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1 month new ICU job. I want to run

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by RNMeagz RNMeagz (New Member) New Member

696 Visitors; 4 Posts

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I really need to vent and get some feedback as this is driving me crazy. I have been an ER nurse for 3 years. I realized I was getting bored and decided to move to an ICU position. New hospital, level II trauma center, this ICU gets everything from traumas to neuro to cardiac, etc. I felt like this was the perfect learning opportunity.

Well here I am one month in. My preceptor has become annoyed with me. The other day she snapped at me for not knowing the different doctors (some of whom I have never met). I asked her a question about a med rec for a patient who was going to be transferred and she sighed and rolled her eyes in front of my other coworkers and said "we just went over this!" Granted, working in ER I have never had to do a transfer med rec in my life. I confronted her about her annoyance with me and she stated that I'm just not picking things up fast enough and that she is tried of repeating herself all the time. I was shocked because as my preceptor I felt it very appropriate to ask her all the questions I need to understand something. She's made it very clear the whole time that I only get 2 months of training and then "it's sink

or swim".

I don't know if she mentioned this interaction to our charge nurse (also totally her buddy) because he decided the 3 of us should have a meeting today. He said that on the continuum of experienced nurses who are new to ICU I am falling behind and not catching on quick enough. They had a big problem with my charting not getting done fast enough but I was trying to focus on the pts and do the charting later (it's not like my chatting isn't getting done). The charge RN said that he's just really surprised sometimes with the things I don't know. I asked for an example

and the one he gave was checking residuals on a tube feeding. I've never had a pt on tube feelings in the ER!

I am just extremely overwhelmed and anxious to the point that my days off are spent worrying myself sick. I know I should take action and study but it's like I'm paralyzed with anxiety. I want to quit and go back to my ER job but then I will probably just feel like a big failure who couldn't suck it up and hang. I want to cry constantly. Any advice? Thanks for hearing me out.

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743 Visitors; 15 Posts

The er and icu are two different worlds, and to make that transition will take some time. More than two months. For your preceptor to tell you it'll be sink or swim after that? Inappropriate! And hell, there are still docs at my hospital who I don't know because I don't see them often.

What do the nurse manager and nurse educator for the unit have to say?

For the preceptor to tell you she's annoyed because you're not picking up as fast as she'd like, is just wrong. I guess she was born into the position?

Charting is important and should be done as quickly and properly as possible, but yes there are times it's not until after lunch that I can sit down and chart.

I wouldn't let this RN dictate your job, but I get its hard to do because she's supposed to guide you and help you transition and it doesn't sound like she's holding up her end of the partnership. :-/

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696 Visitors; 4 Posts

Thanks so much for your quick reply. In our meeting the charge nurse said he's gonna talk to the ICU director and try to get me an extra month of training. But that upper management just sees a big dollar sign on me and wants me on the floor working independently as soon as possible. The goals they thought I should

focus on were things like having meds passed and an assessment charted by 9am. A huge problem is my preceptor is buddies with the charge nurses and director and what not because she's actually a really good nurse (just not a good preceptor from my standpoint) so anything bad she has to say about me will stick with the leaders of the unit. I'm just really lost at what the best thing for me

to do is. Stick it out or go back to where I am comfortable? I don't know if all this anxiety is worth it, not to mention the huge blows I'm feeling to my overall confidence.

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22,569 Visitors; 1,871 Posts

Last time I checked it wasn't EBP to check residuals on dobhoff feeds, only to monitor if there was active concern for aspiration.

It is true in the ICU that you can't really chart later. You NEED to chart as you go. We had a few ED nurses cross-train to ICU and they struggled, but I feel these nurses are being unnecessarily hard on you.

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22,569 Visitors; 1,871 Posts

Thanks so much for your quick reply. In our meeting the charge nurse said he's gonna talk to the ICU director and try to get me an extra month of training. But that upper management just sees a big dollar sign on me and wants me on the floor working independently as soon as possible. The goals they thought I should

focus on were things like having meds passed and an assessment charted by 9am.

That's a logical goal. I try to have my assessments charted by 8 and meds done by 8:30-8:45. Then I start doing care plan, restraints, patient education, I/Os and reading notes.

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Rocknurse works as a Emergency Medicine and Critical Care.

5 Likes; 26,584 Visitors; 1,350 Posts

I'm sorry you're having a tough time. Here's my advice: don't let it get to you personally. Some people suck. Just let some comments roll off your back and do what you can. Try to get organized. I used to make myself two sheets: a report sheet and an hourly checklist. I made them on my computer as a template and photocopied them every day for new patients. The report sheet was divided into body systems and I'd write down whatever I could from report. The checklist was divided hourly and I'd plan my day by jotting down what needed to be done hour to hour. I'd write down turns, meds due, labs due...whatever was pertinent that I'd be worried I'd forget about. It helped me get organized and be able to remember things. You could also have a litte notebook that you could write down all the doctors names, depts and numbers in so you'd know who was who for that day. If you're given a new piece of information you didn't know, then write it in the book for reference. You could then show them to your manager when you were evaluated so that you could show how organized you were and aware of all the things your patient needed. I hope that helps. Good luck.

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Txldy has 30 years experience and works as a Retired LVN.

1,701 Visitors; 36 Posts

Time to take a step back. If you feel overwhelmed it's because 2 months in a preceptorship is not enough. I'm have a hard time with nurses going in to a specialty right out of school. I'm old school, and think you need that education that 2 years in med surge will get you. It is basics that you will get and never forget. I acquired that attitude WAY back when. I was a graduate nurse from LVN school, and was approached to put in a catheter for a nurse that was about to graduate from a 4 year school and had never seen it done, let alone knew how to do it. ALL nurses need experience in basic nursing. Critical care will fall in to place much ease if you have the basics. I've seen pts with ventilators on med- surg floors. Get your basics, graduate to a step-down unit then go to the units. It's a slow process for a nurse, but you will be able to work anywhere if you get that experience.

Edited by Txldy
Basic grammar

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7,949 Visitors; 449 Posts

Time to take a step back. If you feel overwhelmed it's because 2 months in a preceptorship is not enough. I'm have a hard time with nurses going in to a specialty right out of school. I'm old school, and think you need that education that 2 years in med surge will get you. It is basics that you will get and never forget. I acquired that attitude WAY back when. I was a graduate nurse from LVN school, and was approached to put in a catheter for a nurse that was about to graduate from a 4 year school and had never seen it done, let alone knew how to do it. ALL nurses need experience in basic nursing. Critical care will fall in to place much ease if you have the basics. I've seen pts with ventilators on med- surg floors. Get your basics, graduate to a step-down unit then go to the units. It's a slow process for a nurse, but you will be able to work anywhere if you get that experience.

I guess you missed the part where the OP said they have been an ED nurse for 3 years.

Good luck, OP. I think you'll be fine once you establish a routine. Prove to them you can achieve the goal they have set for you, and they'll probably be more apt to work with you.

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4,053 Visitors; 164 Posts

Did you read her post? She's been an ER nurse for 3 years. She's not a new grad just new to the specialty

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1 Like; 1,804 Visitors; 163 Posts

Time to talk to your unit manager and tell her that perhaps you need to change preceptors. I don't understand why they sign on to be preceptors if they hate traching.

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Jensmom7 has 36 years experience and works as a Hospice Nurse.

11,134 Visitors; 1,907 Posts

Did you read her post? She's been an ER nurse for 3 years. She's not a new grad just new to the specialty

The thing is, ER nursing is so much different than any other specialty that she essentially IS a new grad when it comes to acute and critical care.

No, she doesn't need to be taught how to be a nurse. Yes, she needs to learn how to be a critical care nurse, and as a PP pointed out, some experience in med-surg may have smoothed the way a bit.

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traumaRUs has 25 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

466 Likes; 14 Followers; 127 Articles; 184,821 Visitors; 20,483 Posts

Moved to Critical Care Nursing

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