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.
I'd say the ICU takes around 3-6 months (depending on the acuity level when you start which I've noticed can be vastly different at times) to even feel halfway comfortable. I didn't start feeling competent until year two! Now I have my CCRN and charge most of the time, but I still feel inadequate fairly often. That is part of being in the ICU. If you don't feel that way, you don't belong (with some exceptions).
Having a good preceptor is vital. No orientee deserves having eyes rolled at them and such. I'd politely tell your director that you feel that you would benefit from a new preceptor. To avoid drama and conflict, talk to your preceptor first and let them know that you are going to ask for a different preceptor because you want to see if another teaching style fits you better (nice way of saying you suck). But sometimes it truly is just a clash in teaching/learning styles.
Do not be afraid to ask for more orientation time. Some of the best ICU nurses I've worked with had a rough orientation and asked for an extension. Some of the worst I've worked with were seemingly having no issues with their orientation but once off showed that they were not ready. I'd much prefer honesty. It protects you, the patients, and your coworkers.
Seek out good learning experiences. Preceptors should look for opportunities for you. Don't let them take the easy patients day after day. Take the scary ones so that when you get them off orientation you won't be a deer in the headlights.
Having all meds and charting done on 2 patients by 9 am in the ICU is bull **** says this experienced ICU nurse.
I have worked at a hospital where the next shift had to get there by 630-640, which made getting things done by 9 am easier. Just saying, this poster may have a situation like that. Otherwise, they did say it was a goal so I'm sure it doesn't always happen.
I'm with another poster, though. I always worry about my I&Os being current way before my assessment. Nobody cares about my (charted) assessment except the people auditing them later (ha), but they do care how negative or positive they are when they round.
I have worked at a hospital where the next shift had to get there by 630-640, which made getting things done by 9 am easier. Just saying, this poster may have a situation like that. Otherwise, they did say it was a goal so I'm sure it doesn't always happen.
I'm with another poster, though. I always worry about my I&Os being current way before my assessment. Nobody cares about my (charted) assessment except the people auditing them later (ha), but they do care how negative or positive they are when they round.
That may be the case. I worked on a floor (not ICU) where it was expected to get there early and look up your patients (on the clock). In both of the ICUs I've worked in, you get there around 7, get your assignments - report starts 7:15ish and could go as late as 7:45-7:50. With physician rounds starting as early as 7:45, it would be ridiculous to expect nurses in my facility to have everything done and charted by 0900. Sometimes I don't even have my physical assessment done before rounds, and sometimes I don't have it done by 0900 (I think the latest I've done it is 0930) depending on how long rounds takes. Because nobody cares about our charted assessments until after the fact, as you correctly point out, it IS ridiculous to expect/require them to be charted by 0900. When I orient people, I tell them the goal is to get everyone fully assessed by 0900 (realistic 95% of the time) and assessments charted by 1100. That's reasonable where I am. The other issue is that some EMRs are easier to chart in than others. At my old hospital, having assessments quickly charted was more realistic because the EMR was far less cumbersome than the one at new hospital.
The MDs care about Is & Os, timely collected labs, meds given (timely), and having changes in conditioned *reported* to them, not charted in an assessment they may not even be able to access in the EMR. I think the OPs co-workers have some screwed up priorities.
ETA: At my facility, we are only expected chart 1 full assessment per shift, unless there is a change. This helps with reasonable charting requirements unlike many ICUs where they expect you to put in q4H full assessments which to me says they want you sitting at the computer all day instead of actually providing care to the patient.
I'm a new grad nurse working on a med surg floor. I just applied to an ICU residency program. It's 8 months long of training with a preceptor. I think 6 weeks or however long you got is way too short. At most hospitals near me, if you have already been a nurse, you still at least get 12 weeks
I did ICU before ER. Icufaqs.org. Great resource. Seize the opportunity to learn as much as you can even if you hate it. It'll be good experience. 6 months to get "comfortable" you should give yourself. Dobhofs are not an ER nursing skill, I'll bet you have some great IV skills and you will hold your own just fine in a code.
Focus on the positives, her comments suck and if there's an opportunity for a Different preceptor with perhaps a more Similar background might be a better fit.
iCU nurses can have perfectionist and OCD attitudes, it's just what makes them food at their job when they notice those trends. You have to be able to let it roll off, (I was never good at that and still get offended). I just believe in mutual respect in a professional environment which not everyone can manage.
To the person asking why she'd leave ER, people sometimes want to try different specialties. Maybe ER isn't her calling, maybe she wants a change, I did ICU for over 3 years before I realized it wasn't for me.
Specializes in Med-surg, telemetry, critical care..
And don't forget the all systems assessments, drips, vent, O2 sats, vent settings, central lines, catheters, urine outputs, etc. Generally one higher acuity patient with a lower acuity person is preferred assignment and SO much less dangerous. Or a single high acuity PT with a helper/buddy next bed.
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54 Posts
I'd say the ICU takes around 3-6 months (depending on the acuity level when you start which I've noticed can be vastly different at times) to even feel halfway comfortable. I didn't start feeling competent until year two! Now I have my CCRN and charge most of the time, but I still feel inadequate fairly often. That is part of being in the ICU. If you don't feel that way, you don't belong (with some exceptions).
Having a good preceptor is vital. No orientee deserves having eyes rolled at them and such. I'd politely tell your director that you feel that you would benefit from a new preceptor. To avoid drama and conflict, talk to your preceptor first and let them know that you are going to ask for a different preceptor because you want to see if another teaching style fits you better (nice way of saying you suck). But sometimes it truly is just a clash in teaching/learning styles.
Do not be afraid to ask for more orientation time. Some of the best ICU nurses I've worked with had a rough orientation and asked for an extension. Some of the worst I've worked with were seemingly having no issues with their orientation but once off showed that they were not ready. I'd much prefer honesty. It protects you, the patients, and your coworkers.
Seek out good learning experiences. Preceptors should look for opportunities for you. Don't let them take the easy patients day after day. Take the scary ones so that when you get them off orientation you won't be a deer in the headlights.