New Grad Journeying to the Big World of ICU Nursing

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Hi everyone,

I just received my first job as a new grad in the MICU at a large teaching hospital (yay!). This is my dream position and after reading how hard it is to get such a job, I am still slightly in shock that I have it. I guess reality is starting to set in and as my orientation date draws closer I'm seriously freaking out about what I should know vs. what I'll be expected to learn on the job. I completed my practicum in the ICU so I guess that should make me feel a bit less anxious, but the unit manager told me that my new unit is higher in severity and the number of patients so I'm paranoid/anxious that I won't know what they expect me to know. I did ask what new grads are expected to learn and I was told that new grads should be open to learning, ask questions, and always follow safety measures. I ordered a critical care reference book, a critical care textbook, and I've been reviewing on ICUfaqs.org. Am I taking it overboard??? If you've oriented a new grad on your unit, what did you expect them to know? I am someone who asks a lot of questions, but I'm just worried that I'll mess up or not know something. Plus, after hearing how people have been asked to quit during orientation has me super scared that maybe that'll happen to me. Sorry this has been quite a rambling post but as you can tell I'm probably freaking myself out. Thanks for all of your help!

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Just starting my orientation on the SICU unit but I've been in the classroom so far. Like you I'm nervous and anxious but i know the most important thing is to have confidence. Ask questions , pay attention, and ask more questions!! We can do it. Good Luck

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Thanks :) I think a lot of it for me may be "fear of the unknown". I know a big part of it is confidence so I'm definitely trying to strengthen mine before I start. I think it's kind of like when you want something so bad you're scared you'll lose it lol thanks for the advice though. I'll be asking tons of questions! I hope your orientation works out for the best as well :)

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I started in the ICU a little over 4 months ago. The good preceptors know that new grads know little to nothing and just look for people who are eager to learn and proactive to be safe by looking up unfarmiliar meds/disease processes/ect (even on your own time). Pt safety is the priority even if it means sacrificing some down time at home to get to a place where you have enough basic knowledge on things to be safe.

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Thanks for your reply! I'm starting to feel a little better. I've always been someone to ask questions and I feel like I'm very conscious of patient safety. I think I'm more scared from a technical point of view. For example, I've only put in one NG tube. Do preceptors/unit managers care about this? Or am I making myself anxious over nothing?

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Try not to worry too much and always ask questions! Don't be embarrassed about what you don't know...my preceptors always welcomed questions and I never felt bad saying I never did something before, etc. I started on the ICU 6-7 months ago and I just put my first NG tube in a few weeks ago! I learned so many skills on orientation it made me feel like we did absolutely nothing in clinical during school! There is so much to learn but even off orientation nurses will be there to help you and answer questions. You'll have good days and bad days but just stay positive!! Apparently it will all make sense for us one day! :)

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Specializes in Critical Care(SICU).

Yeah i Worked went into the SICU fresh out of nursing school and worked there for a little over two years.. also i have precepted 3 new grads.. and i would say from my experience and theirs i knew nothing really about true critical care nursing.. I fell that nursing school teaches you a little bit about a lot.. but not a lot about any one certain thing.. especially critical care stuff.. the biggest advice i give any new grad is always always always ask questions.. never do anything initially that you do not feel 100 % confident about.. because it's not nursing school if something happens to your patient.. it's your nursing license and theirs.. be constantly learning drugs your giving.. vent stuff from respiratory.. don't be content with just knowing how to do something but learn why your doing it..i know from personal experience the first few months of orientation were some of the most stressful times of my life.. their will be times where you fell like you are not doing anything right.. and are constantly making mistakes.. just learn from those mistakes and keep at it.. it will get better..

Another important note they do not tell you in nursing school is how Callus many ICU nurses can become.. dealing with so much death and sickness.. I once had a older Blind individual who was very septic he came from the nursing home and had no children or family.. he was a DNR and had gotten to the point where his pressure systolic was in the 30's.. he had gotten to the point where he was unconscious taking very shallow breaths.. basically he was on his way out.. our icu was full at the time and they had three very sick patients on the in the ER they needed a bed for.. the house supervisor came to me and told me she had called the Dr. and gotten orders to move my patient to the floor..... I asked her if she was serious.. and when she said yes I Refused to send him.. again this man had no family blind and was dying.. i asked the supervisor if it was her father or brother would she want his last few minutes on earth to be spent scared not knowing what was going on.. pulled from one bed to another and put in a room alone.. she stormed off.. i was beside his bed holding his hand when he passed away.. My point to all of this is Remember that your taking care of a real person who cared loved and had feeling and always stand up for what you believe is in the best interest of your patient and always try to treat them as if they were one of your family members and you will be ok..

Sorry for all the rambling but hope this was helpfu!l good luck!!

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Thank you for your reply! I just started orientation and the instructors/educators have been trying to reassure us that it's a big learning curve and that we have a lot of resources available. That has actually been helping with some of the anxiety. I kept reading of how new nurses have been asked to quit during orientation but I learned that this almost never happens at our facility. I think I'm slowly building more confidence lol thanks!

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Thank you for replying! It's nice to know that there's someone else out there like me. Sometimes I feel like I don't know enough and they're going to wonder why they hired me lol but they keep telling me to ask plenty of questions and that I'll be fine :) I also have some skills that I've never had the opportunity to practice!

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Specializes in Pediatrics, Women’s Health.

I started as a new grad in a Surgical/Trauma ICU in July. Our orientation is 20 wks so I'm very close to the end. You will be AMAZED at how much you learn! My first month was very rough - I felt like I had no idea what I was doing (because, really, I didn't) and was scared that this wasn't for me. You are probably going to have some moments like that. I absolutely love it now. Take advantage of the advice that older/more experienced nurses have. Take your job seriously but not yourself. You are going to make mistakes - just keep learning everything you can and questioning everything you aren't 100% sure of. Your managers and coworkers will respect and trust you so much more if they know you are cautious and inquisitive. And even the simplest of procedures (NG/OG tubes, foleys, etc), you are going to re-learn in the unit so don't worry if you don't have experience. You're going to do great, just keep the great attitude : )

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Specializes in ICU.

You will do great! I started in a MICU and I love it. I'm four months in, and while I don't know everything, I sure do know a heck of a lot more than when I started. You will get it and you will love it!

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Specializes in Critical Care(SICU).

haha honestly right now you don't know enough ha but they knew that when they hired you! :) They hired you because think your smart and capable and have a good base to build on again you will learn the majority of everything you know as a nurse once you begin orientation!! as long as you ask question and are eager and have common sense you will do fine!! now as to not cutting it.. i know in the two years i was in ICU they did ask 2 people to leave but that was mainly because they made to many decisions that affected patients and turned out negatively without asking.. or acted like they knew it all.. it will be very stressful and the time management is one of the hardest things to catch on to.. but it will come

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