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

Specialties MICU


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!

Specializes in ICU.

If you are having issues with time management, make it a priority at the beginning of your shift to write down a plan for your day. I normally write out the hours in my shift and then write in when things are due (eg., 0800: meds, NGT flush, mouth/eye care, ABG, 0900: vancomycin, new noradrenaline). For important drugs like sedation and inotropes, I will have them ready to hang at LEAST 30min before the bag finishes (your facility may or may not allow this). On my planner I will write them in to get ready the hour before they are due - so I know if I get busy, I still have an hour to get organised.

In regards to "freezing" in an emergency - find yourself a job where you are doing something, but can still pay attention and learn what everyone else is doing - be the nurse titrating up the noradrenaline, or give the fluid bolus. If the patient is getting tubed, do the cricoid pressure or be the person ready to connect the ventilator and watch what the airway nurse is doing. I was always taught that emergencies shouldn't happen in ICU - we should be ready for it. If your patient looks like they're going to need to be tubed, plan ahead. Think about what equipment you're going to need, then think about the procedure ahead so that when it happens, you're not panicking - you already know what you're going to do.

Specializes in CCU MICU Rapid Response.

as far as time management, that is learned. To go to another unit or specialty, is going to require retraining and a whole different mindset as far as time and how you prioritize. ICU is stressful! Especially in a big unit with no "warm fuzzy" people like yourself. I get it, Ive been there.

Work on your "brain" the sheet you write all of your things on, use one piece of paper and fold in half. start a system of how to get things checked off. As you begin to understand the flow of the unit from a nursing perspective, you'll begin to piece it together.

If you are on days, maybe nights may suit you better. Ask the advice of those you trust. Identify what takes your time. Is it accuchecks? Entering vitals? Charting your head to toe? Inquire about what works for people. Ask the nurse thats been there 20 years and you'll get an answer. Also ask the one that started last year.

Chart in the room if you can, if you're logged in to give meds, chart your assessment, or your lines, or whatever. Devise a strategy, and make it work.. You will have to revamp, but it will work.

Hang in there. The first year out of school, learning to be a nurse and learning critical care superimposed into that is hard. Don't give up. It gets better.


I was wondering if you eat regularly at all. Sometime all someone needs is proper break and eat (protein carbs and caffeine). You will be amaze how easy time management becomes and how much more left over time you got yourself and always ahead. You never have to do over time again!

Specializes in MICU.

You guys are all the best! So, in response to some of your questions, I already work full-time nights. I can only imagine how much harder it would be on day shift! I do have a brain sheet, and try to write out all the hours on my shift, but I could become more organized with that. I also need to be better about looking at my brain sheet all the time instead of going off of memory. WorldDay, I do not eat frequently on my shift. I have a really high metabolism and normally have to eat all the time, so I need to get better about eating regularly. I'm sure that would help. Thank you for that tip!

I am also very meticulous about managing my patients' pain and seeking out new orders if I have exhausted all the PRN meds I have to give. I don't think a lot of the nurses on my unit are great about that. So that takes extra time for me, but I believe it is important to do that.

I've met with a nurse educator, and she's given me some more tools for organization. I've also started talking with her about doing share time with the code team, etc. Hopefully I can become more comfortable with those crashing patients! It's still a struggle at work, but I am trying to adjust my attitude at work and trying to stop letting the stress and anxiety get away with me. Thank you all for your help and support!

Specializes in ICU Surgical Trauma.

Sorry no matter how bad you want to leave... you gotta hang in there. Wait a year and then leave. The experience you get will take you a LONG way

Specializes in Family Nurse Practitioner.

How are you doing girliegirl?

Specializes in MICU.

Hey all,

Thanks for your feedback! Lev

Hi just wondering how its going? I'm in the exact same position and looking to see its worth sticking it out!

Specializes in Cardiac.

Im not in the ICU but am trying to move to a MICU from a CRAZY BUSY Cardiac stepdown where we have up to 6 patients...ideally we should have max 4 but due to short staffing we max have 6...anyway, Ive been there for 8 months and ive gotten very very very good at time managament...I am a NOTE person and find if I have a good brain sheet and jot everything down and then immiediate tasks I put on a postit and put on my cart its front and center...which is wonderful when you have 6 patients and on day shift are discharging sometimes your discharging 3/4th of your assignment and getting new patients and you need to chart and do discharges on them all...floors are CRAZY but personally id think your issue is with time managament more than nayhitng else...if your a note person dont feel ashamed putting notes on your cart or have a very detailed brain really helps. MOst days im out after report unless something crazy occurs but thats rare.

Organization...just figure out what works for you. Skills will come and dont forget its OK to accept help and ASK more experienced coworkers for advice.

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