New Grad in the ICU/Feeling overwhelmed

UCDSICURN · Sep 6, 2004

We've all been there. There is a massive learning curve going from nursing school to becoming a staff RN in an ICU. We may be able to help you more if you are more specific with your issues. What exactly is overwhelming? The drips? Vent management? Swans? The transition from being a student? The transition to 12 hour shifts? Be specific and we can hopefully answer questions or push you into the direction of an appropriate resource.

Don't give up so soon. It takes time to get acclimated to the environment, the pace, the people, and of course new responsibilities.

Keep yer chin up,

Donn C.

apaisRN, RN, CRNA · Sep 6, 2004

What kind of rotating shifts? Switching all the time could really mess you up. People underestimate the importance of sleep and routine. I know I never could work evenings. It completely screwed with my biorhythms. Now I work 12-hour days and have to do 3 nights every 3 months. Mine are this week, blech. But it's only three nights and then I'm done til December.

I was very depressed and miserable on my previous schedule. It was harder to learn and concentrate, and I hated my job. Could your scheduling be part of the problem?

trakstar · Sep 6, 2004

Nursing school and being a nurse are two different things. Remeber being comfortable as a new grad in the ICU will not come over night. They or quick remedy that may help your sitution is that you talk to your nurse manager and say how you feel about having inconsistent preceptors and request a more permanent preceptor. I remember that was an absolute requirement for my unit at which I trained. If you precepted it was not only a committment of the new grad but the preceptor as well. This ment no vacation and a regular schedule while precepting. You can do it. Don't give up

pokey sn · Sep 6, 2004

Orgami----I posted the exact same thing about a month ago. I just started in the CTICU only I work straight nights. I was feeling the same way you are(still am only to a lesser degree). Let me tell you, hang in there. Try to put things into perspective. This is the only thing standing between you and CRNA school. Also, don't expect like a lot of us new grads do, to be an expert or catch on right off the bat. We are new, and we are learning. Try to hook up with some of the other new grads on your unit. It really helps to know they are feeling the same way. It's also a great way to get out some of your frustrations.

My advice, hang in there. We are all going through it. Stay strong and try not to put so much stress and pressure on yourself. You CAN do this!!

Good luck!

Pokey

EmeraldNYL, BSN, RN · Sep 6, 2004

Orgami, I've been in the MRICU for almost a year and I'm just now starting to feel comfortable and that I don't have to "prove myself" all the time. I think a large part of the problem is that you've had so many different preceptors. Why is this? Is there any way you could have one primary preceptor who actually likes to teach? Also, what are you uncomfortable with exactly? Expect to do a lot of learning on your own too. Go home and read about stuff you don't understand. Does your hospital offer a critical care course, if so take advantage of it. Ask EVERYONE questions. Don't be afraid to ask for help-- you are still new so people will understand this. It is VERY overwhelming at first, but if you work really hard and don't get discouraged, you can be successful with a little help. Did you talk to your nurse manager/ clinical specialist about your concerns?

CRNAsoon · Sep 6, 2004

OrigamiAirplane,

I am a new grad in CTICU, as well, and I know exactly how you're feeling. I agree with everything that everyone else has posted, but I just want to offer some advice regarding my experience. I was placed in the same position as you with multiple preceptors. Not only was this problem difficult to deal with, but no one wanted to precept in my unit and all of them told me as much as they dragged their feet about teaching me. I took my concerns to management and was told that I was courageous for bringing this to their attention and that they would work on it for me. A few days later, I was told by management that they had chosen a primary preceptor and that the problem was corrected. What they did was send me right back to one of the persons that was outwardly vocal about not being willing to preceptor. Being new to the unit, I certainly didn't want the team to think that I couldn't handle the pace of the unit or any one person's specific personality, so I worked hard to suck it up. After a week, I was so frustrated that I too considered my options. I brought it up to another person in the chain of command and again was told it was being worked on. Apparently, the unit was so short-staffed that this was the only option. After another week or two, I had reached my boiling point because if I'm not trained adequately then I can't be a productive member of the team or be counted on by other nurses. I flew my issue up the chain of command a third time and have now been moved to another unit. The preceptor that I have now is amazing. She loves to teach and she's a powerhouse of information. The point of my whole post is that new grad's have to be proactive about their orientation into the nursing job and culture. If it's not working out then take as much responsibility as you can to try to make it better. In my situation, I've already lost 60% of my orientation time with ineffective preceptors and horrible experiences, but I am hopeful that I can catch up with this new dynamic person that I've been assigned to.

Feel free to PM if you want to chat about anything. I'm definitely here to support other nurses as much as I can.

CRNAsoon

I just started in the MRICU at the hospital I had clinicals in. I got the job and passed my boards. It feels good to check those off of a long list of things to do in preparation for CRNA school.
I was so excited when I started, the enthusiasm has faded fast. Now I'm feeling nothing but overwhelmed, exhausted and disgruntled. The mandatory 40hr weeks and rotating 12 hour shifts are grueling. So far I've been with 6 different preceptors. When I do have time off all I can think about is quitting, leaving nursing all together. I told myself I would at least stick it out for a year.
Did any of the SRNAs or CRNAs on the board feel this way when they started in the ICU? What was your experience? I don't want to have a negative attitude but its been hard for me not to.

OrigamiAirplane · Nov 6, 2004

So I made it through orientation, yeah for me! After posting this thread I went to shadow two different CRNAs. My perspective changed and I had a more positive outlook when I went to work.

I'm now almost two weeks out of orientation, still very green and I'm feeling the strain again, questioning "is this right?" The other night I had two very sick patients (I'm suppose to be taking stable pairs only.) I went home crying and vowing to quit. I was back the next night.

While talking to some of the experienced night shift nurses I realized the unit is in an unusual state of chaos. We are expanding from a 12 bed unit to an 18 bed unit. The one unit is split into two seperate units now (across the hall from each other.) Half of the staff now is supplemental and travelers. The buddy system that was once implemented for those coming out of orientation was nixed because the staff can't support it. I was told the experienced staff is strained too because they are being "spread thin." We have so many new bodies on the unit the experienced nurses have to help.

I was told that I wasn't the only one that goes home and cries and to hang in there. It was suggested I find a mentor- um, easier said than done.

I have a sick feeling that this unit probably isn't the best place for a new grad, not to mention I'm flipping between nights and days every week I feel like I have no life (my family, friends and dogs miss me).

Should I suck it up, do I just sound like a whiner? I feel like I can do the job, but I hate it. I'm physically, emotionally and psychologically drained. Is it worth it? Is this just how nursing is?

trakstar · Nov 6, 2004

I can remember feeling somewhat similar. You will learn a lot very quickly and become very efficient. With out people to lean on or even to call for help you will become resourceful and a better nurse. I don't think that it is ideal or for that matter safe (a few times I can remember but was later reassured it was safe) but in a year or so you'll look back and realize how valuable for experience really is when your on your own making independent educated decisions practicing as a CRNA. YOU CAN DO IT!.

TennRN2004 · Nov 7, 2004

I am also a new grad in the ICU. I understand what you are saying and don't think you sound like a whiner. I would be very concerned if I was in the type of environment you describe as a new nurse. You need reliable staff to lean on and back you up and it doesn't sound as though you have this. I would consisder looking for another ICU to work in. Does your hospital have another ICU, or is there another hospital close to you with ICUs so you can get the necessary experience?

I know we all want to become CRNAs and need the ICU experience, but you need a good solid base of nursing in order to advance. Even if you have critical patients and can manage okay through your shift, do you have time to learn why you're doing things or to read through their charts and know what's going on? The situation you're describing is not fair- for you or your patients. Ulitimately human lives rest on you and your decisions- that is a heavy responsiblity RNs carry. I can understand why you are stressed out and go home crying. I think it would be more worrisome if you didn't get upset.

I can say though what you're describing is not just part of nursing. In my unit on my second night off orientation, I had a 4 day post patient w/ sepsis start deteriorating very rapidly. She ended up w/ 3 docs at the bedside, a Swan and an A-Line in. All of my nurses were in there helping me out, supporting me. It's always scary to be on your own, but if you have nurses you can trust willing to help you and teach you that's the best type of experience you can get in the ICU.

Good luck to you. No matter what don't give up. You worked too hard to get this far, so only go forward now!

OrigamiAirplane · Nov 8, 2004

Thanks for your understanding TennRN2004. I am no longer at the job I described above. The last straw was when my manager coaxed me into working two 12 hr day shifts right after two 12 hr night shifts, one day in between to sleep. I reluctantly said "yes, I guess I'll try it" even though we are suppose to have at least two days off in between flipping nights and days.

This type of situation sealed the sense of I'm just a warm body, here to fill gaps. The morning of the first 12hr day I woke up feeling like crap because I didn't sleep good (probably because I slept all day.) I didn't want to go in not only because I felt like a zombie but I knew it wasn't safe.

I talked to the charge nurse later on that day and told her the situation and that I wouldn't be coming back. She said she understood, she also added she hated the job too and hopefully nurse anesthesia was her ticket out. The nurse manager is on vacation, I don't know if it would be appropriate to call her at home or not.

I feel bad leaving the way I did, it was a bit unprofessional. In a big way I feel as though I failed or maybe I could have toughed it out. I do feel a sense of relief though and I'm looking forward to not being so miserable.

There are other hospitals in the area, quite a few actually. The one I was working at was the only level one trauma center though.

TennRN2004 · Nov 8, 2004

I'm glad to hear you're out of that situation Origami. I wouldn't feel bad about leaving, the nurse manager certainly wasn't feeling bad about taking advantage of you and putting you in a bad spot. As far as that hospital being the only level 1 trauma, that's not a deciding factor for you getting into anesthesia school. If you can find another ICU and get the experience with vent pts, titrating invasive drips, good critcal care pts, and actually have people to help you and teach you, then that will be alot better than where you were. Bottom line, if you were so stressed and dreaded going to work everyday you weren't getting what you needed to go on. I look forward to work each night because I'm challenged and learning to branch out more on my own, but I know I'm never alone. That's the type of situation you want to be in where you have support and encouragement. Good luck to you with a new job. Let us know how it goes.