New grad in icu not ready

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I'm a new grad in the icu, my 12 week orientation is 3 weeks away from being over. I'm not ready. I haven't even taken over full care for two patients yet. I'm pretty sure I'm at fault for not pushing it. I had a meeting with my charge and preceptor for and both don't think I'm ready and strongly hinted at working at a regular floor for a year. I have a meeting with my supervisor this week. I feel like crawling into a hole and dying.

The med/surg thing is fine for time management development as many new grads are scared of more critical patients. I use to think all are grads should start in med/surg or tele, but have seen many do well in an ICU setting. This new grads who make the smoothest transitions are the ones who worked as techs in the unit while in school.

Everyone is different. I do not think that one plan fits all.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
I would STRONGLY encourage you to take their generous offer, go to med/surg or wherever, and learn everything you possibly can from the nurses there. It may take a good 3 years or so, don't rush it. Believe me, you're being given a huge gift. TAKE IT.

I agree with this! OP, rather than letting you go, they want to retain you but grow you appropriately. Do not beat yourself up!!! Critical care is tough, and some areas are more tough than others. Please keep us posted!

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Specializes in Critical Care; Cardiac; Professional Development.

I have been the preceptor who has had to recommend someone be either moved to a lower acuity unit or let go entirely. Believe me, if they feel you would benefit from the experience (and internal sense of success) by a year of lower acuity, it means they think you are TERRIFIC. Please please PLEASE don't feel like failure or like curling up and dying. There are much worse things than needing a little more time to be proficient in something as important as caring for the critically ill! They would not be looking to retain you if you were hopeless or a failure or dangerous or stupid. Work hard over the next three weeks but also admit to yourself if you aren't ready and be gentle. Imagine talking to a small child the way you are talking to yourself and adjust accordingly. You have every reason to feel good about what you are doing and every reason to have faith in yourself. This will be okay in the end.

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I have been the preceptor who has had to recommend someone be either moved to a lower acuity unit or let go entirely. Believe me, if they feel you would benefit from the experience (and internal sense of success) by a year of lower acuity, it means they think you are TERRIFIC. Please please PLEASE don't feel like failure or like curling up and dying. There are much worse things than needing a little more time to be proficient in something as important as caring for the critically ill! They would not be looking to retain you if you were hopeless or a failure or dangerous or stupid. Work hard over the next three weeks but also admit to yourself if you aren't ready and be gentle. Imagine talking to a small child the way you are talking to yourself and adjust accordingly. You have every reason to feel good about what you are doing and every reason to have faith in yourself. This will be okay in the end.

I agree, 1000%.

I have had several orientees in the OR who I have had to recommend that they go to a less intricate specialty team for a while. They've learned a lot, and are valuable, but not strong enough, yet, to be cut relatively loose in situations where delaying 30 seconds can mean a life altering injury or even death. I can't recommend, in good conscience, someone who cannot function well in the most basic of the cases on our service line (neuro) to be able to do the incredibly complex cases we do. ANY procedure can become critical very quickly, as patients can have an anaphylactic reaction, or develop MH. Not only that but anesthesia induction and emergence are the two most critical times of nearly all procedures (risk of losing the patient's airway). Sure, lots of things are scary, but losing an airway proceeds to emergent trach very quickly. Any general case can go south, there are lots of important vessels in the belly, but most laparoscopic cases (appys, choles) are more routine or predictable than cranis. The number one thing I always stress with ALL of my new grads is that they should call for help when they even kind of maybe think they might need it. On day shift, we have people available to help. If you're running for the crash cart, probably need to call you manager or the charge nurse. If there is a lot of blood in a case where minimal blood loss is expected, then you need to call for help. It may be that you just need better hemostatic agents (more drugs, different type of coagulation, etc), or that you need to have blood in the room or someone to help check blood. But it's far better to call for help early or when you don't really need it than when you're up to your eyes in problems.

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Go to emcrit.com and watch these 2 videos/ podcast. The first is called "dominating the vent" and there is a part 1 and 2. The second is called "vasopressor basics". Watch them both at least 3 times a week each. Understand basics of ABGs and Vent status to correct ABGs. Know these following things pretty well: 1. What resp distress looks like 2. Treat pt not monitor, vital signs are often a late sign of crap going bad 3. Adding on to number 2, screw the monitors how does the pt look? Are they about to take a stroll through the zoo or do they look like they ate some really bad Mexican food in Mexico and washed it down with some warm Mexican tap water 4. Know sepsis 5. Know DKA. 6. Know ARDs 7. Watch every line that you have things going through regularly. 8. Know your A&P. Best wishes

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