New grad in ICU last week of orientation!

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I am a new nurse in a CICU. I am off orientation next week and I feel I am doing well. My preceptor got my orientation shortened because of how well I am doing. However, I am still so nervous. My question is for those of you who started as a new grad in the ICU. When did you start feeling comfortable? When did you stop getting the feeling that "you don't know what you don't know"? I am starting to feel comfortable with the unit, the policies and procedures, the meds and the charting but still nervous to be on my own! I study outside of work and look up things at work as I go and as things come up. I ask questions of my preceptors about policies and etc. But I feel like as I start to make more independent nursing decisions I am told "well I would've done it this way" or "you should've done this" and I understand that they want to help guide me but what happens when I don't have someone right there to guide me? I know I still can ask questions of my coworkers but I'm not going to be able to ask about every move I make because they will be busy with their patients...

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Get together with your preceptor to help you identify your resources once you're off orientation. Asking the wrong person for help with critical thinking or about a protocol is worse than not asking -- they might not know either. So identify the crusty old bats on your unit who can help you. You can ask any nurse who's been off orientation a week longer than you (or some that haven't) where to find the Foley kits, but asking a newbie a question about a protocol is risky -- look it up yourself!

Make sure you know where/how to look up unit policies, protocols and procedures. Know where to look up drugs, who to call for a lab result that hasn't been entered into the computer yet and which charge nurses are likely to help you out and which are still overwhelmed simply with being charge.

In general, it takes about a year for a new nurse to start feeling comfortable, and about two years for her to start being competent. Anyone aspiring to be a "great", "exceptional" or "awesome" nurse, be prepared to put in five or so years. You will never EVER know everything, so keep the idea that you don't know what you don't know in the back of your mind for the rest of your career. Over time, you WILL know much of what you don't know, but you'll never know it all. (Did that make any sense?)

If your first few months off orientation don't scare the stuffing out of you, there's something wrong. That said, you're asking great questions, so you're well on your way to being a competent ICU nurse. Good luck!

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Thank you, I am good at asking questions. I think that's why I'm nervous to be on my own because I don't have my own personal experienced nurse to ask anything to. I am prepared to put in the effort and the time to become great at what I do! Thanks for the reply :-)

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Get a great brainsheet. ESME12 posted many on AN. Do a search and look for them. My brainsheet consisted of all perterninent info. on the front ( labs, med, hx, cheif complaints, and etc). The back of the brain sheet had 12 columns for each hour of the shift where I'd write down every thing that was either due ( meds, labs, tests/ procedures) and I'd check it off as I go along. I also made my brainsheet blue, pink or green so that it would not blend in with other papers and it was easy to find when I misplaced. I agree with Ruby, it is imperative to find a great resource. Not all ICU nurses are great resources even though they may be excellent nurses. Don't be afraid to question the intensavist on there rationales for orders. That is the only way you will learn. Most of the time they love educating nurses.

My favorite advice I was given: Keep your head low and mouth shut. Basically be sociable but please don't get caught up in any unit politics, gossip or drama. ICU can be a stressful environment and you don't need the added stress from dealing with drama from your peers.

When you do have your bad days, it is okay to walk to the bathroom and cry. Never cry out of frustration infront of your peers. Some may see it as a sign of weakness. Good luck and I hope you have a long lasting career in ICU. Unfortunately, I lasted 1 year in CVICU. It was not the specialty for me, but I am greatful for my experience there.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Get a great brainsheet. ESME12 posted many on AN. Do a search and look for them. My brainsheet consisted of all perterninent info. on the front ( labs, med, hx, cheif complaints, and etc). The back of the brain sheet had 12 columns for each hour of the shift where I'd write down every thing that was either due ( meds, labs, tests/ procedures) and I'd check it off as I go along. I also made my brainsheet blue, pink or green so that it would not blend in with other papers and it was easy to find when I misplaced. I agree with Ruby, it is imperative to find a great resource. Not all ICU nurses are great resources even though they may be excellent nurses. Don't be afraid to question the intensavist on there rationales for orders. That is the only way you will learn. Most of the time they love educating nurses.

My favorite advice I was given: Keep your head low and mouth shut. Basically be sociable but please don't get caught up in any unit politics, gossip or drama. ICU can be a stressful environment and you don't need the added stress from dealing with drama from your peers.

When you do have your bad days, it is okay to walk to the bathroom and cry. Never cry out of frustration infront of your peers. Some may see it as a sign of weakness. Good luck and I hope you have a long lasting career in ICU. Unfortunately, I lasted 1 year in CVICU. It was not the specialty for me, but I am greatful for my experience there.

Intensivists, residents, even attending physicians love to teach. It's a great way to learn the "whys". It also is a great way to build good working relationships which is important. If the providers like you, they're far more willing to listen to you later on when you have valuable information or observations to give them!

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Thanks for the advice! Last night was my last shift on orientation! I can't wait but am scared to death!

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Specializes in Med-Surg Nursing.

Don't be afraid to ask questions...be sure you're asking the right person though. If you can, try to find the answer yourself. I know for me, I'll remember it, if I sought out the answer on my own. I think you'll be ok...the fact that you say you're scared to death is a good sign....if you were overly confident, I'd be very worried! The new grads I worked with who thought they knew everything were the ones who didn't know anything and were the most dangerous!

Good luck!!

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