New to Cardiac ICU and concerned

[NewtoICU]

Hi! I have a question for those seasoned ICU nurses out there:

I started my ICU orientation as a GN about a month ago. In short, I am really having some doubts about my choice to work in the ICU. My orientation has been nothing short of extremely stressful. My preceptor is a pretty harsh person and, to be quite honest, I sort of dread going to work. Like, to the point that I have considered calling out. I understand that this is an environment that can swallow up a new grad pretty easily, but I had at least hoped it would be a bit more supportive. I feel as though i get the "Are you stupid?" look when I ask questions. I have more of my flaws than successes pointed out to me it seems. This has been very difficult for my self-esteem and has made me uncomfortable about asking the most basic of questions (about lines, gtts, etc). Also, I live in constant fear of not responding appropriately when my patient crashes (which I'm sure will happen sooner or later...). The people on the unit are generally kind, but it still feels like I'm walking on egg shells all the time. I look at all the drips, hear the monitor alarming, the vent alarming... all of these things, and I feel in over my head. I'm freakin' out.

I came to the ICU because of a strong desire to learn and become expert at managing critically ill patients (ie, I have no aspirations of CRNA or grad school at the current time). I also felt more attracted to it than med surg. I am beginning to wonder if I chose the wrong path or if these are feelings many people experience...Right now I'm just wondering if I'm in the right field.

Thank you for your wisdom,

AJ

[meandragonbrett]

You're a new grad. You don't know how to be a good nurse much less throwing a critical care education on top of it. Give it time. Remember your ABC's. There are often times in the unit that there are so many things you need to get done but you can't possibly get them all done. You've GOT to learn to prioritize: What WILL kill my patient if I don't do RIGHT now. What MIGHT kill my patient. What WON'T kill my patient. MedSurg can be just as overwhelming as Critical Care but the tasks aren't quit as life threatening sometimes.

[NewtoICU]

Thank you for the words of advice and encouragement. I think it is helpful to remind myself to conceptualize of things that way. I am getting better with prioritization and organization each day, but it is still a major challenge. Thinking ABC's at all times is definitely helpful. Beyond that is where it gets a tad confusing! (titrating drips, etc). And I am doing a lot of studying on my own time at home, etc. Thanks again.

[tri-rn]

Give yourself time. Try not to stress the whole "what-if-my-patient-crashes-and-I-don't-know-what-to-do" mindframe. Right now (and hopefully for a few more months at least) you're on orientation and youaren't alone. When you're off orientation you still won't be "alone", you will have the backup of more experienced nurses. One thing that really helped me was asking myself "what if" questions, as in "what will I do if his pressure tanks" or "what will I do if he starts bleeding from his (name that surgical site)". Having a plan really helped ease the stress for me.

[grandmawrinkle]

I don't have much to add to what the previous two posters did but this sounds normal, normal, normal. Being new to ICU practice is tough for nurses with some experience under their belt. Being a new grad makes it at least twice as hard (you did realize that was what you were getting into, didn't you?)

ICUs are stressful environments and you need to learn how to act quickly and adapt to rapid changes. This is how your preceptor is used to operating -- imagine how he/she feels now to be teaching someone that isn't anywhere near that level yet. I can very much sympathize with you feeling eaten, and no matter how great or lengthy your orientation is, at some point, this is going to be a "sink or swim" situation for you. Absorb as much as you can, internalize it, know the basics and the emergencies, and ask questions and ask for help when you need it. You might not feel supported, but your staff absolutely is watching you and will be right there behind you if you fall.

I think I had nightmares my whole first year of ICU practice. It gets better. Sooner or later, you'll be able to do it in your sleep...it's just a lot of hard work to get to that point.

[NewtoICU]

Thank you, everyone. That is very reassuring to hear. Everyone I have talked to has said that their first year was rough, but that they finally came around to feeling confident in their practice and more competent working with critically ill patients after about a year and a half. I know I will get there, it will just take time and a lot of frustrating moments. I definitely realized what I was getting into...I knew it was going to be rough. I guess I just hoped to have a better relationship with my preceptor. I think this is where a lot of the anxiety/questioning of competence arises from. It is, of course, a lot to learn and it helps when you have someone who also realizes that and remembers what it was like. Someone who can help you connect the pieces a bit.

I like the advice of thinking through scenarios before they happen. This may have prepared me the other day for when my patient's blood pressure starting tanking. I felt like a deer in headlights. It's those moments that are difficult learning experiences- the ones that make you sweat for a minute- but that you gain knowledge and experience and improve from. When a code happens, I don't know where to jump in. It's overwhelming, but each day it becomes a bit less so... I get a better sense of how ICU nurses operate. I think doing ACLS and the studying I'm doing at home will help. It's just going to be a tough year. But I'm determined to hang in there and come out an excellent nurse. Thanks for the wisdom and keep the input coming!

AJ

[RNforLongTime]

Is there any way you can ask for a different preceptor if this one is causing you so much anxiety? Sometimes preceptor/orientee personalities don't mix and you are well within your rights to ask for a new preceptor if you aren't comfortable with this one.

I started in ICU after being an RN for 5 yrs. I felt uncertain as well. I know I went home a lot of evenings and spent time researching and reviewing illnesses, treatments etc that I had dealt with that day. I know it helped me a lot and had a lot of questions to ask my preceptor that day.

You've been at this for a month. You're still learning how to be an RN let alone an ICU RN. Keep on keeping on!

[calijaz]

I am a new grad in a cardiac icu as well. I started in June (graduated in May). While a lot of times I feel as though things are way over my head and the patients and workload can be very intense, I feel relatively comfortable because of the support I have from the older nurses on the unit. I am constantly asking questions and learning and the second I ask a questions, there are a few nurses in the room with me to help me.

I did my 400 hour preceptorship at the end of school on Med-Surg unit. The preceptor I worked with just expected me to know things and never taught me much of anything. She made me feel stupid when I would ask questions, and when my patient was going downhill, she was never anywhere to be found. She was not very nice, and not very supportive, kind of like how you describe yours as. It caused me a lot of anxiety and made me rethink about my career decision. Luckily, I was able to find a supportive environment for my first job. Since I had had that experience, I knew what type of unit i was NOT interested in working in. (One without staff support for new grads)

I guess my point is that it doesn't matter what type of unit/job you're in, we are new nurses and we NEED that support. Most of us are not going to be successful without it. If I were you, I would seek that support... maybe go to your manager and see if there is a better preceptor for you, or at least find older nurses that you can ask questions when needed. I think that will do a lot for your anxiety. In my experience, you have to fix that before you can really learn effectively and gain confidence.

Good luck to you! Let me know how everything goes.

[NewtoICU]

I completely agree with you. I think that having supportive people around has been what's gotten me through this. I look to the more experienced nurses on the unit for guidance and support, and fortunately most of them are wonderful. It's unfortunate to hear stories about preceptors like yours and mine. One should never, ever feel stupid for asking questions about patient care. To me, that's a dangerous environment to create. I wish there was more of a spirit of cooperation at times and that we were more focused on taking care of the PATIENT (and helping make new orientees/students/etc more competent and able to do so). Unfortunately, not everyone seems to be of that mindset. Sometimes, it seems people would rather withhold their knowledge and feel powerful and superior than help you. I don't think they realize that 1) we will all be coworkers and should be functioning as a team, and 2) some day, we might be taking care of their behinds! :) If anything, these experiences will make us better preceptors years down the road.

Thanks for the words of support and encouragement, everyone!