New grad in ICU needing advice

in2ICU · Dec 17, 2010

I am in a MICU in a large teaching institution, towards the middle/end of orientation (new grad). I too have a lot of stuff in 3 different huge binders. We had brief classes that were specific for hemodynamics, ventilators and neuro, but the meds were only covered at a high level. This may not sound so supportive, but what I learned in those classes hasn't really changed anything for me. Unless I work with a drip or therapy (like CVVHD), the classroom stuff doesn't do much. I get most of my learning with OJT and asking senior nurses and physicians to explain, explain, explain.

I spend most of my evenings looking up what I encountered each day and jot down notes in a notebook (making my own reference material). I also make a list of follow-up questions for the next day.

This may not be the most helpful for your current dilemma, but I wanted you to know comparatively what other people have gotten for training and what might be useful in making the best of your situation. I hope you find a happy resolution!

PMFB-RN, RN · Dec 17, 2010

Have you tried going directly to your manager with your concerns?. I too was a new grad in a very large fast paced trauma/CV/surgical ICU but the hospital where I worked offered and excellent 9 month nurse residency program for new grads going directly into ICU. New grads absolutely do belong in the ICU, if the hospital is willing to spend the money and time to PROPERLY train them.

I would be very, very careful about leaving any paying new grad RN job right now.

pinkynbd99 · Dec 19, 2010

well I don't want to leave b/c I know how hard it is to find a job as a new grad. And with my manager, well I've just really felt like my manager as been out there to see me fail. I feel like she says she wants to support me but then again points out all my faults and makes me feel like it's the worst and I shouldn't be there. And with this last incident, well I feel like it's "proven" her right about me. And this is why I feel like I should leave, b/c I don't feel like my manager wants me there and that's something I don't know if I can deal with for another 3 years! Im trying to prove her wrong but it's hard when I feel so much pressure and this expectation of failure.

LoveActually · Dec 19, 2010

First of all....6 months orientation, you are lucky, embrace it and make the most of it! I had a little less than 4. Remember that it's hard being new (especially a new grad in the ICU!), and everyone makes mistakes, new and old! You should know your drips at least the most common ones. As far as exactly HOW they are titrated, it depends on your facility. Your continuous med infusion order set should tell you how exactly to titrate, or you may have specific instructions, but it should be on your MAR. You should be able to create a drip table. This is what we used to to until we just got Alaris pumps that calculates it all. You should know all about what is common in your ICU. Levophed, vasopressin, dopamine, dobutamine, nicardipine, nitro, amiodarone (need a filter!!!!!), cardizem, propofol, Versed, fentanyl. Less common in my ICU is epinephrine, Neosynephrine, Esmolol, Primecor and others, but if I can't remember what something is you better believe I'm looking it up. For the most common ones, you should know what they are used for, what the side effects are, what to watch for...You have to keep studying this stuff over and over, but the more you use them, the easier it gets!

In the beginning, you are inundated with information and learning how to be a new nurse. Know this is all part of the process. I am still a new nurse, and still have questions every day, but it's so much better than it was a year ago when I was first off of orientation, and you will not always feel like a fish out of water!

Don't stop asking questions...Whenever I'm about to ask a question that I feel like I 'should' know the answer to....I preface it with a smile and, "ok not to sound like a total dumbass, but I can't remember what........" A little humor goes a long way, and the only dumb questions are the ones that should have been asked....

PMFB-RN, RN · Dec 19, 2010

Back when I was a new RN in the ICU I found the Cathy White book to be invaluable.

pinkynbd99 · Dec 20, 2010

Thanks for the advice. I hope things get better, it just really sucks to be a new grad! I never thought it would be this hard after nursing school but I guess ppl were right when they told me all my "REAL" learning will start after nursing school!

LuckyoneRN · Dec 20, 2010

Sounds like you have had to start in less than ideal circumstances, in terms of your ICU classes and orientation; however I too started in a MICU as a new grad with a fantastic orientation full of classes on vents, hemodynamics, you name it...and it took me a very long time to feel "comfortable" with things...Working in our environment is something that you can only learn by doing, reading books can help you understand the how's and why's of what you do, but only the actual doing will give you the confidence you need to continue on in this very challenging area of nursing.

Remember to give yourself credit for how far you have come already, and remember that everyone was new once too!

General E. Speaking, RN, RN · Dec 27, 2010

check out icufaqs.org too. Great resource

MSICUNurse131 · Dec 28, 2010

I also started out as a new grad in a small community hospital Medical Surg ICU. I think that we are so focused on learning the book material to understand what is going on in the ICU coming straight from school it's important to learn from your preceptors and on the job. I really did feel like I don't know anything about critical care when coming out of school I had a 4 month orientation and did fine, I still had to ask my old preceptors questions and am still asking questions. It was not easy being a new grad in the ICU but learned alot and moved on from that community hospital to a bigger hospital and am doing just fine.

Ruby Vee, BSN · Dec 28, 2010

i suspect hating your job is just a part of your first year of nursing. it certainly was for me! as a brand new gn (we were allowed to practice as graduate nurses before taking our boards), i spent most of my evenings after work looking up new drugs, procedures or disease processes i had encountered at work that day. i made drug cards for the drugs i gave routinely, just as i did in school. i spent time studying at home. and then when i switched from telemetry to oncology, i studied again. our staff educator actually assigned homework. we had classes, but most of what we learned we learned from studying at home on our off hours.

i'm not a big fan of starting off as a new graduate in icu, but you've already taken the job and signed the contract. you owe it to yourself and your employer to stick it out. i appreciate that you're having difficulty keeping up, but i'm wondering how much actual studying you do when you're not at work. if you're not studying, do so. with a six month orientation, there's no excuse for not knowing your drips, how to mix them, what they do and how to titrate them by the time your finish orientation.

everyone makes mistakes, even med errors. if you were placed back on orientation after making mistakes, i'm wondering if you've made the same mistake a number of times. or whether you aren't demonstrating to your manager or your preceptors that you understand the potential ramifications of medication errors.

it would be nice if our managers, preceptors and staff educators could just spoon feed us all the information we'd need to successfully complete orientation, but that isn't going to happen for a number of reasons. if you have to study on your own time to learn what you need to learn, study on your own time. it sucks, i know, because you thought you were all through with school. even after decades as a nurse, however, i have to study on my own every time i change jobs. each facility has a different concentration for their common drips, procedures differ and the drugs may be referred to by their generic name rather than the trade name you're used to (or vice versa). different physicians prefer different drugs so you may have new drugs to learn.

switching jobs with less than two years of experience not only looks bad, it deprives you of the time you need to become secure in your practice as a nurse. what happens if you switch to peds and then find in six months that you can't stand that and want to do psych instead? it doesn't take long to get a reputation as a job hopper, but it takes a long time to overcome it.

MomRN0913 · Dec 31, 2010

I started out as a floater for 4 months as a new grad, in which I recieved 8 weeks orientation. Then I got a position in the mICU. 4 weeks orientation! That's it! I did have a great preceptor. I didn't get to experience alot on orientation though. I basically referred to the infusion book, because I wasn't given a class on the drips either.

Hang in there. It's experience. You will learn when you are actively getting a chance to do these things. You do need a mentor, a veteran nurse you can trust and go to when you have questions on your own. I served as one for alot fo the new grads, because i remember feeling uncomfortable. I made myself open to anyone's questions, never made them feel like any question is stupid or like they were bothering me. I know they needed that. find someone you feel comfortable with when you are on your own and ask for their help, it's OK.

Bring this up to your manager or head of education. They may want to change things around a little. Feedback is always very important, else we can't better out way of doing things.

It can be daunting, but you will be fine. See to it atleast you start of with patient assignments youa re comfortable with. whenever another nurse has a bedside procedure, code blue, intubation, try to be there on the forefront with it to get the experience and so when your patient is that position, you feel more comfortable.

Good luck and hang in there, it gets better.