New grad overwhelmed in ICU

[novicenrs]

Long post ahead!

I graduated nursing school in May of this year, and was lucky enough to have an ICU position waiting for me as a new grad in a large hospital. I was ecstatic. Critical care is where I've always wanted to be, and I knew it was going to be a huge learning curve, but I jumped in feeling more ready than ever. In this ICU, they do 18 weeks of orientation with a preceptor (which I was also incredibly excited about). Fast forward to now, I am currently on my 15th week of orientation and terrified of the thought of being on my own in just a few weeks.

I feel as though I am not ready at all, and every day it seems to get more overwhelming. Every shift I feel like I make a different mistake or forget to do something minor, and I really beat myself up for it. For example, last night I had to call a doctor to ask a question about a patients insulin drip. Before calling, I wrote out everything I needed to talk to him about, had my chart open in front of me, and had out my most recent set of vital signs and lab values. I paged him, and when he called me back I explained to him the situation, gave him my patients most recent electrolytes and asked what he would like to do next. Instead of telling me, he caught me completely off guard by asking me why we monitor electrolytes with patients on insulin drips. I was dumbfounded, and after a moment of thinking I told him that I honestly was unsure. This angered him, he scoffed at me over the phone and asked to speak with my boss. I handed the phone to my preceptor who was sitting next to me and he proceeded to give her the new orders instead of me. I have never been more embarrassed and I immediately asked my preceptor to explain to me why we monitor electrolytes afterwards. I was near tears the rest of the night.

As I sit at home now, I can't stop thinking about how I should have known the answer. I will be on my own soon, and I won't have a preceptor that I can hand the phone to if a doctor gets mad at me. It's all so overwhelming. I feel like there's always something I'm missing or not even thinking to check. I'm comfortable performing my assessments and passing my medications, I'm decent at time management, but I feel like when it comes to the big picture there are always a few things I'm missing.

The nurses on my unit are very encouraging, they told me that I'm one of the good new nurses and that they will be there for help when I'm off orientation, but I still can't get over this panicky feeling. Will I ever feel ready to be on my own? Does this overwhelming feeling ever get better? I would appreciate any advice right now.

[Ruby Vee, BSN]

The feeling of being overwhelmed does go away -- but it takes time. The first year of nursing is pretty awful, and you have to GO through it to GET through it. I remember crying on the way to work, on the way home from work and even in the staff bathroom at work because I felt so stupid, incompetent and overwhelmed. I hated nursing -- I was SURE I wasn't cut out to be a nurse. I even got my MBA so I could be a stock broker. But something happened when I got that graduate degree -- I realized that I loved my job in the CCU and didn't want to be a stock broker -- or anything else.

As a preceptor, the new grad who terrifies me is the one who ISN'T scared or overwhelmed. The over-confident new grad is the one who does something stupid and endangers a patient. The scared new grads will ask the "dumb question" before they do that something stupid. I really hesitate to let someone off orientation if they're too confident. New grads are supposed to be scared.

As for the physician -- I don't suppose you'll ever forget why you follow electrolytes with a patient on an insulin drip, will you? Some physicians really like to teach, and you can learn a lot from them. Not every one of them is good at teaching, but you can still learn a lot from them.

I will say that if you're good at time management at this stage of the game, you're almost certainly missing something. So take your time and make sure you aren't missing anything. Make a checklist or a task list or a brain sheet -- whatever you need to do to keep on top of what you need to assess, medicate, dress, change or measure.

Good luck -- almost every new grad who ever turned into a good nurse was anxious at the idea of being on her own.

[KeepinitrealCCRN]

yes the overwhelming feeling will go away! also, this may sound mean but i mean it to be more empowering; you need thicker skin. doctors are going to be upset and may even yell at you but who cares they won't even remember in 15 minutes so try to let it roll off your shoulders (i know easier said than done). you are new and have a lot to learn but you will be fine, just continue to ask questions, look things up and don't kill anyone . best of luck!

[AceOfHearts<3]

Remember everyone starts from somewhere and that doctors aren't born knowing everything- they too were once beginners. Some of the residents in my ICU got a talking to by the attending this week, so remember when a doctor or anyone is rude to you that they had a big learning curve too and most likely made mistakes (heaven knows the residents I work with do- God only knows what would have happened with some recent patients if not for nurses).

[DavidBeckerCCRN, RN]

I had many of the same struggles as you. Check out the link in my profile signature to read how I overcame everything.

Learning Critical Care Nursing is hard at first. Took me a year or so to feel competent. 2 or more years before I felt like a really knew what I was doing.

Good like to you!

Kind Regards,

David

[brap740, BSN, MSN]

As an Italian man once said: "fuhget about it"

You'll be fine. You'll find that many doctors will get chitty with you....and many are awesome. Don't let the jerks bog you down.

[gemmi999]

I've been there! I'm not an ICU nurse, I do ER. But recently with this weather/flu season we've had a *lot* of ICU holds. I had a patient I got from night shift who was in DKA, but night shift didn't start the insulin drip until about 8 hours after it had been ordered for a variety of reasons. I had to be the one to tell the doctor that because he wanted to know why the patient's acidosis hadn't gotten *any* better from the previous night according to the numbers! He asked me what the insulin was for and I said it was to help correct the imbalance, etc, and to close the anion gap.

He then lectured me on how the gap was a symptom/measurement tool but it was the acidosis! I had to listen to him lecture for like, five minutes, when all I wanted was a better guideline for what he wanted the drip at because the pt. was much more insulin sensitive then we suspected and he kept dropping from like 600 to 200 over 1 hour with 6 units running per his protocol! Ugh.

All that to say the doctor came in later and didn't even remember the conversation/the lecture! So take a minute, think about what the doctor said, and then forget about it because the doctor already has! If you feel you learned something, keep what you learned and forget about the tone from the MD.

Everyone is nervous/anxious the first year or two! If you weren't, well...that'd be a different story! But it sounds like you have a good group with you for support! Good luck!