New Grad PICU RN

[Llamanodrama]

OK long post. I need advice and moral support. 

 

I graduated last December and started working in a peds cvicu in January. It’s been intense. I went from loving it, to being anxious and petrified every day before work, to hating it. And now I mostly hate it but feel okay going to work. I feel like the unit is great and has so many resources. It’s a brand new unit and they’re still expanding, so expectations are mighty high. I work dayshift, everything moves fast and doctors aggressively put orders in. I put my best foot forward every day. 

 

I’ve had a couple incidents where things didn’t go as planned, but nothing detrimental to my patients. I’ve had a good share of rude encounters from other nurses or providers due to these incidents (3 since I began). I feel like the effect lingered and I try to prove myself every shift. I’m not one to feel isolated or like the world is out to get me but I’m starting to feel like the odd one out. I feel like I’m talked about in a negative light and I’m being looked down on by some. I can tell by my interactions with colleagues and their shift of attitude. 

 

Recently, the assistant nurse manager pulled me aside to talk about my performance. She said that the general perception of me is that I come off like I don’t know what’s going on and that I don’t prioritize things well or understand the high acuity of the patients. I was a little taken aback. I understand that I’m on this crazy learning curve and my competence builds up over time. I’ve always been very aware of myself and my actions. I really thought I was in a good spot. I ask questions when I need clarification, I get the job done, I’m able to connect with the families I take care of, I help my coworkers. I bust my *** every single day. I don’t go home feeling that gratification people talk about. I feel like I’m constantly critiqued. It all around sucks. 

 

After this convo with the ANM I felt like absolute crap. It made me feel insecure and incompetent. 

I asked if this was a consistent general consensus of me or if it was based on the couple incidents we had to talk about. She said it was based on the incidents but that they’re too many in a short period. I almost thought I was going to lose my job during this conversation. 

I was able to open up fully about how I felt and the ANM was extremely supportive of me. I’m not good at being a novice learner and the conversation humbled me big time. Not that I ever felt like I knew everything there was to know. But for a second I thought I had a good foundation to build upon. Suddenly I felt like I was back at square one. 

 

I was initially planning on leaving when my year was up to maybe try working with adults (I floated there a few times and liked it) or a low acuity PICU closer to home, but now I feel this need to prove myself first. 

 

How can I sharpen my skills as an ICU nurse? Has anyone gone through this during their first year? How do you take care of your mental health away from work (I have kids and we currently homeschool on my days off and I work weekends + a weekday). 

 

If you read all of this, you deserve a trophy. I appreciate your feedback and support more than you know. 

[LibraNurse27, BSN, RN]

Starting in PICU as a new nurse sounds extremely overwhelming. I'm not sure what type of incidents you're talking about, so it's hard for me to say whether the concerns are justified. I think it's good that your assistant manager is being supportive, and that makes me think it's more of a warning or a check in to see how you're doing than a threat to your job.

But if you dislike the job and it's causing you anxiety, and you think you'd be happier working with adults or in a lower acuity Peds setting, I don't think wanting to prove yourself is a good reason to stay, if that's your only reason. Gaining confidence/competence as a new nurse takes time, and critical care PLUS Peds adds other layers. I think your unit should be expecting that you will still need a lot of support and be willing to help you. If you want to move on, at least you are almost at your one year mark. Maybe you can ask some trusted coworkers for tips; I am always flattered when someone asks for my advice, so it could help you gain knowledge and allies at the same time. Even if you choose to leave, the knowledge they share may be useful in other settings too. Good luck!

[Llamanodrama]

40 minutes ago, LibraNurse27 said:

Starting in PICU as a new nurse sounds extremely overwhelming. I'm not sure what type of incidents you're talking about, so it's hard for me to say whether the concerns are justified. I think it's good that your assistant manager is being supportive, and that makes me think it's more of a warning or a check in to see how you're doing than a threat to your job.

But if you dislike the job and it's causing you anxiety, and you think you'd be happier working with adults or in a lower acuity Peds setting, I don't think wanting to prove yourself is a good reason to stay, if that's your only reason. Gaining confidence/competence as a new nurse takes time, and critical care PLUS Peds adds other layers. I think your unit should be expecting that you will still need a lot of support and be willing to help you. If you want to move on, at least you are almost at your one year mark. Maybe you can ask some trusted coworkers for tips; I am always flattered when someone asks for my advice, so it could help you gain knowledge and allies at the same time. Even if you choose to leave, the knowledge they share may be useful in other settings too. Good luck!

Thank you for the thoughtful response. I think you are right about leaving if that’s what I need to do. I guess I’m worried that the manager wouldn’t give great feedback to a potential employer. But maybe that’s me over thinking things. 

1 incident involved giving a med just over an hour late and not following up with an X-ray that was supposed to be done stat.

Another involved having to go to IR to get an nj placed if I was unable to place it. I didn’t go down in time and had to wait until the next day (luckily charge was able to properly place it next shift). For reference, I asked for help with placement and no one was available to help (my first time). Eventually I put it in and although I was cleared to use it by the provider, the official X-ray reading showed it was not where it needed to be.

And a few months prior (fresh off orientation) I gave a couple meds late. 

I understand there should be some grace for new grads so it has me wondering if things were bad enough that we had to have this conversation.