New grad nurse starting in ICU

[Nursebusybeee]

I am a new grad nurse in the ICU. My program offers a 12 week orientation and then I'd be on my own. I have had a total of 3 weeks on the unit with my preceptor and I am starting to second guess my choice. I feel very incompetent and don't know if I can truly handle it. I have been handling 2 patients on my own since only the second day on the unit and it has been a problem figuring out time management. With all the tasks, medication administration, and documentation I feel like I am just running around but not entirely sure why certain things are being done. When we get report in the morning, my preceptor has never explained what our main priorities for these patients are instead I am just let loose to take care of both patients. When I ask questions she seems annoyed which has turned me off from asking her further questions. I never do anything unless I am confident I'm doing it correctly. If I don't know I will ask whoever is available.

My last couple of shifts I have left crying because I did not feel supported. When I had to give report at shift change I was missing information and was chewed out by the night shift nurse.... rightfully so. But the nurse covering me that night was not helping or showing me how to find that information and instead was making me feel very stupid. I don't know if I can do ICU and am considering asking to be put in another unit where I can hone in on my practice.

Any advice from other nurses in the community?

[MKayK]

I hope things are going better for you! If you are open to sharing, I would like to know if your work environment has improved at all..

[291tiger]

Many new ICU nurses feel overwhelmed and question their decision at first. It sounds like your preceptor isn't providing the support you need, which isn't your fault. Advocate for yourself and try to reach out to your educator or manager about getting a more supportive preceptor. I hope it gets better for you

 

[nurse1285]

I hate to say this but welcome to nursing.  Not saying its right, but not all preceptors should be precepting. I would speak with my manager and ask to be assigned to a new preceptor.  Yes you don't know what your doing yet, but should be better in about 6 months. Let us know how your doing. 

[RNNPICU, BSN, RN]

Part of orientation is also on you.

You have outlines several instances when you felt unsupported.

Why not try this.

1. At the start of your shift, ask your preceptor. "This is what I think the priority is for our patients today." Is there anything I am missing or should be thinking about?  

This lets your preceptor know where you are at. Don't wait for them, 

2. Prior to giving report to the oncoming shift ask your preceptor to listen to your report and ask if there is any critical information you are missing.

3. If there are new tasks that are due that shift, start by discussing your approach with your preceptor. Then ask "Am I missing any steps?  

This is your orientation, maybe this preceptor thinks you are just going.  See if this might have a different reaction from your preceptor, It is possible it is not a good match but also try and think how you can also have some control of your orientation.

[Hannahbanana, BSN, MSN]

Everything you list here is a learning opportunity. Go to coffee with an older nurse you trust and see what she says about how she felt like this in her first week. Go in every day with the attitude that darnitol, you're gonna learn three new things today. Nobody expects more of you than to learn, learn, learn. You will start picking up the bigger picture a bit at a time, you will. 

[Alice Evans, ASN, BSN, MSN, RN]

It sounds like your preceptor should not really be precepting. I would speak to your unit educator or your manager about potentially switching preceptors.

 

However, there are several things that you can be doing to improve your experience. 

Time mamagement. Every single new graduate on the face of the planet could manage their time better. You are trying to gain your footing in a whole new profession. This can take time. I liked to structure my mornings when I was in the ICU. 

1. Immediately following bedside shift report at 0700, I jumped into my rooms. I would start by cycling a blood pressure, doing my sedation vacation, and complete my head to toe assessment, oral care, and 0800 turn. Prior to leaving each room, I would check each patient's med bin to see if I needed to order anything from pharmacy to have on time for my 0900 med pass. I would do this for both of my patients.
2. By the time you are done with this,  as you gain efficiency, it is 0800. I sit down at this point and complete my documentation. This includes initial head to toe assessments, vitals, turns, care planning, oral care, sedation vacation, EKG rhythm strip analysis, etc.
3. Then, it's med pass time! Complete your med passes and then do your 1000 turns.
4. Document in real time as much as possible! If you use Epic EHR, it has made this very easy. Frequently in the ICU, we use the sedation, admission, and code narrators. Avoiding the buildup of documentation burden can really save you time.

Take a systems approach to your nursing reports. ICU patients are very complex. Approach report by body systems, and don't forget to also include main occurrences/issues faced during the shift, consults, running infusions, vent settings (include this in your respiratory system report), and prophylactic bundles (DVT, bowel regimen, etc). I like to take the last few minutes of my shift to review doctor's notes to aid me in filling out each patient report by system.

Ask the physicians! Many intensivists love to teach. If you ask them the rationale for a treatment or medication, they really enjoy telling you about it.

Make the first move with your preceptor. This should never fall on you as the new graduate nurse, but you can say, "This is my focus for the shift for this patient. Do you agree, or is there something else I should be focusing on and why?"