds, charting, turning, oral care... don't dare sit... find any nurse in a room, go in and just help... NEVER sit. By being a team player, you've now gained a bath buddy, now talk about your patient and questions over the bath and ask about the other nurses patient while you bathe them.
3 nurses in a room, prioritize, can you stop what your doing for 15 minutes and go in there? DO IT, something is going down, watch, learn, ask "I want to help, what can I do?", be careful initially not to fall too far behind with your own patients.
for gods sake, if you're over 30 minutes behind and nurses are sitting, ASK for help, while a nurse is helping, ASK for time management suggestions. EVERYONE prioritizes different, you've so much to learn by asking EVERY nurse on their shift how they organize it,,,,, emergencies barred.
Study your ACLS at home, in the car, wherever and know the BIBLE until you can spew it out per vatim, learn the defibrillatior, pacing, shocking and become an expert with it... last practice the code sheet, in a code, grab the clip board, stop hidding and start charting.... you'll learn ACLS faster.... 1-3 minutes for each drug... YOU call out when time is up and the next one is due. You just ran a code with out realizing it.
so in summary..... don't focus on the personalities, only how you can improve your practice independently as well as with help to be a functional and independent ICU nurse..... THIS is what the difference is between those that can acclimate and those that can't. If I have to hand feed you, baby sit you, be expected to give you quick and easy answers in an non emergent situation... tell YOU, YOUR patient looks bad.... then we've issues. IN ICU, YOU have the responsibility to read at home, read at work, get involved and be a capable independent provider...... In a Years time.
If your working at this, the staff will have your back. If not, RUN, run now.

Wow. Great suggestions.

arual56 · May 29, 2007

I am a new grad icu rn in training and am finding the most challenging part to be interacting with the nurses on my unit. Granted some are nice, friendly, and helpful, but the majority of them are unfriendly, condescending, and outright mean to us. I have heard of nurses eating their young but this is ridiculous. It makes me dread going into work everyday. I have been nothing but friendly and professional and am getting glowing reviews at my evals. I am wondering if anybody else has gone through this and if these nurses are being so nasty bc i am new and on orientation. I hope this passes. I really do like all other aspects of ICU nursing.

I am sorry that you are having to experience this. Unfortunately, it has been this way for a long time, and is not likely to change soon. But school taught you what it is to be a good nurse, and what kind of nurse you don't want to be. Let their example be a driving force in you to change the "traditional" way of treating new nurses. You are part of a new and better generation of health care providers, and your patients will benefit from your understanding, compassion, and patience with your co-workers.

Lisa CCU RN, RN · May 30, 2007

I'm one of the mean old timers in the ICU. I wish it was different but with the responsibility level for critical care I dont have time to teach a newbie how to start an I.V., why levo not dopa, how to suction, extubate, intubate, code, etc....QUOTE]
I appreciate your honesty, but aren't some skills reserved for the ICU? Intubation and extubation would not be done on a Med/Surg floor would they? Starting IV's, suctioning and running codes I can understand, but what emergency drugs to use would be something learned in the ICU wouldn't it?
I want to go into ICU, but I have taken what some nurses have said as far as learning "nursing" first and then going into critical care and I think I may spend a year on a Telemetry floor first.
Just wondering.

arual56 · May 30, 2007

While I understand that ICU has some very time and skill intensive patients to deal with, suanna;2220556 is, self admittedly from the old school. There seems to be some skills she believes to be isolated to ICU only. In her unit, she may be right. But in other hospitals, intubation and extubation, as well as use of the meds she was discussing are also used in ED and sometimes on MS. Intubation and extubation also occur in ED, and in an emergency, can and is done on the MS units. I respect the fact that she does not feel that "teaching a newby" is something she has time to do. If she is uncomfortable with having a student, then the best thing she could do is bow out of the position. Thankfully, there are a number of ICU nurses that are willing to step up to the plate and teach/orient a newby. Often, this ICU nurse will have her own knowledged reinforced as well as possbily learning from her student. It is not always true, but when it is, it makes the learning process easier for everyone. Suanna belongs to the old school, and is not likely to change, but you are from the new and coming generation. You can be one of the first to make a difference in how the nurses coming after you are taught. Just take the good that those who are giving you trouble and attitude can offer, and leave the rest. They are good examples of the kind of nurse that you want to be, and the kind of nurse you don't want to be. Consider it post graduate work and one more lesson of nursing school.

Jo Dirt · May 31, 2007

I guess some people were never newbies, but were born in scrub suits.

Wish I lived such a flawless exemplory life.

DKJW · Jun 18, 2007

I totally agree with LLG's evaluation, especially #1. I am an RN with 16 years experience in ICU and that is exactly how I feel about training new nurses in the unit. Time and time again, I explain basic nursing procedure and train people who decide to leave within a year, then I have to start over with someone else. It is draining. Not only do I have to train someone else, I have a full patient load myself. Then some days we get student nurses in from the local colleges and they expect me to precept them as well. And if I don't give the learners what they expect because I am just too busy, they report me to their instructors for being unhelpful! I am happiest on days when I can just take care of my patients without having to constantly explain everything to someone else. My favorite kind of nurse to train is one who acts eager to learn, has his/her own Critical Care reference book, and doesn't expect me to spoon feed them the basics of care. After getting report on a patient who has a condition they aren't familiar with, they should immediately get out their book and look it up, read the doctor's orders, and look up all the medicines they are going to give that shift. Most just sit there and expect me to explain the patient's condition, and feed them all the drug information myself. "How fast do I give this Lasix?" is a question I should not have to answer ever again. Look it up yourself - that's the only safe way to give any medication. *sigh* I have begun ranting, sorry. I truly believe that there must be a better way to train new nurses, better for them and better for us. I am just so tired....

pebbles, BSN, RN · Jun 19, 2007

I truly believe that there must be a better way to train new nurses, better for them and better for us. I am just so tired....

In Canada, ICU training is extra schooling. When you apply to the ICU course, you must have had minimum one year of acute care experience. The course is two and half months of classroom theory teaching, two months of clinical with a teacher. Then you have a "practicum" where you work in the ICU buddied with a senior nurse who volunteered to take a student.

I loved this. The hospital paid for the whole thing, and we got our wages covered - because we are so short of critical care nurses. But by and large there are not the problems you describe. Nurses start in the ICU needing some help, but they are basically independent.

This puts the actual basic teaching into the hands of teachers and educators whose job it is to do that, not burdening the nurse who is next to the newbie with trying to teach all that - or making the newbie learn it all on her own.

UpstairsCare · Jun 19, 2007

I appreciate your perspective Arual56. I was encouraged by my clinical instructors and others to apply to the icu right out of nursing school. I decided to go ahead and apply there along with the ms and telemetry units. I ended up getting the icu position. Apparently someone thought I belonged there.

I'm so thankful to have an extremely knowledgeable and experienced preceptor who does not mind answering questions regarding basic med administration...etc. My preceptor said she enjoys orienting new grads because they keep her sharp and up to date on new trends in nursing care. She also said that she is amazed at the solid knowledge base that new graduates have today. She did not have that when she was in nursing school. I think that "old school" nurses should keep that in mind. My preceptor keeps reminding me that it won't take long for me to pick up basic nursing skills, such as starting iv's ....etc, but that my good understanding of abgs, fluid and lytes, hemodynamics, ...etc are what will allow me to be successful in the icu (along with my strong desire to learn).

There is such an incredible shortage of nursing staff. Thank goodness for the overwhelming majority of forward thinking and supportive icu nurses that make a new grad's orientation possible in the icu. I, for one, am incredibly grateful.

dorie43rn · Jul 16, 2007

I have been a nurse for a year, but just started in the ICU. I have only run across a couple of nasty people, the majority are great. Here is my opinion on why they treat newbies bad. They don't like the fact that they hire nurses with no ICU skills into the unit, meaning they will have to be answering alot of questions, and basically be responsible for not only their patients, but the newbies paitents when she runs into trouble. I say this because the nasty nurse on my unit was totally flabergasted that they hired me without basic arrythmia class, or critical care classes. She said, "it isn't fair that I have to interpert your ecg strips and analyze if there is a problem!" What the other nurses told me was that no one comes to the unit with all their credentials! I am perfectly able to care for paitents that may not be as critical as some. In our ICU, we dont' get the traumas, burns etc. We live close to the Pittsburgh hospitals, and they get flown. I would not accept a patient that I could not safetly care for. But, as it turns out, this certain nurse was reported, by another nurse because she continued to treat me like an idiot, which I'm not. All I can figure is she is unhappy somewhere else in her life. Don't let them get to you, find the nurses who are great, and stick with them. They will stick up for you when needed.

Dorie

iLovemyJackRT · Jul 24, 2007

I feel your pain, and let me start by saying....where do I begin....new grad/RN working in the icu...one preceptor had me bawling my eyes out in the patients room...best thing I can say is stick it out, i love ICU but dislike many people, this is my third night off orientation and it is going much better now...the hardest thing about nursing now is fitting in with people who have known each other and have their own cliques for 5 years....i feel so out of place sometimes, like the second i leave the room everyone is talking about me....people act like THEY never make a mistake....stick it out, it will get better with more experience.