5 months in, someone talk me off the ledge :/

ambr46 · Nov 10, 2015

Gosh that sounds really rough especially with your mother's health condition on top of it all. Have you thought about possibly switching units in the same hospital? Are there any other departments that seem more of a fit for you? The ICU is a really tough starting out point for new grads.

If your director is approachable maybe you can discuss the possibility of moving departments. I hope things get better for you and please keep us posted. Sending a hug and a prayer your way.

BlueDawnRN, BSN · Nov 10, 2015

I can't speak to what you're going through with your mother, but be assured she's in my prayers.

I am correct that you've only been on your own for a month, right? If so what you're experiencing at work is normal. You will feel like you're sprinting from the second you walk in to the second you leave. You will feel like you can't get done your charting and you will feel very nervous about going to work. It's normal. Nursing is a tough job but if you hang in there it will get better.

If you're not happy on your unit you can look elsewhere but if the only reason for your move is being overwhelmed you may not find it to be easier in other areas of the hospital. For example, if you moved to a med-surg floor with less high acuity patients you would be running around taking care of 6-8 patients instead of 2-3.

I've been working about a year and I still feel nervous about going to work but it's so much better. The fear you have of killing a patient is a good thing. I used to have nightmares all the time. You'll hopefully never lose that fear, but as you get more experienced you will gain more confidence.

ixchel · Nov 10, 2015

OP, I am so sorry for your mom's decline in health.

Your first year will continue to leave you feeling this way. You will experience a few things as time goes on. First, certain diagnoses have predictable presentations overall. You WILL get better at expecting these and knowing what is "out of place" the more exposure you get. This will allow you to have less brain clutter figuring things out, and more time for you to streamline your focus where you would like it to be.

Next, some techs you actively have to tell, "I need your help." If you are more assertive and you get resistance, this is a problem that may need charge nurse involvement. We aren't the bosses of our techs, but if they're just sitting around when you are trying to get their help, that is NOT okay. Break out that nurse voice!

You WILL have an a-ha moment during which you acknowledge to yourself you just might be getting better. It may not come for a few more months, and that is okay and normal.

Those things aside, the first year is horrible for all of us. I got on an antidepressant to get through it. I stayed late charting every shift and I always felt like I just could not keep up because I constantly was putting out fires. I was afraid of absolutely everything. Mistakes were made, thankfully small ones. I was beyond miserable and work was tearing me apart. But, as time moves on, things got way easier.

I'm at a year and a half now, and I still am late often wrapping up charting when I'm there for day shift. But, overall, I'm not late because I'm second guessing everything or messing things up. I'm late because sometimes a patient needs more. More education, more explanation, more help, whatever.

My point is, things will get better. YOU will get better. My mantra, which pulled my dragging butt through that horrible year, is you have to go through this to get through this. If school did a better job of showing us REALITY, this wouldn't be such a horrible shock to all of us.

In case you haven't heard it yet, you're doing a great job, newbie. I know that because this is on your mind enough that you've reached out for guidance and validation. You mention taking care of your patients, and being careful to the point of getting some anxiety over it. You are doing well, I promise. Dig your heels in, and get you through this initial terrible year. This WILL get better, I promise!

(And, btw, the adrenaline and fluster to get a patient "back" just hasn't happened on your shift yet. Brace yourself - it will.)

cupcakeluver · Nov 11, 2015

I'm just a student. I'm set to graduate in May. I poke through these forums to get a better idea of what to expect during that scary first year.

I don't have any advice. I just wanted to say hang in there. You made it through school. You're on your own. You haven't killed anybody yet. You must be doing something right.

I wish you the best and pray that you find your comfort zone soon.

Come back and let us know when you get there.

nursej22, MSN, RN · Nov 11, 2015

You must take your breaks, for your health, to deliver safe care, and it's the law.

I agree, involve the charge nurse if the PCA flat out refuses to help. That's her/his job and if they don't want to do it, there are plenty of others who will.

Mavrick, BSN, RN · Nov 11, 2015

No, do not quit. You can do this.

As a new grad in ICU you are taking an enormous first step. It is hard. Very hard. It is the kind of thing that is a terrible experience while you're going through it, but makes a great story. (Kinda like white water rafting) If you are any kind of a conscientious nurse, which sounds like you are, you are even more aware that you just can't "get it" fast enough.

The additional stress you are under with your mom's illness is unfathomable.

Yeah, you're slow, have to check stuff twice or even look it up, not sure why things are not going right, maybe you've made a little mistake or two while anxiously dreading the "big one", always feel like you're behind and the last one to figure it out, feeling personally responsible for bad outcomes. That was my experience as a new ICU nurse and other nurses had the same. So much so, I would call it typical and NORMAL.

It does get better as you start seeing things again and again. Drugs and drips start getting more familiar. Things do start to go your way and sometimes you even catch something before it goes all to hell. It's a process and it does take time.

You're right, these times can be very draining and self care can take a back seat. I would suggest, if you can, keep from working too many days in a row. It's an opportunity to regroup your energies and give yourself a chance to juggle all the demands that are attacking you.

That ledge does have it's slippery spots and can get kinda narrow and hazardous in places but the view is amazing. I had a most satisfying career in ICU and have many great stories. Stick it out and you will too.

snaps · Nov 11, 2015

Thank you all so much for the thought out replies. They have truly helped me more than I can explain. I love the white water rafting analogy. Thank you all for renewing my spirit and giving me back some inner strength to make it through.

HouTx, BSN, MSN, EdD · Nov 12, 2015

I began my career in ICU also - back when the Earth's crust was still cooling. I loved it from the get-go. Looking back, I realized that I was surrounded by supportive co-workers who 'had my back' but I didn't always realize this. They kept a watchful eye, but didn't step in unless I asked for help. This may also be happening for you.

In ICU, there really isn't as much "team work" as other specialty areas. Nurses work solo unless a job actually requires more hands-on assistance. It's important to demonstrate respect to your colleagues - so it's unlikely that anyone is going to rush over and push you out of the way to take over if you look like you are faltering. Instead, they will wait until your request some help. When you request, be specific. "can you help me pull my patient up in the bed in 15 minutes?" rather than "when you get a minute, can you give me a hand?". OTOH, never hesitate to get a 'second opinion' when you need it - asking a more experienced colleagues to validate your interpretation of a difficult arrhythmia is usually interpreted as a mark of respect for that person. But if you ask all the time - for easy stuff - you'll come across as indecisive and needy. Definitely NOT a good look for an ICU nurse.

There are some old studies ('80s) that indicated higher levels of job satisfaction in (female) ICU nurses that had more androgynous personality types - AKA, more assertive, self-reliant and decisive. This finding shows up a lot in subsequent studies. So if you are not normally very assertive, you may need to work on this - beginning with that PCA. Instead of 'asking', make an assignment... "At 10, I want you to start on Mr X's bath. I'll join you to help with changing the linens".

On behalf of the ICU Nurse 'Tribe', I extend a very warm and sincere welcome. We need your energy and talents.

marie.rn2419, RN · Nov 16, 2015

No, do not quit. You can do this.
As a new grad in ICU you are taking an enormous first step. It is hard. Very hard. It is the kind of thing that is a terrible experience while you're going through it, but makes a great story. (Kinda like white water rafting) If you are any kind of a conscientious nurse, which sounds like you are, you are even more aware that you just can't "get it" fast enough.
The additional stress you are under with your mom's illness is unfathomable.
Yeah, you're slow, have to check stuff twice or even look it up, not sure why things are not going right, maybe you've made a little mistake or two while anxiously dreading the "big one", always feel like you're behind and the last one to figure it out, feeling personally responsible for bad outcomes. That was my experience as a new ICU nurse and other nurses had the same. So much so, I would call it typical and NORMAL.
It does get better as you start seeing things again and again. Drugs and drips start getting more familiar. Things do start to go your way and sometimes you even catch something before it goes all to hell. It's a process and it does take time.
You're right, these times can be very draining and self care can take a back seat. I would suggest, if you can, keep from working too many days in a row. It's an opportunity to regroup your energies and give yourself a chance to juggle all the demands that are attacking you.
That ledge does have it's slippery spots and can get kinda narrow and hazardous in places but the view is amazing. I had a most satisfying career in ICU and have many great stories. Stick it out and you will too.

Beautifully put! Your post encompassed all that I wanted to say to snaps and more! :-)

shopaholicRN · Nov 16, 2015

Sorry to hear about your mom

I am also a new grad starting out in the ICU. I have been on my own for 2 months now. I feel the exact same way you are feeling so I don't know what to offer for advice but I just wanted to reach out and say you are not alone. Everyone tells me to give it at least a year. Which is really tough to imagine at this point. But everyone above has offered great advice and support and I agree that there are a lot of reasons to try to stick it out :)

SororAKS, ADN, RN · Nov 25, 2015

What you're going through is quite common. I remember feeling that nervous feeling for quite a while working in the ICU, rather like I was tiptoeing through a mine field. I did the best I could to give good care, studied constantly, took as much continuing education in the specialty as I could, asked a lot of questions, and asked for help when I needed it. Gradually, I gained confidence. It doesn't come overnight, but it does come.

For me, that AHA moment came when I was getting ready to defibrillate someone, realizing that the practice, study, and work really paid off. I had just gotten my ACLS certification. There I was, with the paddles in my hand, for a split second it was as if I stood outside of myself and was watching ME. Then it was like a flash, "Wow. That's me. I'm confident. I can handle this." Having that insight was Golden.