New to ICU, Orientation and Assertiveness

[JuliaSN]

I'm changing nursing jobs and am going to a small hospital ICU. I'm looking for tips on having a great orientation experience, developing organizational skills and becoming more assertive as an RN>

I've been on a super busy tele unit for just under a year -- at times with 15 patients, including CABG's. (I've survived!)

I'm going to a smaller community hospital SICU, and expecting to have 2 pts each.

I feel that my preceptors in the past, instead of wanting to help me understand as much as possible about the unit, wish me to carry the patient load while they have cigarette breaks or chat with friends. When work is divied up during shifts, senior nurses choose the orders while the juniors assess and medicate admits. This leads to a continued cycle of incompetence...juniors are slow at the orders, so seniors take the desk, juniors have no opportunity to practice putting in orders, so seniors continue to take the desk because juniors are slow.

I don't want this with my new orientation coming up, and I am hoping for the best. Does anyone have any tips on how to maximize one's orientation experience?

Is there a good way one can ask lots of questions without being irritating? I still ask a lot of questions, and probably a lot I could answer, but if there's time I do like to make sure my nursing judgement is correct.

Also, I'm not very assertive with my patients who believe RN's = personal maids...juice, crackers, blankets, tuck me in, boost me up, to the chair, back to bed, to the chair, back to bed, and listen to my life story because it is very important. While I am definitely improving, I believe I need to be more assertive for time management reasons. However, I do not want to be rude, and some patients can be extremely needy. (I do have compassion, I realize patients are stressed and ill and need TLC, however, on my current floor, I need to assess and medicate a number of patients in a reasonable amount of time)

I have checked out some of the icu websites and report forms on allnurses.com, but if any experienced ICU nurses/educators or preceptors have any tips for me, that would be great.:typing:wink2:Thanks.

[sicushells, RN]

Every place is different but... where I work if you don't ask questions nurses are going to think you're either a know it all or you don't care. You can study theory all day long, but practice is often different. Regardless, nothing you can do before you start is going to prepare you for all the little things you'll need to know (where stuff is, who to ask for what, when and what to delegate). So much of that is just going to be on the job learning. You "only" have two patients, but you're 100% responsible for their care, so the more experienced nurses are going to want to get you going and being as independent out of orientation as possible (at least, I hope so). They should be helpful, as patient as possible, and informative.

As far as being assertive with patients who think you are their personal assistant/helper/waiter... you'll get there. I started out straight in the ICU and was always so far behind from doing the little things for people first, and nursing necessities second but really if some one fouls the bed you can always clean it up, if you need to titrate a drip you need to go do that first.

Good luck!

[TX RN]

A commonly used approach in our unit is to have the orientee(if experienced) split the load with the preceptor. The object is to work on the flow of the unit and expectations, not on assessment or patient management (unless requested). Cover this on day one. It's imperative that you ask your preceptor to split the load with you so that you can spend time learning how the unit functions and how things flow in your new unit.

Good luck.

[shy_des]

Thanks sicushells and tx rn. I could really use your advice. I'm now an orientee in a tertiaty hospital's SICU/MICU complex. Honestly, I've been feeling low recently because I think I have no improvement at all. The training started last week. I've been trying my best every duty time but I still have many mistakes that's why I always feel so so bad.. I really want to improve but it's as if I have no hope in the ICU.. I've been thinking about giving this up but i dunno.. Can somebody please give me some advice on how to improve my organizational skills, time management and become a better ICU nurse/ orientee? Please. Thanks for your help guys..

[jedimasterr]

Hey Shy,

I couldn't tell from your post if you are a new grad or a nurse heading to ICU with some experience from another floor. If you are the new grad, my first piece of advice would be to relax and just try to accept that you are not going to become a crack ICU nurse overnight. Just over a year and a half ago, my preceptor told me it takes a good two years to get comfortable while another nurse I respect told me it's probably closer to five. I still get frustrated at times when I am presented with a situation that seems common yet has never crossed my path until now. It happens to me all the time. Luck of the draw dictates the patients you get and my experience is that you may see tons of common drugs, procedures etc and still go for a long long time before you get to take care of that yourself. In any event, it takes a long time and patience is key.

As for learning how to manage things, something I had to start to do for myself was to literally stop throughout the day and mentally tell myself, "You won't have time to do that later". Once I learned the absolute basics of what needed to happen on my shift, I was able to start to think ahead to what needed to be done. Even with that though, I still got caught short a bazillion times by thinking I would get back to some task later. Repetitively telling myself "You don't have time" seemed to help me prioritize better.

For whatever that's worth!

[shy_des]

Thanks jed for that piece of advice. Actually, I only had trainings so far and still has no experience as a staff nurse. You're right, patience is the key. I know in time I will be able to do my tasks well. I'm being more positive now than the other day. And as with how to manage things, your advice will really help me a lot. Thanks again! :wink2:

[SWEnfermera]

You have gotten some great advice here from other posters. Another thing I have my orientees do is spend a day with the unit secretary. Transcribing numerous orders will help you to learn which department handles what, how do you locate the call list and obtain a consult, etc. One more thing I have new to ICU orientees do is to spend some time with the monitor/tele tech if your hospital has such. It really helps to see numerous EKG strips to refine your skills.