Need some advice...

putmetosleep · Feb 1, 2008

Of course you'll really be the only one to know what's best for you, but first thought is that 6 months in the ICU is really not that much time. I'd recommend giving yourself a full year in the ICU to fully experience it and get more comfortable before you decide to switch.

jb2u, ASN, RN · Feb 1, 2008

I graduated in May 2007 and went straight to the ICU. I love it there. Going in, I knew there would be a HUGE learning curve. Maybe that is why I can handle it. I get a great deal of support from my coworkers and I can always say...can you look at this, can you listen to this for me. I NEVER feel alone in my ICU.

Now, to be honest....I am scared of having to be pulled to the floor. Any day now, I know I will walk in and they will say "you were added to the pull rotation" (we take turns being pulled). I am scared of not being able to just look up and see my patient. I am scared of having 6 patients. I am scared of not being able to monitor B/P, HR, RR, and O2 sats continuously!!! Yes my patients are in critical condition, but many on the floor are as well. Today’s floor patients were ICU patients in the 70s 80s. My CNS said today's floor patients use to be ICU patients and our ICU patients use to be dead!!! We are able to keep patients alive longer and they are sicker. So we end up pushing less CRITICAL (yet still critical) patients to the floor. So yes, the floors scare me.

This is just my thoughts on being a new grad in the ICU. I love the contact with the patient. No CNAs to bath or feed the patient. That's my job. I can observe the patient constantly. I can just sit there and watch how this heart pt is different than my sepsis pt. Many of my fellow new grads on the floor do not have this luxury. Yes ICU nursing is a big responsibility, but no bigger, in my opinion, than the responsibility on the floor!!! I think if you were on the floor and FINALLY got to your 6th or 7th pt after doing assessments and passing 20-30 meds each and found them blue and you called the code and they died, you would feel horrible and wish you were back in the ICU. Of course, if you were in the ICU and missed one of those subtle signs of a declining pt, and that pt coded and died because you missed it...you would probably feel responsible, too. I guess my point is...Nursing itself is a BIG responsibility. You learn enough in school to function minimally!!! You really learn while nursing, and it seems you never stop!!!! Never take the responsibility lightly and be sure you can handle it!!! Think about what your passion is and do that. I love caring for critically ill patients. I love the equipment. I love the hands on nursing. Again, find YOUR passion and understand that no matter what it is...it will be hard until you get comfortable with the amount of knowledge that you have. And knowledge will only come with time...so stick it out (whatever your passion) until you have been there long enough to gain the knowledge.

I wish you all the best.

Sincerely,

Jay

bluesky, BSN, RN · Feb 2, 2008

To the OP. It is completely OK to feel like you do. I would completely trust my instinct if I were you. Your instinct is not telling you " I am a weak nurse who is overwhelmed". Your instinct is telling you "I don't like it here". "I want to try something else". That is absolutely fine. You can always try something else and then return to the ICU if you want to.

Some people spend 6 months in the ICU and think they know it all. These people annoy me. This post isn't about them... it's about you and what you want to spend the next couple of years of your life doing.

What struck me about your post was that you are very specific about what is bothering you. You are not overwhelmed by the tasks or mad at a petty diva nurse. You have identified certain intrinsic aspects of ICU life that just don't mesh with your personality.

Have you ever floated to other areas and found yourself invigorated or like that is where you belong?

All that said, only your own true self and time will tell whether you are experiencing

temporary angst or indeed in need of a permanent exit strategy. I think you may want to figure out exactly where you want to go before discussing it with your manager because the manager won't be 100% thrilled that a nurse she invested in wants to leave her unit. If he/she is a good manager, he/she will help you find placement in another unit and leave the door open for return. If he/she is not a good manager, they will guilt trip and rationalize you into staying.

I don't have the full picture of what you are dealing with. All I can do is encourage you to follow your heart and believe in yourself. : )

jb2u, ASN, RN · Feb 2, 2008

Some people spend 6 months in the ICU and think they know it all. These people annoy me. This post isn't about them... it's about you and what you want to spend the next couple of years of your life doing.

Well, I would certainly hope that this is not a personal dig to me!!! I never claimed to know it all and actually stated there is a lot for me to learn and that I get help from the experienced nurses at times, by NO means a 6 month know it all!!! If this wasn't directed to me, even though I am the only one in this post that has been in ICU for 6 months :rolleyes: then I do apologize.

To the OP. It is completely OK to feel like you do. I would completely trust my instinct if I were you. Your instinct is not telling you " I am a weak nurse who is overwhelmed". Your instinct is telling you "I don't like it here". "I want to try something else". That is absolutely fine. You can always try something else and then return to the ICU if you want to.....
What struck me about your post was that you are very specific about what is bothering you. You are not overwhelmed by the tasks or mad at a petty diva nurse. You have identified certain intrinsic aspects of ICU life that just don't mesh with your personality.

The op stated..."I think its the constant/extreme morbidity of the patients and the stress level that has gotten to me." So, I was just pointing out that there is still a lot of stress and critical patients in other areas, too. I never said that he/she is a weak nurse, but it would appear that he/she is overwhelmed by the stress if they were planning to leave ICU due to "the stress level." (CarboneF11's words, not mine). I would just hate for someone to jump out of the frying pan and into the fire as they say!!! Again, I was trying to be helpful to the op. Offer a different perspective.

Have you ever floated to other areas and found yourself invigorated or like that is where you belong?
All that said, only your own true self and time will tell whether you are experiencing
temporary angst or indeed in need of a permanent exit strategy. I think you may want to figure out exactly where you want to go before discussing it with your manager because the manager won't be 100% thrilled that a nurse she invested in wants to leave her unit. If he/she is a good manager, he/she will help you find placement in another unit and leave the door open for return. If he/she is not a good manager, they will guilt trip and rationalize you into staying.
I don't have the full picture of what you are dealing with. All I can do is encourage you to follow your heart and believe in yourself. : )

Well, this is on track with my advice. I did tell CarboneF11 to follow his/her passion and that all jobs are harder at first until you learn enough to function at an appropriate level. Some people want to go into OR, as CarboneF11 stated, without realizing that it too is a stressful environment. They may not think of the many hours standing in one spot or dealing with surgeons or, as i've heard it, PA first assists!! Now, many love OR and CarboneF11 may be one of those people. I would encourage anyone not happy where they are to seek out other areas where their passions are!!! At the same time, I would hope that they consider that no job is really ideal. I love ICU and there are still drawbacks to me. That being said, again, I was only trying to be helpful, and I think, offered some good advice.

Great advice about the manager by the way!!!!

Regards,

Jay

SusanKathleen, RN · Feb 2, 2008

Hey jb2U.................you don't sound "minimally competent" to me. You sound like the nurse I'd want if I were critical. Really good post.

jb2u, ASN, RN · Feb 2, 2008

Hey jb2U.................you don't sound "minimally competent" to me. You sound like the nurse I'd want if I were critical. Really good post.

That is VERY nice of you to say. I can only be honest and say how amazed I am at my coworkers knowledge base. I know with time I will be the nurse that I so want to be..until then, I am a sponge!!!!

Thank you,

Jay

RNperdiem, RN · Feb 3, 2008

I would recommend staying where you are for now unless you are being mistreated, are breaking down emotionally, or are being pushed into unsafe practices.

Treat that first year on the job like it is your last year in school. Live week to week if you have to.

It is a very common thing for nurses to have stress in all areas of nursing.

Don't be afraid to use your charge nurse as a resource.

I sure got plenty of help from my charge nurse yesterday when I was admitting a very critically ill and unstable patient. I pretty much told her that after many years as a per diem nurse I was feeling a bit out of my depth. (Per diems and floaters are often given more stable patients.) She and all the nurses gave me plenty of help to get through the next few hours. On other days, I help the nurses get through their difficult shifts.

The floor is an idea, but the grass isn't really greener there.

Without monitoring, you need to physically check on patients you are concerned about. No monitor is going to ring when your patient desaturates or goes bradycardic. You might even encounter a dead patient unexpectedly.

There is less control over the patient and their visitors.

There is less rapport with the doctors. See how long it takes for them to call after being paged.

Give ICU a year if you can. With those skills you gain, you can go just about anywhere.

heartrn35 · Feb 3, 2008

Carbonef11

If you are absolutely sure that the ICU isn't for you go to your manager and let him/her know your thoughts. They are nurses with usually boatloads of experience and they can help direct you with your departure. This way also make your return easy if you decide to return to ICU at a later time.

If we would all be a a little more open and honest maybe we could get rid of some of the back biting.

You know what you want, think it through, then make your decision. It's always going to be appropriate to let your manager know what your doing (even if you don't like or trust them) it's professional courtesy. :twocents:

Rabid Response · Feb 5, 2008

CarboneF11, I feel you. I could have written the same exact post as you when I ended my shift yesterday morning. I've been working in a medical/surgical ICU for four months as a new grad. It's hard enough to be a new grad in critical care, but on top of that recently I've been having doubts about what we are even doing for these patients. I didn't realize how depressing it would be to take care of people who were never going to get much better. Most of my patients are full codes even though many of them will never leave the hospital or have any quality of life ever again. I feel for them, and I try to make them as comfortable as I can, but my job requires me to stick them and poke them and roll them around with less pain meds than they really need (because the MDs are afraid the CNS depression will lead to the patient coding). Most days I still feel like I'm doing some good, but every once in a while I am overwhelmed by the futility of it all. I'm going to give myself a year in which to learn everything I can here before I make the decision to move on to something else. Maybe you can stick it out for another six months? I'm thinking of volunteering at a clinic or someplace else where the patients are walking and talking and have good prognoses, just to remind myself why I wanted to be a nurse in the first place.

CarboneF11 · Feb 10, 2008

Thanks for all those replies! It really helped sort things out for me. When I graduated from school I was leaning hard for trying to get into the OR, but I always had CRNA in the back of my mind, and alot of my instructors told me that if I went straight to the OR I would never be that marketable because I would lose my regular "nursing skills". In the end I decided on the ICU, but like I said earlier not sure if I made the right decision.

I'm just going to take it one day at a time for now and try to figure out what I really want to do over the next few weeks. If I decide it's no longer for me, I'll probably arrange for a meeting with my manager.

Mr SN · Feb 10, 2008

Hi to all,

Im in the Navy for like a year already and I really loved being here. I just got back from deployment and I felt so lucky to travelled the world at young age. But It was really hard to be away from your family. Anyways, I dont know if I should stay in the NAvy. I'm thinking about becoming a Nurse Informatics when I get out. With the help of the Navy I'm now working to finish all the prerequisites for BSN. Our ship will be in the yard for a year. Hopefully I'll be able to get that done.....

My job in the Navy is a Seaman. And I'm still thinking about this job in the Navy that can give me some experiences when I get out.. Maybe hospital Corpman or Information Technology...

which one do u think is the best????! and which one should I go to?!

The reason why I want to be a Nurse Informatics is because I love working with the computer and at the same time working with the patients. I have done my research about this career. Jobs in this area might include a nurse programmer who writes or modifies programs for use by nurses; nurse communicators who work with other nurses to identify computer system needs, or to assistant in the training and implementation of those systems;