New to ICU and having trouble adjusting

[NLRN1416]

Hi guys,

I recently started a temporary position in ICU, coming from a medicine floor RN background.

I needed a break from my old job as I’d been there for five years, really felt like I was in a rut and that I wasn’t being very challenged intellectually anymore. I’ve been in ICU for 3 months now and I soon have to decide if I’m going back to my permanent job or want to extend my position in ICU and I’m really struggling. I really wanted to like ICU and wanted a change and a challenge but so far it’s not what I expected.

I've learned a lot in the transition as I had a 3 week classroom orientation which was great other than I missed shift work! There’s undoubtedly a lot of technical skills to learn too. But now that I’m on the floor I’m really struggling to adjust.

My biggest concerns are for one, the pace. My old floor felt like a sprint from the moment you took off your coat in the morning until it was time to go home. I never stopped. The amount of downtime in ICU was very unexpected for me - I like to be busy and for me, watching a monitor And vitals q1h for one patient simply isn’t busy. of course you always have to be ready for the unexpected and I try to fill my time bugging other nurses to show me things that are new to me but the pace is definitely slower in ICU.

My second misconception was that having an ICU patient would be like having a patient on medicine that ended up going to ICU, or that patients would be truly unstable. Instead I’m finding a lot of the patients I’m seeing in ICU (other than those that come stat from the floors/OR) are actually quite stable. Once they’ve been there for 24 hours or so they may be requiring a lot of intervention (sedation, pressors, I&V) but they’re not really that unstable on a moment to moment basis. The shifts I spend with chronic ventilated patients that came from/are going to vented long term care facilities I HATE cause I so prefer being busy.

Finally I really feel like my role is so different in ICU. On the floor I felt like I made a huge difference to patient outcomes. Of course I had a lot of tasks to complete (we had a lot of total care patients) but I was constantly checking bloodwork, monitoring patients breathing patterns, activity tolerance and really their response to their treatment. I could recognize respiratory acidosis in a copd patient by looking at them from the door to their room. I once caught afib in a patient who was to be discharged because they got winded walking from the bathroom when he’d been fine in the hall an hour prior. In ICU I feel like while my assessments matter, there are so many monitoring systems and assessment schedules in place that I don’t feel like I’m offering anything special by being the one to see a change in urine output or minute ventilation or cardiac rhythm or pupil response- how can you miss it?

There are other factors to consider as the unit morale, scheduling and management in my new position are not so great where I never had a problem before, though I do get paid more in ICU. I’m really trying to base my decision on The pros and cons of the job itself though.

I guess I’m just looking for advice from other RNs who may have had the same experience but stuck it out. I don’t want to give up on this too early if these are things I’ll get over in time, but I also don’t want to waste my time if this job isn’t for me.

PS just a final disclaimer, I’m in no way ragging on ICU nurses - I’m absolutely not an expert and I have been given the “less acute” assignments as I’m new to the unit. There have been some train wreck admissions while I’ve been on and I’m in awe of the nurses who can take those and turn them around - I have been warned though that those are the exception shifts and not the rule so I should get used to the types of patients I have now.

Thanks for reading! Appreciate any responses.

[ptier_MNMurse, BSN, RN]

Some days can be slow, as you progress and take more critical patients you will have to use all of those skills! We have a lot of additional monitoring which helps us to see changes in real time more quickly, but the most important monitoring comes from you. You seem to have an appreciation for this! Don't lose it! Sometimes ICU can get slow, but there is always something to do! Get your patient bathed (like a real bed bath, not just the CHG wipes), up to the chair, teeth brushed, hair washed/combed, walked, lotioned, massaged, etc. if you have the "downtime". That is the nursing touch you can bring to the bedside that gets overlooked at times in the ICU I would say.

If you are looking for more critical stuff to do, practice starting IVs, learn about the various pressors/inotropes, study hemodynamics, study vents, get more in depth with heart rhythms, etc. Then you will be more prepared for when the fit hits the shan... at least a little.

Also, you have only been there 3 months and are brand new to the ICU so you won't get the critical patients, and if you are bored that hopefully means you get everything that has been put in front of you. Show your coworkers you have it all together by doing all of the stuff above and it will show 1.) That you care about the patients, and 2.) That you know what's up and are maybe ready for some further advancement.

If you really want to advance, take a permanent gig on a unit you like. If ICU really isn't for you and you want to use more kinesthetic clinical assessment, ED might work better for you! Though you will experience the same general monotony of most patients being less acute, and then some that are absolutely crumping.

Overall, I would say give it some more time and try to learn some more.