New grad in ICU, feeling discouraged. Advice?

__CArn · Oct 10, 2014

Hey everyone,
I just wanted to vent a little bit and maybe get some words of wisdom. I know I am not the first to feel this way, nor do I think this isn't a normal feeling to have being a new grad (especially in the ICU). I graduated over a year ago and couldn't find a job in the hospital right away, so I settled for a job in long term care to get some experience. Now believe me, I fought tooth and nail to land that elusive job in the hospital but the new grad job situation isn't the best right now so I had to take a less-than-desirable job to at least call myself an employed RN. Unfortunately, being out of school for over a year left my critical thinking skills (as well as some basic nursing skills) a little rusty.
Luckily, I was able to land a new nurse residency in my desired area (ICU). It is a total of 22-26 weeks of orienting, as well as 18 weeks of "general" nursing training (combined with critical care specific classes). Overall, a pretty sweet deal! I was ecstatic to get accepted and have been loving it thus far. However, some days more than others, I definitely feel like I am behind in terms of my ability to critically think and use some hospital-specific skills that I never utilized working in LTC. If you don't use it, you lose it!
My preceptors and manager are super supportive and we have regular meetings to discuss how things are going. They are more than willing to work with me and help me become the ICU nurse I need to be, but it's hard to not feel a bit disheartened after hearing that I am not quite where I need to be yet. They are well aware that this year out of school has left me a bit unprepared to tackle ICU, but are sure they can get me where I need to be. I am about 8 weeks into my orientation and have worked a total of 17 shifts. I KNOW this is normal to feel a bit overwhelmed and I haven't had the exposure to feel total comfortable in my new role, but I feel like I am at least doing "alright". They don't think I am doing poorly, by any means. They do feel like I am playing catch-up after being out of school for a while and unable to get into a hospital.
Naturally, I want to succeed and I feel like they are here to help me. I have until mid-February on orientation so there is still time to improve and get where I need to be, but it's tough to feel like I am doing pretty well but have my preceptors/managers have a different opinion. I am passionate about ICU and really have found my niche in nursing. Everything about ICU is attractive to me: focusing on one patient, more autonomy, critically thinking about pharm/patho, being more a team atmosphere and working closely with the MDs/RTs. I love it!
I just wanted to vent and maybe get some words of wisdom from those in similar situations. I desperately want to succeed in this job and will do whatever it takes to get there. It is not in my personality to let anything stand in the way of my goals. I know I am smart enough and hard-working to succeed in the ICU, but right now (and especially after recently meeting with my manager/preceptor) I just feel a little discouraged.

Hey!

I am also a new grad in the ICU. I actually haven't started yet, just got hired this past Monday and looking forward to next couple months.

From reading posts from other new grads and experienced ICU nurses; the learning curve upon entering ICU is high, even for nurses with floor experience. Don't be hard on yourself. Be positive, stay positive and do your best to study on your own times as well as ask lots of questions when you're on the floor!

I'm also nervous going into the ICU as a new grad, but just keep a positive attitude and do your best :)

if there is any experienced and new grad ICU nurses, feel free to chime in.

firstlight · Oct 12, 2014

First stop the negative thinking about yourself. 17 shifts! Not many at all. Not even a month.

It is normal to feel this way.

We all have days we love or wish to forget no matter how many years we have.

It takes time to learn the ropes.

ICURN1980 · Oct 14, 2014

Hey firstlight,

Yeahhh I know I should stop all the negative thinking. I honestly felt like things were going well (at least given my lack of experience) but it was a major bummer hearing otherwise from my preceptors. One of my preceptors has 9 years of experience, the other has 14 years. Clearly, with my 17 shifts, I am not going to be anywhere near their level. Obviously they don't expect this, but I feel as though they could cut me a little more slack.

I'm completely open to constructive criticism; believe me, I want to know what I'm doing poorly and where I need to improve. However, I just left that meeting with the sinking feeling that I'm letting down my manager/preceptors and that in the their head they were thinking, "Geez why'd we hire this guy?!?!". Crazy, I know. Guess I'm just too hard on myself.

On a more positive note, just got done with a 3 day stretch and all went well. Confidence is slightly restored, but not I am determined to ask more questions, gain more knowledge, and be hyper-alert to areas I need to work on...and succeed at them!

lidleanjel · Oct 14, 2014

I went straight to the operating room after nursing school then to icu. I felt the same way but I had to relearn almost all my nursing skills and disease processes. It is tough, but I have now worked in the Icu for almost 2years and it was the best decision I have made. Plus my dream job since nursing school.

Best advice: stay positive and ask lots of questions whether they seem dumb or not. Do not hesitate to ask anything because you do have a persons life in your hands. Use you gut instincts... If it feels off it most likely is. When you get home look up something from that day to refresh information whether about disease process or diagnostic test. Make sure you also take care of yourself. Do not burn yourself out. At this point in my icu career I am now just finally feeling comfortable and feel I know what to expect when things get hairy. It all takes time. I continuously ask my coworkers their opinion when something is wrong with my patient. I feed off their knowledge regularly and also learn a lot this way. I was recently told by a coworker " I don't have to worry about your patient when things are hitting the fan because you will come for help when you are over your head", it really is all about teamwork too in the icu. We look at a whole patient and each team member knows more about something then another team member. You will do over the best people to talk to about concerns. Just remember we treat the whole patient not just the original problem. Our body works together and something else may need assessed.

Hope this helps some. I love learning new things in he icu.

ICURN1980 · Oct 15, 2014

Thanks, that helps to hear it from someone who had to "relearn" a lot of stuff going into the ICU. That's one of the main reasons I love the ICU: I learn so much each and every day! Rounds are amazing...sometimes if the MD goes off on a tangent with the residents I get to sit there and soak up all that knowledge. Plus, as you mentioned, treating the whole body and anticipating what could happen (or reacting to something completely unexpected).

I know I'm being hard on myself but I just want to be the best I can be. I guess what it boils down to is that after 8 weeks (approx 18 shifts) I feel like I should be farther along because of what my preceptors are saying. I don't want them to NOT give my constructive criticism, but are their expectations too high for me at this point in my ICU career? I feel like I'd rather hear more bad than good; it drives me to improve even more. I just want to feel like I am on the right path and am making progress to where I need to be.

And btw, this is a level 1 trauma teaching hospital so we do get some pretty sick people. I did my senior practicum in an ICU, but nothing compared to the types of patients we get here.

SanDiFrangles, RN, NP, CNS · Oct 16, 2014

Hi, new grad ! First off before I begin, I think this is normal. Everyone wants to be successful, accepted and competent at their job. No one wakes up in the morning and says "I really want to suck at my job today ..." Work ethic with the motivation and desire are powerful attributes and go hand-in-hand with working in intensive care. Your employer obviously saw something special in you, otherwise you wouldn't have made it this far !

So I come from a similar perspective ... I was a new grad in a large 800-bed university hospital with a 28 bed MICU. Like you, I went through a nurse residency program except we had a six-month orientation, from system orientation, to basic dysrhythmia and critical care class to actively precepting. I had been an extern in another ICU for a year and a paramedic before and despite all of that I found it challenging a total new way of thinking. I say this not to discourage you but just to know that being a new grad in the ICU is hard, whatever your background. Ten years later I survived and now teach clinical emergencies in the nurse residency program and I couldn't imagine doing anything else.

Realize everyone have problems when they come to the ICU, its a totally new way of caring for patients that is unlike any of the nursing areas other people might have worked in. Sure, I'll acknowledge that having acute care experience is helpful (and especially at the same facility) however I think regardless you have to meet the standards of the particular unit, and every unit is a little different in terms of their needs for their staff.

All this being said, I think you should stick with it. Realizes you there are going to be problems, mistakes are going to happen (they are EXPECTED to happen), but better make them NOW on orientation than when you work. I had thought the most challenging period is not orientation but the three to six months off orientation. It's easier said than done, but be aware of the mistakes, short-comings and move forward. A supervisor/manager is usually impressed for a new grad to accept responsibility than try and hide it (and if they don't that's an indicator that the unit might take a punitive perspective when it comes to nursing errors ... and reconsider working there).

When it comes to preceptors, find out exactly what they want you to do to take care of patients. This is not the time to explore different styles. Mimic what your preceptors want and learn from them. After you get off orientation, I guarantee everyone has their own style and so will you, but first a base standardized approach is the key. I had a preceptor that wanted it done his way, every time and didn't matter the outcome. I was very frustrating because sometimes their was a better, more efficient way but I just had to bite my tongue and deal with it. Also, perhaps my most important piece of advice. No matter what your prior education, experience or other degrees. Treat all of your preceptors as if they are the experts. I wouldn't try to spout out that you've seen or done this particular skill before (unless you've performed it under their supervision). This is good advice also when transitioning to a new unit, even when you are an experience ICU RN. Finally, always ask for help if you are not 100% certain. Again, that's why your preceptors are there and asking for help will show that you have patient safety in mind by demonstrating safety awareness, compassion. I can't tell you how many times it earns the respect of your colleagues because we all do not know everything. Even as an experienced ICU RN, you do NOT need to know everything but you have to be resourceful and know where to find that information. Asking the clinical nursing experts on your unit are the first step.

You will feel overwhelmed, you will feel that despite your best efforts, you wish you could have done everything right. As long as you have the fundamentals and routine you should be fine. In our ICU, new grads get one then two stable patients until they have masters their routine and time management. Then they'll get one sick patient only, then one sick and stable patient. Finally, the last month or two of orientation (depending on their progression) we give them the two sickest patients on the unit. It isn't meant to be harsh ... just so that when they come off orientation they feel that they can take care of sick patients. Then they work up to that once their on orientation.

Hope this helps ! Please feel free to reach out to me if needed, this is a great forum we're all here to support you in anyway we can. Good luck !

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