New Grad in ICU feeling terrible...,

[janelicurn]

I just began a job in the MICU in a large teaching hospital as a new grad 7 weeks ago. My orientation is 12 weeks long, which includes 7 weeks of working 2 days a week with preceptor and doing ecco course 1 day, 5 weeks doing three day weeks with preceptor. During my interview, the management was pretty hesitant about letting a new grad work in their unit. I left the interview feeling like there was no way I would get the job, but then I did! I feel so lucky to be in my dream position right out of school, but although I feel like I am a "cream of the crop" new grad (I graduated first in my class w/ BSN, did an externship in a level 1 trauma center ED, etc), I am still A NEW GRAD.

Long story short, I alternate between 4 preceptors (which is a problem in itself) and one of them really thinks its unacceptable that they must teach me "basic nursing" rather then only the critical care component. I was told all along in school, you really learn how to be a nurse in your first job in a new grad program. Well, my program wasn't designed for new grads, it is the same program "New to the ICU" nurses go through (that's what all my documents state--new to the icu RN).

Regardless, I am meeting the minimum goals for each week. I am, however, still slower then most nurses at many things. I am still learning to organize and time manage. I feel like they don't understand that my 6 month externship does not bring me up to the same starting level as an RN who worked years in tele or medsurg.

I am just wondering, are there expectations of me unrealistic?

Is a new grad RN supposed to be learning basic nursing things (by this I mean becoming comfortable with giving report, talking to doctors, organizing your day)?

If I am the one who is wrong, I would like to know, because in that case maybe I am truly NOT ready for icu yet...

[ProgressiveActivist, BSN, RN]

Congratulations on your new job. Buy the book Critical care made incredibly easy. Carry it to/from work and read it. In a medical ICU you are going to see a limited number of situations over and over and over, such as: sepsis, DKA, GIB, HHNK, afib RVR, S/P MI, symptomatic bradycardia, SVT, belly surgeries, thoracotomies and chest tubes, liver failure, renal failure, heart failure, resp failure. Take the patients with conditions that you need to learn. Get in there with every crisis and learn. Learn your equipment: Find the smart nurses (the dumb ones hate questions and will bite your head off). THE NEW PEOPLE WHO WORRY ME ARE THE ONES WHO DON'T ASK QUESTIONS. But don't break my focus when I'm busy. In other words this is your fifth year of nursing school. Be humble honest and energetic. Their expectations of you are very realistic-they know that you don't know ****. I have a great ICU worksheet if you're interested.

[ICURNer]

May I ask what the ICU worksheet has on it?? I am a new RN as well and would love a copy!!

[ProgressiveActivist, BSN, RN]

I will post a copy tomorrow night at work. It covers everything you need to call a doc, manage your day, system assessment, etc.

[TiffanyRN!!]

I would love to see a copy also. TIA!!

[ProgressiveActivist, BSN, RN]

Here it is. If you want me to explain the old time graph for CBC and Chemistry I will. Also I will write down repeat labs with a box around them or in the right hand column when they are due to be drawn with the results.

You need to get your ducks in a row when you call a physician. You get one shot to tell them the problem and current assessment, history and tests and lab results and hemodynamics. They want facts, test results and numbers. Know what you want before you place the call.

The reason that most nurses don't want to orient is that we have taken new nurses under our wing, helped them develop skills and confidence - and then had them stab us in the back. I guess that is just the nature of the business. I am very jaded when it comes to mentoring or precepting because I have given 100% and then been treated like crap once the new grad can function independently. It sucked and I will never ever do it again.

report sheet.pdf

[PMFB-RN, RN]

I am a big believe in training new grads to be ICU nurses. Doing so has been proven safe and very effective. Some hospitals prefer new grads for ICU nurses. For example in one hospital where I work they will not even hire med-surge nurses into ICU. There are only two paths into the ICU. Either through the nurse residency program, or be hired as an experienced ICU nurse. I see this happening more and more among the more progressive hospitals. However there needs to be a special program in place for that.

I went from nursing school directly into a large trauma/surgical ICU. However I went through a 9 month nurse residency program specifically designed for new grads.

[CCRNDiva, BSN, RN]

Our orientation program for new grads is 5-6 months and it is modeled after Benner's Novice to Expert Theory. They start off learning the tasks of nursing, how to schedule their day etc., while taking easier patient assignments and then work their way up to fresh traumas and MSOF. We've had better succes in retaining new grad ICU RNs since we changed our orientation program. I started in the unit as a new grad and my orientation consisted of taking the sickest patients every day for 5 months. I had difficulty with the tasks of nursing but the critical thinking aspect was my strong suit. It took time for me to learn how to organize my day, like clumping tasks together instead of going in and out of the patient's room several times.

If you truly want to succeed in this position, and only you can answer that question, be prepared to study at home and at work. Utilize that report sheet provided above. I wish I would have had one like that during my orientation. Look up each new diagnosis and unfamiliar medication. Read the H/Ps for each new patient, paying particular attention to those written by the ED and intensivists. They will "paint the picture" for you. Please don't be afraid to ask questions. Nothing is more dangerous than a health care professional who is unwilling to ask questions. Be prepared to learn something new every day. I've been in the unit 7.5 yrs and I still learn something every day.

My last tip, forget about being "cream of the crop BSN grad". Nursing school is over and now the real learning begins. I've seen ADN prepared graduate nurses run circles around some of our BSN prepared nurses fresh out of orientation. Accept that you are a novice and the only thing that is going to change that is nursing experience and time. ICU nursing is not for everybody. If you decide you're not ready for ICU nursing there is nothing wrong with admitting that. You can always transfer to the ICU at a later time. Good luck

[PMFB-RN, RN]

CCRNDiva said:

My last tip, forget about being "cream of the crop BSN grad". Nursing school is over and now the real learning begins. I've seen ADN prepared graduate nurses run circles around some of our BSN prepared nurses fresh out of orientation.

*** Ya that! Exellent advice.

[Always_Learning, BSN, RN]

Hi there. I don't have any specific advice for you per se, but I just wanted to let you know you're not alone. I am a new grad in ICU, completed orientation, and have been on my own for going on 2 months now, I think. I definitely went through that "Dear God, what have I gotten myself into?" stage, as well as the "why-oh-why didn't I just go into med-surg?" and the "visualizing giving my 2 week notice" stages.

That said, I am still nervous a lot of the time (ok, ALL the time), but I am recognizing that I do learn something (usually several somethings) every single shift. It may be where to find something, asking a more experienced nurse about a judgment call, whatever. Some of the questions I ask make me feel dumb, but you know what? Next time that situation comes up, I know a little more about where to find what I need, or how to critically think through it. I try to give myself credit for the small victories.

There are still days where I come home thinking "There is no way I can do this." But then there are also days where I think, "Hey, I caught that! (whatever the condition might be). I did the right thing, called the doc, and now we're on the way to helping this patient." You take those days and really hold onto them. Give yourself credit for what you learn each day, and cut yourself some slack now and then; try to be patient with yourself.

If I get the vibe that someone is annoyed by me asking a question, I try to bring a little levity to the situation or, if all else fails, I will simply say, "This might be a dumb question, but I'd rather ask _____ than do something wrong and harm my patient." That's pretty hard to argue with. At any rate, you tend to find out which nurses you can go to with certain questions. Keep an open mind, though...some of the nurses I initially thought were grumpy/crotchety have taught me the most.

I recognize that I will be slower than experienced nurses, and I will be more "scatterbrained" (going in and out of the room more), but I am working on organization along with everything else. So I'm right there with you! Hang in there....I keep telling myself experience only comes one shift at a time, and it seems 99% of success is just showing up. Hugs to you! :hug:

[Freedomsong, NP]

Hi, I just want to say you are not alone and hang in there :) I am a new grad in the ICU also, I've been off orientation about 2 months. I have good days and difficult days but I constantly learn either way. I agree with a lot of what was said from above posters, especially the studying part! I have learned my co-workers well enough to know who I can go to with questions and believe me I have plenty. I am still nervous and I pray a lot going and coming from work but I love taking care of my patients :) I look at each shift as a new day, a new chance and I try to do better than I did the shift before. Being a new nurse is a life changing transition and I believe in my heart it's worth it :)

[FrankyStarling]

Could you please explain the graph for the CBC/chemistry?