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.
Specializes in Med-surg, telemetry, critical care..
Working in the ER is so very different from working ANY floor, if you don't have any other experience anyplace else in a hospital. I think that the preceptor should have been given that information, even if it probably not have made much of a difference. That person was just the wrong person to be a preceptor. Don't even get me started on the manager. There's an old, unwritten hostility of ED nurses from unit nurses. It looks like things don't change over so many years. It may be part of the preceptor's AND the manager's attitudes.
Don't worry, I feel the same way sometimes. I would suggest to brush up on your skills sometimes. Also, try to find the policy that states the standards of care in the ICU. It will guide you on what is expected of you on the care of patients in the ICU. There will always be a website where you can find these in your intranet hospital website. I am new in the ICU as well. Sometimes, I want to run and hide because of the stress and anxiety but I always tell myself to keep moving forward. I write in a journal about what happens to me at work and my thoughts in my head afterwork to reevaluate what happened and what should I do next time. In that case, those thoughts are out of my mind the next time I go to work. You can do it! It takes atleast 2 years for someone to be really comfortable in ICU so I have heard from the experienced nurses where I work. Also, ask for another preceptor. Your preceptor has attitude problems and has a very high expectation of you.
I agree with the post that your preceptor should not be precepting if she's so easily exasperated, or rolling her eyes and snapping at you. As others have said, the ICU is a different world compared to the ER. But don't feel bad. ICUs are known to attract some personalities who think that they know it all and love to show that off---especially to those who are new to the unit. Don't let them scare you off. When I was new to the ICU, even though I had some critical care experience the manager still sent me on a 4 week ICU course which was part of a 16 week orientation (ah, the good old days!). That 4 week class was excellent because it incorporated most of the more commonly used protocols in the unit, so by my first day with patients I had a pretty good idea of what the expectations were. The biggest help though was that I had a preceptor who loved to teach and didn't mind my questions. I got a copy of the Pass CCRN book and studied it bits at a time, and whenever the doctors (well, some of them) showed up and wrote weird looking orders I would ask them questions. My preceptor would also give me mini homework assignments related to the patients I took care of that day. It wasn't like graded homework, just another way to help me learn more about why certain things are done. After a while I found that I was seeing a lot of the same types of cases again and again. And, with given patient-specific issues I knew what orders to expect and what to do.
It is a lot of stuff to learn and you really need at least 3 to 4 months of orientation to get off to a good start, but I doubt that most places are offering extended orientations or an ICU course these days because they view training as a cost rather than an investment. They should have given you a copy of the unit protocols. Familiarize yourself with it because you're going to be doing these things routinely. When I was working as an ICU RN what I saw most new nurses struggle the most with was time management and understanding those protocols. When you take report on certain types of patients you need to highlight your priority interventions right away. You're doing focused assessments and documenting things like vent settings, drip rates, vitals, and Is&Os at least hourly anyway so organize your workflow and do your documentation on the fly. You can't let the documentation fall behind because when the docs log in or walk in they want to see the latest everything on the chart. If it's not there then they're not going to be happy. It's also not good practice because if you're patient crashes or is downgraded for transfer off the unit you may not have time to input all the data you've been writing down on your piece of paper before you have to give report, and as soon as that patient is gone another one will be coming. And, may God help you if you lose the piece of paper.
You're feeling anxious because you're not prepared and because your preceptor is judging rather than teaching you. That charge nurse isn't helping either by saying that he's surprised at the things you don't know. He should know better. No matter how much knowledge and experience we have we are supposed to ask for help before attempting to do things that we don't know or don't remember clearly. It's probably easier for a med surg or telemetry nurse who's had a couple years of experience to learn ICU nursing that it is for you because there are many things that both floor and unit nurses routinely do in patient care that an ER nurses don't do. I would stick it out. Its just a matter of getting yourself organized.
There is your problem. Preceptors teach, guide, and lead. I have precepted many nurses in many areas. I identified their problem areas, we worked on it, resolved it .. and they ALL succeeded.
Stop spending your energy.. feeling that you are failing. You are not , the preceptor is failing.
Discuss your concerns with management and nursing education. You just need a good preceptor.
It sounds like you have a preceptor that doesn't have the patience to be one (she shouldn't be one) and you don't need to take her acting like a rude idiot to you to heart. The charge nurse being her buddy doesn't help and the 3 of you having a meeting together sounds like he is buying whatever bull she is selling about you. I know that I and the majority of the nurses in the ICU I work in are always doing our charting later--many times after our shift ends--it just can't be helped with the acuity of care. I know the normal thing to say would be to stick with it, but with the charge nurse and your preceptor seemingly against you--the odds are stacked against you right there between those two. If you are really determined then stick with it, but if I were you then I would go back to ER and down the road look at a different specialty ICU in the hospital or if there is only the one there, then an ICU in another hospital. I just think between those two nurses--the one being a charge nurse--even with another month of preceptorship will find issues with whatever you are doing and it isn't worth you being all anxious about your job security. If you have the option now (at my hospital they changed it to a one year wait once you go to a new position before you can transfer to another one due to high turnover in all the units in general) Go back to the ER where they actually appreciate you!
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.
While yes, I agree that ER is a totally different animal than Critical Care nursing, ER still takes care of acute and critical patients. Our focus is simply changed from a more rehabilitation stand point and getting that patient back to where they started from to a stabilize and transfer the patient to the appropriate inpatient/outpatient/observation status or D/C.
I'm in somewhat the same boat OP. My preceptor (so far) is absolutely amazing! But I don't know if I'm going to like Critical Care nursing or not compared to ER. Im still working full time ER at one hospital and working PRN in a critical care unit in another hospital and going through orientation for the CCU position now. I really want to like Critical Care nursing because I need the experience for the future (I want to be a CRNA), but I want to be happy and enjoy my job at the same time (which I love the ER).
Good luck OP. Dust yourself off, get back up and show that preceptor what for!
This was an interesting read for me. I always figured an experienced ER nurse would be a quick learner in an ICU where things are a bit slower and one has only 2 or 3 patientWThis was an interesting read for me. I always figured an experienced ER nurse would be a quick learner in an ICU where things are a bit slower and one has only 2 or 3 patients. But I see it is the co-worker you have and the process she wants is the issue. None of your story is about patient care/staffing issues.
You mention you may return to your ER position. Don't be afriad to do it. Let the nurse manager know things are not working out. Another option is to ask for a different preceptor. When I was a new nurse, it took me a month to tell my manager that I did not like my trainer. My manager told me I should not have waited so long. Don't take too long to speak with your manager about the fact that you don't like who you are training with.
Specializes in Med-Surg, OB, ICU, Public Health Nursing.
The problem appears to be an unreasonable preceptor and insufficient time for training.
I would not let the preceptor determine my future. I think the question is, do you like/love working critical care? If you think there is a good possibility that you do, hang in there. Request a new preceptor. Good luck to you.
I stayed a year in ICU and realized I was still going home stressed. That was when I made a decision to make a move.
cylmara
20 Posts
I can feel your pain
I'm a new grad and have been doing my residence program in the tele floor..
My preceptor acts just like yours, she always yelling at me in front of my pts..
I feel so bad and when i go home can't stop thinking about how miserable I felt...
Hope we can survive..
Good luck