New grad struggling...should I stick it out?

[girliegirlieRN]

Hi everyone,

I was wondering if I can get some advice from more experienced nurses. I was hired as a new grad to the MICU at a large teaching hospital 8 months ago. I worked there as a tech during nursing school, and so thought my transition would be a little easier than those of others but I am struggling a lot more than my other new grad peers. I want to stick it out here and learn as much as I can, but I'm just not sure sometimes if I'm cut out for it.

First off, my time management is horrible. I know that. I am trying so hard but every shift I feel like a chicken with its head cut off no matter how easy my two patients may be.

I've had one occasion where my patient really started crashing and had to be cardioverted and rapidly started on pressors. I got the doctors to the room right away and had the help of other nurses, but when I was in the room I just froze and didn't know what to do. I had never experienced a situation like this at all on orientation, and the nurses that helped me kind of just came in and took over. The doctors were yelling out orders and the nurses were doing things so fast I couldn't even wrap my head around what was going on. I'm glad people who knew what to do swept in, but I was just expected to know what to do. I got a stern lecture from the charge nurse afterwards telling me that I need to be more present next time and basically just do a better job. I burst out crying at that point, because I have no idea how I can do better. I am trying my absolute hardest.

My orientation was 12 weeks long, and for me I did not feel like this was enough. I have friends in the ICU at a different teaching hospital who had 6 months of orientation. I wish that was the case for me. Other new grads seem just fine with the 12 weeks, but maybe for me that just isn't enough time.

My preceptor was also extremely critical and expected me to be able to manage everything for both patients without getting behind right off the bat. I had a couple days on orientation with a different preceptor (who was actually the nurse I originally requested to work with but didn't get) and I felt so much better. I wish I could have had her the whole time because I feel like maybe I would be a better nurse right now.

I feel so much anxiety at work, and work so hard but still feel like I am always behind. I am always there later than all the other nurses, usually staying until 8, and sometimes even until 9. People from the oncoming shift make so many comments about me still being there, and it makes me really self conscious.

I think about switching to a different unit, but I know med surg is super busy also and I never want to assume the grass will be greener on another unit. I have met with a senior nurse on my unit, and she referred me to the nurse education department at the hospital. I'm seeking all the help I can and don't want to throw in the towel. I'm also a really warm, fuzzy person. I don't feel like I get that at all on my unit but I know the ICU is a great learning experience.

I was just wondering if people think I should stick it out and things will be better? Or am I just one of those nurses not cut out for the ICU, or nursing in general? I know they say it takes a year or two to really get the hang of things, but I feel just as helpless as the day I got off orientation.

Any constructive advice would be really appreciated! Thanks!

[CrunchRN, ADN, RN]

Stick it out. Get all the help you can from the nurse educator. The unit and the nurses in the unit are for the most part a trial by fire sink or swim type. If you can come through it as a decent nurse their attitudes toward you will change. Maybe the educator could do some mock codes with you that would help you adjust to the emergency stuff.

If after all that it still isn't a good fit then that is ok. Not everyone (many) are not a good fit for that atmosphere. There is absolutely no shame in that.

Wishing you all the best.

[bcburke90]

Hi there, I was a new grad on MICU when i started in july 2012. It was indeed very overwhelming at times (i had many different preceptors, one of which who sounds exactly like yours) but defintely got better over time after orientation. I know many nurses on my floor who stay until 9pm (or later sometimes) but that doesnt make them a bad nurse, just thorough!. I would definitely focus on time management though, what really helped me is using sticky notes on my report sheet to make a to-do list as I went through the day of things that needed to be done/ mentioned to doctors (ie lab values, dressing changes, drips needing changing) This allowed me to stay focused on task when you start to feel you have too much to do.

As for emergency situations I am surprised you didnt have much exposure to this during orientation, but that is definitely the reason you froze in that room.... and thats expected!!! One time I was already on my own and my pt had wiggled to the bottom of the bed and extubated herself. I had no idea what to do so i turned around and put an isolation gown on.... the patient wasnt even on isolation!!! I yelled out for help and the other nurses swooped in and started bagging her while others grabbed respiratory, the doctors and paged anaesthesia to reintubate.... and this all happened while i was gowning up! But thats how you learn! I hope that during that experience you had you learned the most important things to do when a patient drops their pressure and you can start anticipating what needs to be done, (pressors, fluids etc). But all that comes with experience!

All in all, stick with it! YOu are learning more than you think you are and you wont realize until the next time your patient drops there pressor and youll be in there doing everything and a new grad will be in awe of you as you're zooming around being super nurse!

Stick with it, ask for help, if another patient on the floor is crashing GET IN THERE! the more exposure the better! And def contact the nurse educator!

Good luck!

[francoml, ASN, RN]

Here is my 2 cents. First off everyone has a moment or two when they freeze and feel overwhelmed that is why you have a team of nurses on the unit to back each other up. Second, if time management is what is hurting you then I say stick it out. The more experience you have the better your time management will get. When I first started I was pretty scatterbrained but now a year later I feel much more focused and detail oriented. It just takes time to wrap you head around everything that is going on. I say give yourself at least a year or more before you throw in the towel. I bet you soon you will have your "ahh ha" moment and the pieces will all come together. Good luck!

[ChipNurse]

I started as a new grad in ICU too. It is going to take time for you to be comfortable. The other nurses at my job swoop in too when things go sour, it's part of the team atmosphere, just enjoy the extra help when you need it. As for time management, do you have a report sheet you work off of? I usually jot things down that the other shift need me to follow up with on my brain and put a check box next to it and check it off as I get it done. I also write the times of my meds, water flushes, nutrition additives, neuro checks, etc on the back of my sheet. I check it every hour to stay ahead of the game and not miss anything. I also try to stay on top of my charting all day, because I find when your day is slow and you are sitting and chatting instead of charting, then at 6pm your patient starts to crump and then you are behind. Stay on top of everything. Lastly, it is natural to freeze when something bad is happening. Take a second to think and then act on it. Have you taken ACLS? I would take ACLS if you haven't as it walks you through emergency situations, meds and interventions. Lastly, study outside of work. ICUfaqs.org is a great resource, a CCRN review book is a great resource as well. If you have time at work, you can pick others brain about things you don't understand or look it up. I also find rounding with the docs when they round on my patients give me a lot more insight into their disease process and what's happening between all the body systems. It's humbling to hear our staff docs quiz the residents and they don't know the answers all the time... you will never know everything, but as long as you ask when you need it, you are doing right by your patient. Good luck and don't be so hard on yourself. :)

[ER Night Club]

Many people may disagree with me on this, but I promise it's not because I'm trying to be negative.

I don't think you should stick it out. Many new grads in the ICU put on an act, but many things get missed by them and some people have bad outcomes. When there's a megacode situation and you feel overwhelmed and unable to move, you are demonstrating that you don't know how to function as a critical care team and don't know how to critically prioritize in that situation.

IT'S OK. You are brand new! This is such a difficult and hard thing and it DOES take time!

However, knowing your boundaries and your weaknesses, then taking the time to improve on them is essential for you and your patients.

In other words, I would respect you a lot more as a person who knows their boundaries and leaves to the floor, then later comes back to the unit. People have so much pride sometimes and real people suffer and die because of this. Please don't read this comment and think that I think you suck or are not good enough. You're amazing! You're a nurse. Stick it out on a different unit, then come back and take on those very critical patients and become something amazing.

[iluvgusgus]

I dont think there is any shame in going to a floor to get more experience with time management. In med/surg you will learn time management well. Ive had co-workers come from ICU to my floor and said " i could not handle ICU, I knew I needed more experience first". Only you know yourself and I dont think the manager interviewing you would look down on it either.

[girliegirlieRN]

Thank you everyone for your kind feedback! All the posts have great advice. I want to stick it out until the one year mark at least, but I also realize I just don't have an ICU personality. I think the type of unit in which I would really flourish is L&D or oncology. In the ICU I am missing all the warm fuzzies that I thrive on. My heart really isn't in it. I thought I would like the adrenaline rush, but I really don't think I do! Not in the ICU at least. ICU has always been a means to an end for me...I KNEW it would be a good learning experience for me, but everyone who knows me says "I just don't get ICU from you." I really love reading all your responses. It helps me so much to weigh the decision in my mind.

[Ruby Vee, BSN]

It is always a good idea to stick with your first job for a MINIMUM of a year; two years would be better. Some folks are cut out for ICU and others aren't, but it's going to be very difficult to figure out whether you are or not until you've been there for at least a year. The first year of nursing is difficult, and there's a huge learning curve. Until you're competent as a nurse (usually around 2 years), it's really hard to say what you're good at and what you enjoy.

[beckster_01, BSN, RN]

For what it's worth, I truly don't think a 12 week orientation to the ICU is sufficient for a new grad. Where I work it is 6 months for a new grad, 12 weeks for an experienced floor nurse, and 4-6 weeks for an experienced ICU nurse. My guess is that your new grad colleagues are putting on a good front, but they are probably either just as overwhelmed as you are, or are too green to "know what they don't know." Seriously, 12 weeks is long enough to be comfortable with tasks, it is not long enough to be aware of the "big picture." Having a big picture mentality will help you recognize warning signs before patients go downhill fast so that you can be prepared, and it simply comes with experience. This is simply crucial in an ICU setting.

With that being said, what can you do now? I would spend some time thinking about what your strengths and weaknesses are, and figuring out how to maximize your strengths and coming up with plans to work on your weak areas. After each shift honestly evaluate what you did right and what you would have changed, but don't dwell on it any longer than it takes to drive home. I would work with your manager to see if you can get some additional experience with rapidly declining patients. Can you spend time in the Trauma Bay if your hospital has one? What about following the code team or rapid response team? Review ACLS frequently until you have used it enough to be proficient. Remember that when coworkers rush in to yor room, they are there to help, not to intrude. That is a constant struggle to remember- most nurses are control freaks, and see "help" as a sign that they aren't doing their job (which is a total lie). As the primary nurse of your patient is coding you should NOT be the one doing compressions, you should be busy reviewing the possible reversible causes for cardiac arrest, and making sure that everything that needs done is happening ( the doctor runs the code but the primary nurse should be helping to coordinate it). Get yourself organized before you see your first patient in the AM, establish goals for your shift, keep a mental or physical list of work that can be delegated if someone offers. If you hit a slow spot remember to offer help to someone who seems busy (karma). Last but not least if you ever EVER have a judgment question then ask. So many things in critical care are based on judgement, and two heads are always better than one.

None of us here can really tell you if you belong on the floor or the ICU. My one warning about going to the floor: it is much more chaotic, and chances are time management will be MORE of an issue there. I worry that going to the floor and finding that you still chase your tail will blow your confidence. The benefit is that the stakes are lower. You really just have to know yourself and know your limits to make that decision. If I had to put it in a nutshell I would say that if you think that your knowledge of pathophys and clinical assessment skills are not adequate to care for ICU patients, then you should consider moving if only for a short period of time. But if the problem is simply that you are overwhelmed, and that is why you freeze up, then follow some of the advice here to fix the problem. It is a struggle for all new grads no matter where you go, so there is no point in running from your problems instead of facing them.

[beckster_01, BSN, RN]

One last piece of input: if you decide to stay and a year from now you feel comfortable and confident and have a good relationship with your boss, you really should talk with them about extending orientation for future new grads. You can be a walking testimony and it is not hard to demonstrate that better orientations --> better staff retention. Use similar teaching hospital's orientation programs as models.

[Catridge]

Heck yes you should stick it out. I was 53 when I entered nursing and started out on a busy med surg tele floor. My preceptor was one of those who says "I'm not one to stand over your shoulder", which translates to: "I'll be off talking to my buds, hope you learn something". When I got off orientation I felt like a moron with a capital "M" and that first year was the longest year of my life. But by hard work, some great co-workers and God's grace I made it. I worked there for two years and now in MICU for the last three years, all at a large busy teaching hospital. First make up your mind that quitting is not an option. Leaving quitting on the table gives you an out and leaves you tentative. If you let this job beat you, you will regret it. Quitting is a disease that becomes easier and easier, and I am speaking from experience. Decide now that the only way you are leaving this unit is in a postmortem bag. I'm sorry if I'm sounding like a football coach during a halftime talk but I have quit when the going got tough in several situations and again I promise you will regret it. I have frozen during emergencies also and if someone tells you that never happened to them they are a liar. As far as time management goes, find a good report sheet you can work with, write things down and keep referring back to your sheet. Prioritize task just like you would ACLS Ask yourself "What is the most important thing I need to do for my patient RIGHT NOW?", and that will point you in the right direction. Hang in there, work hard, be humble but let people know you are not going anywhere and if in two years you want to do something else, then it will be on your terms. You are a LIONESS and you will be a caring competent ICU nurse !!! May the LORD be with you.