My first 100 days on the job: Week 2

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Specializes in Critical Care.

Background: I recently relocated 1,000 miles from home to the East Coast after accepting a New Grad Resident position in the ICU. I want to share my story on here as I begin my new nursing job to get some feedback, share what I've learned, ask for support, and to help me reflect and grow as a new nurse.

Days 4 & 5

Me and Report:

"BB is an 80 year old female admitted yesterday, now border status (huh?). Has a BIV (a wha?), went into A-fib (why?), TEE negative (what's that?), cardioverted (uh oh), received Neo boluses. Numbers for DDD VT VF are... (what do THOSE mean?), ejection fraction 30-35% (I forgot, is that okay?...)"

I scribble scribble scribble, frantic, making no sense of this information, as my preceptor nods and mhmms casually. This is basically how every shift starts on the ICU.

Due to scheduling and staffing issues, I have many preceptors now. This makes tracking my progress more difficult but I learn multiple ways of doing things, and I get to know the staff more quickly, so I don't mind. But being short staffed meant getting tripled, so after 7am huddle, Preceptor#2 and I work hard and fast all day. We get a 10 minute lunch break around 3pm and then resume work until 830pm. I knew more about pacemakers by the end of the shift than I did at the beginning of it, but still far from understanding them. Preceptor#2 tried to explain them further after our shift, but I was so exhausted, the information went through one ear and out the other :dead:

I really appreciated Preceptor#2's patience with me that day... We were really falling behind at one point and she asked if I'd be willing to a task alone. I started the task, messed up, and she had to fix it, making us fall even further behind. I felt horrible. But she just said, "Oh it's okay! No problem."

The nurse who wound up helping us out because we fell so far behind wasn't so patient with me. I'll call her Nurse A (like Type A personality, kinda on the more intense side). Nurse A got a bit snappy with me. I get it. We were busy. I was slow, new, asking stupid questions (her responses to my questions were harsh and sarcastic, leaving me feel pretty stupid) :bag:

I felt intimidated a lot that day...

I was asked to call the doctor for my patient and I couldn't do it. I froze up. I didn't know what to tell him, how to answer his questions. I felt like an idiot. The doctors I've met aren't mean or rude or anything. I just freeze. WHY? It's so frustrating... :(

Day 4 wasn't bad really, but Day 5 was better. I met Preceptor #3, and we had a slightly more efficient day. When I repeated the same task I messed up with on Day 4, I didn't repeat my mistake on Day 5. Progress :up:

Things I learned:

I feel like I'm learning something every few minutes... How to start IVs, draw blood and send it to lab, change central line dressings, trouble shoot chest tubes, reach certain providers, search protocols, that BIV stands for Biventricular Pacemaker, status post radical mastectomy = increase risk of swelling/ infection = no BPs/blood draws (trauma) on affected arm. I saw a Swan Ganz for the first time.

Things to Improve:

Confidence is a big one this week. I'm sure it'll be one many weeks to come... And I need to get better about organizing my day. My time management skills stink.

Victories:

At the end of my shift on Day 5, my patient's brother went up to me and said: "Thank you for the wonderful care you gave my sister today. You are a stellar nurse. Really, you are to be modeled after."

= Forget all the things that went wrong this week :D

So my questions this week are: How long does it take before one feels comfortable on the unit? How do you talk to doctors? Handle co-workers who are... less patient with you? How do you organize your day on the ICU, or any unit really?

Previous Post:

The Beginning: https://allnurses.com/general-nursing-discussion/my-first-100-1000287.html

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Specializes in ICU.

I felt at least somewhat comfortable on the unit right away - but then again, I did my preceptorship in nursing school in a high acuity ICU, so I'd already spent 36 hours a week for six weeks in the ICU before I graduated. If you didn't have an experience like that, I imagine it's a little shocking.

I didn't feel 100% comfortable until I got off orientation. I felt 100% better after no one was breathing down my neck and I could do my own thing by myself.

I hope you are studying on your days off if you have the time! It will do wonders for your confidence if you're not so lost during report. Icufaqs.org is a great resource if you haven't come across it already. I'm a big fan of the SkillStat ECG Simulator for being more confident in your rhythms. Having a good lab and diagnostic test manual handy so you can look up those tricky tests that you aren't familiar with helps, too.

Good luck, and most important of all, have fun!

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Awesome great job.

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Specializes in ICU.

Love hearing about your experience! I start a new grad residency in the ICU in 3 weeks. Keep up the hard work :)

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I absolutely love your post. Your commentary in parentheses actually made me laugh out loud. Thanks for making my day!!!

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I love your posts. I am a new grad in ICU as well, except my orientation was only 16 weeks and I'm now on my own. Going on my third week. I can surely relate to your posts. I can't wait to feel comfortable at my job. Thanks for the great posts!!!

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Specializes in Critical Care.

I never rotated to the ICU during nursing school clinicals. I hadn't even had experience on a Tele unit, so all of this heart stuff is new, shocking, and fascinating. The heart is an amazing organ. I am definitely studying on my days off. If I don't I find myself repeating questions and I'm sure that gets old for preceptors... I did come across ICUfaqs and Skillstat but haven't looked into them much - I shall do that. The lab book is a good idea, too!

I'm glad you guys are enjoying the posts! The ICU is a fun ride!

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Love reading your posts! When I am dealing with grumpy preceptors I try to just be as pleasant and cordial as possible, and don't acknowledge their rudeness. It can be very upsetting though. You are new, and learning, and all tasks take you ten times longer to complete. On top of it you are trying to make a good impression on the new unit and you have no choice but to be around this person. It stinks!

Where on the East Coast did you relocate to?

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Specializes in ICU.

This is what I find so frustrating about nursing schools these days. When I was in school, we rotated thru several different intensive care units, learned IV skills, blood draws, learned about swans, managed chest tubes, etc. Some people might like to call these "tasks" that can be learned on the job, but we are finding our new grad hires do not have even basic skills. Are they not teaching EKG's in school anymore? Also, we had to perform X amount of central line dressing changes in order to graduate! We had plenty of theory, too, of course. Oh well, that was my rant for today. I guess I just don't see what is the point in going to school for 4 years, if the nurse still has to learn basic nursing skills "on the job." We spend a ton of money, just trying to orient new nurses. Gone are the days of being able to hit the floor running. Good luck in your new job.

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Specializes in Critical Care.

Simply Jenny: I'm glad you enjoy the posts! I'm sorry to hear about your preceptors... Good for you for not letting it affect you too much. Just remember this experience for when you start orienting! I am in the DC area :)

Applewhitern: Believe me, it's frustrating for us, too. We would rather be useful than to be stuck on a basic nursing task. I had a conversation with a very experienced nurse once and she told me all about how when she was in nursing school she rotated to every unit and did EVERY THING. In the OR she was right there at the bed, assisting the surgeons. Students aren't even allowed in the OR now. It's all about liability. Plus it's more important for nursing schools go have good NCLEX passing rates than to ensure their students can start an IV. In fact my school recently changed the curriculum and cut their student clinical hours in half. I still have never done a central line dressing change on an actual patient. As for EKGs... We ran through them in a med-surg class once and just had to interpret lethal from non-lethal strips. We didn't measure anything or go much into how to treatment.

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