I have been a nurse for almost nine months now and work in the NICU. This was my absolute dream job, and I worked so hard to land it. While I was on orientation I felt challenged as I was learning SO many new things. I have been off orientation for a while now and have have been stuck with feeder grower patients for over a month. My unit favors nurses with many many years experience and assigns them the sicker kids, daily. They are never given an intermediate assignment.
I am talking more about the nurses who have less than 2 years experience getting mostly the stable ICU cases and some intermediate patients. We are supposed to be mixed around the unit, with at least 30% ICU exposure. I have also (politely) asked my charge nurse to assign me anything ICU because I need the exposure. Usually I am given an excuse, and the next day I am back with the feeder growers. Managment likes me, and there has never been an issue with the care I have provided my patients. I don't understand. I am just about at my wits end with this matter. I did not go to school to be a daycare provider who rarely uses her brain. I understand that an intermediate case can shift quickly, but I need consistant exposure to vents, bcpap, umbilical lines etc to remain competent. Ugh!
Just hang in there. Its your dream job, remember? While not ideal for you to stagnate your growth by "paying your dues," it wont last forever. Maybe use some of your time to help with the sicker pts if the nurse will allow. I was a tech on ICU while doing nursing shool, I learned so much from discussing stuff while bathing pts with another nurse.
OP seems to have flown the coop, but I'll answer for anyone else looking for guidance. Just a few thoughts:
1. As a PACU nurse right out of nursing school, it was very important for me to have a lot of "uncomplicated" cases during my orientation because I needed to hone my process and learn what normal looks like... and there's a HUGE range of normal. I had a preceptor who wanted me to take all critical patients so that I could get over my fears about them, but it was sort of useless until I had a good rhythm going and knew what I was looking for. Once I could get through a case without going crazy, I was ready to start tackling the complicated ones because the background process was comfortable. So I agree with OP's assessment that some more critical babies would be instructive... AND the replies that you can't care for the sick ones until you know how to really care for the relatively well ones.
2. I have been working for 4 years now, and there are still things I learn on every shift. A colleague retired last year after about 40 years as a nurse; she always said the day she didn't learn anything new would be her last day on the job! 9 months, with all due respect, is not a long time. You will see that after you reach a year, 2 years, 5 years. There is absolutely no substitute for experience: nursing experience.
3. I would encourage anyone in OP's position to a) take a breath and enjoy not having a death-defying job, and b) make sure you have advocates in your department that will bring you over to show you the "interesting" (read: critical) patients and what's going on with them. I was a student in my unit before I worked here, so my coworkers STILL call me over to show me things I may not have seen before. I love it! In PACU we see odd problems so rarely that there's a lot of show and tell...
Post of the Day.
Really, really great. Thank you for taking time to write that out. Sums it all up.
P.S., I'd love to do PACU, but PACU call is worse than what I have in my own gig. Zoiks, you people have some insane call hours.
Specializes in Cardiology, Cardiothoracic Surgical.
I work stepdown, and I'm more than happy to sit on more stable patients and learn on them vs. being busy with a fresh lung Tx from the unit, a fresh CABG, or an unstable respiratory patient.
Charge nurses aren't complete idiots. Ours staff the unit according to experience and acuity, so I appreciate that some thought went into
" Why are you being so rude as to call the OP a kiddo? How do you know how old she is? Nice ageism. Get over yourself -- seriously."
...um I think it's just an expression in terms of new to the field not said or intended for any insult...unlike your end sentence.
That would be a convenient interpretation. However, no one would let it slide if the positions were reversed and the OP used the expression "old timer" when arguing with someone else who was experienced in the field. People would flip out and call it ageism in a second -- which is what this is.
Big metropolitan areas, or suburbs that have hospitals that have the funding to handle such cases, are examples.
There are so many congenital defects and premature births now that keep NICU busy. Six months ago I was talking to a nurse who had a niece with ToF, something rare and unheard of (it's like less than 2% or something like that) - but if not monitored correctly and treated, it can be very deadly.
Now if the population of the area is like 15,000, and the local community hospital has a lot of NICU patients that need transferred - then I would raise eyebrows. When you are talking about a population that is in the millions, though, it's not uncommon to have a very busy NICU.
Big metropolitan areas, or suburbs that have hospitals that have the funding to handle such cases, are examples.
There are so many congenital defects and premature births now that keep NICU busy. Six months ago I was talking to a nurse who had a niece with ToF, something rare and unheard of (it's like less than 2% or something like that) - but if not monitored correctly and treated, it can be very deadly.
Now if the population of the area is like 15,000, and the local community hospital has a lot of NICU patients that need transferred - then I would raise eyebrows. When you are talking about a population that is in the millions, though, it's not uncommon to have a very busy NICU.
I think you might have missed that the OP said all 4 of her (as in her own biological children) babies required NICU stays which she thinks makes her a better nurse clinically.
I'll comment as someone who was a new grad in a tertiary NICU for the region and now works as a NNP. I don't think the OP is necessarily expressing herself in a great manner and I don't know how her practice is as a RN. However- I will point out my own experience.
I was a young 22 year old and did reasonably well on orientation, got an extra two weeks from everyone else not for my skills per say, but because I had just barely failed one of the orientation written tests. The other new grad RNs in my class were given some of the sickest babies right off orientation (while I was still on orientation) and unsurprisingly they were pretty overwhelmed and the message came down from above not to give us such sick babies right off the bat. Which I totally agreed with reflecting back on it.
The problem was that for the next 6 months I was not given a single patient on a ventilator. Because I was new grad nurse, having learned how to manage ventilated patients for the first time on orientation, I was not prepared to take care of them very well once I did have the opportunity. I got a ventilated patient about 6 months off orientation and predictably, the baby self-extubated. I had lost the skills I had gathered from orientation. This had an enormous effect on my self-confidence and part of the reason why I think I waited so long to go back to grad school.
There is a medium between "feeder growers" and stable vents and critically ill patients. I certainly don't think I was ready to take on critically ill patients, but certainly a stable ventilator. For those who don't work NICU, there are many babies that remain on a ventilator and intubated for months at a time, on full feeds, working on lung growth. While they meet the ICU definition of "critically ill" since if they lost their ETT they would immediately decompensate, it's not the same as a baby in septic shock on pressors and various other drips who is also intubated.
OP, I think it would be beneficial to ask the charge nurse for a stable vent to take care of so that you don't lose your skills. I think most charge nurses would understand that request. Alternatively you can see if you can sign up as a primary for one of those "stable vent" babies if your unit does primaries.
Ironically, it was when I started grad school that I seemed to get sick kids for every single shift. It was exhausting, to be frank. I learned a lot but also wished for a day or two when I had more stable babies.
I think the OP did a piss poor job of expressing herself and may have some arrogance issues, but 2 years before getting a real ICU-level patient is beyond ridiculous.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I think the OP did a piss poor job of expressing herself and may have some arrogance issues, but 2 years before getting a real ICU-level patient is beyond ridiculous.
It hasn't been two years. It's been nine months, some of which was on orientation. The OP is coming across as thinking she knows it all, and I can understand a charge nurse's reluctance to assign her a sick baby. The OP is too arrogant to realize when she needs help and to ask for it -- and that's a really dangerous situation. I suspect the OP is going to need a major attitude adjustment before the charge nurses trust her with sick babies.
It hasn't been two years. It's been nine months, some of which was on orientation. The OP is coming across as thinking she knows it all, and I can understand a charge nurse's reluctance to assign her a sick baby. The OP is too arrogant to realize when she needs help and to ask for it -- and that's a really dangerous situation. I suspect the OP is going to need a major attitude adjustment before the charge nurses trust her with sick babies.
I didn't say it had been two years, but if that's the expectation then I, personally, would be looking for another opportunity. This in no way excuses the OP's attitude.
They probably care less about what you "need" and more about the safety of the patients. While you patiently wait for your day to come, learn all you can where you're at right now. At nine months in, I doubt you know it all ...even when it comes to the most stable babies.
I think her point is that she does not know it all and wants the exposure in order to learn more.
Managment likes me, and there has never been an issue with the care I have provided my patients. I don't understand. I am just about at my wits end with this matter. I did not go to school to be a daycare provider who rarely uses her brain. I understand that an intermediate case can shift quickly, but I need consistant exposure to vents, bcpap, umbilical lines etc to remain competent. 
Malenurse1235954
101 Posts
Just hang in there. Its your dream job, remember? While not ideal for you to stagnate your growth by "paying your dues," it wont last forever. Maybe use some of your time to help with the sicker pts if the nurse will allow. I was a tech on ICU while doing nursing shool, I learned so much from discussing stuff while bathing pts with another nurse.