Need Advice - Not cut out for ICU

lopezjeff · Dec 11, 2021

First off, don't feel like a failure. Just because you're "not cutting" it now doesn't mean you'll never get there. It also doesn't mean you wouldn't cut it at another hospital system.

Is there a way you can change preceptor and extend to 4 weeks? Layout a plan to tighten things up? Good educators and management wouldn't just toss you aside after 12 weeks. For my orientation at a level 1 trauma ICU became almost 5 months because I struggled but I made it. My preceptor laid out what I was doing wrong.

The ultimate choice is yours but I encourage you to seek out more options than what they gave you. A third option could be to try for 4 more weeks and if you're not where they want you to be talk to your previous unit manager and see if you could transfer back. Look into policies as well about termination. Express that as an option that you love the hospital system. However, I will say that the grass can be greener and it also isn't always greener. It's a double edged sword but sometimes leaving one system and learning at another would be helpful.

Good luck! Take it from someone who has experienced multiple failures. I failed my EMT course the first time. I was told I wouldn't work in a level 1 trauma ICU. I was told that I wouldn't cut it to become a flight nurse. I'm annoyingly persistent and did all those things. Be annoyingly persistent because stranger I believe in you.

eventerjazz6 · Jan 26, 2022

I am literally in this exact same situation now. I feel so defeated. I had 12 weeks of orientation, 15+ different preceptors, completed all the critical care core classes, I was already ACLS certified from my previous unit (PCU/tele). My first 7 weeks I was on day shift, and it was a mix of good days and insane days. My preceptors were mostly complimentary and said I was "rocking it." Then I transitioned to night shift. The preceptors hovered over me, visibly anxious when I was doing the simplest things, like checking a temperature or flushing a peripheral IV. One stated she had concerns about me because I did not intervene when a vent was beeping. We were both at the bedside, the vent would beep for a second and then stop alarming and show a green light. At that point I had not had any vent training aside from how to put it on 100% and pause the alarms prior to inline suctioning. I'd asked about the vents, wanting to learn more, but was mostly met with the "respiratory deals with those" response. So I was expecting my preceptor to intervene for vent alarms if it were something that required intervention, and when she didn't budge, I didn't either. Unfortunately she was testing me, and I failed. After that, I've felt like I've been put with far more controlling, borderline nitpicky preceptors, both on days and nights. My orientation was extended another week on day shift, and if the week went well, I would do another week on night shift. If the night shift week was successful, then I would potentially be off orientation. If any of the weeks did not go well, or I did not make adequate progress, the plan is I would be placed on a structured 90 day "performance plan" where I must make progress each and every week and if I fail to make progress any one of those weeks, I would be terminated.

My orientation has been less than ideal in many ways. It's a pandemic and we are the COVID ICU. We have lost tons of staff already to travel nursing and burnout, including 4 of the people that were precepting me. We are also staffed with a large number of agency nurses that staff RNs are expected to be a resource for (even fresh off orientation). The staffing shortage has required my preceptor and I to be doubled and tripled frequently, even for intubated, sedated, paralyzed, proned patients on multiple pressors when we would normally be singled, we just don't have the staff, which led to so many days where I was in one room with one patient trying to fix them when they were crashing, and my preceptor was with the other patient fixing them when they too were crashing. The expectations for me coming off orientation are so high and I have been losing confidence faster each day.

Unfortunately the preceptor I was with did not have good feedback for me my first day of the final week, and the second day of the week I was with the same preceptor, but I was basically just going through the motions because I had already contacted my previous manager to ask about transferring back. I feel so much anxiety and feel like such a failure. I've tried looking back over my orientation and pointing out things out of my control that made it difficult for me to be successful, but with 13 years of hospital experience I have very high standards for myself and felt I should have been able to overcome these challenges. I have no confidence left, I dread going to work every day, I cry every single time I leave work. I tear up every single time I start to feel a little behind or feel like I need to ask my preceptor to step in and help me. I feel like I'm one disapproving comment away from a panic attack at all times. I cry when I meet with the manager and the educator, and when they ask me how my shift is going, I don't even know how to answer because when I felt things were going well, they had heard differently from the preceptor that shift, so I don't even trust my own assessment of how the day is going. I don't want to give up and quit because I truly enjoy the work of the ICU, and I've loved learning new things, and I have a lot of qualities that would make me a good ICU nurse, but I don't really know that I could make much meaningful progress with 90 days of wondering if this would be the shift I got fired. I would be more willing to stay and give it a chance if it could be ensured that I had the same preceptor or just a couple preceptors, not a different preceptor every week/even every shift. This is a level one trauma center, and I have begun to wonder if maybe I would be more successful in an ICU at a smaller hospital, with a slightly slower pace, but I'm honestly afraid to even try at this point. I feel so guilty when I think that they wasted all this time, money, and resources on me just for me to end up being a failure. When I think of returning to my previous unit, I feel so unbelievably embarrassed that I couldn't hack it in the ICU, but with losing so much confidence during my 13 weeks in ICU, I feel like the only way I could be successful in my nursing career right now, is to go back to a unit where I felt like I actually knew what I was doing in order to rebuild some confidence. It's been a very humbling experience and I still don't know if I'm making the right choice or not.

I wish you luck in your future. This is a hard world right now.