New nurse in ICU

[proudRN2456]

I started my orientation on the ICU as a new graduate at the end of June. I had worked as a CNA for a few months prior to starting my job as a nurse. I didn't have such background in health care but I didn't necessarily see this as something that would hold me back and I feel the same way today. My orientation was scheduled to be 12 weeks long, I thought for sure I would feel comfortable to come off orientation by that point. Don't take that the wrong way, I know you should never feel comfortable as a nurse but I knew I would have a neighbors if I had to ask questions. During my time in orientation I went through about 4 preceptors. The first one I had, we were together for about the first six weeks.

Let me back up a little and tell you the story of my orientation. I passed my boards on a Wednesday, started my classroom training that Friday. The next week I was on the floor. I was thrown in day one with my patient. I had never worked night shift before and this is the shift I was going to be working. I was willing to give it a shot! I shared my preceptor with another orient. The person over seeing my orientation told me if I didn't feel like it was working sharing a preceptor to let him know and we could change it. The first week came and went. I was eager to learn, excited and thankful for my job. I was one of the lucky ones to be chosen for the ICU! I kept chugging along. I felt I was learning. Although my fist preceptor would always nag my charting. I say nag because when I was with all of my other preceptors there were minimal complaints about my charting. Anyway, I thought I was progressing and no one had told me otherwise. I asked my preceptor her thoughts on how I was doing, she said my charting and my hand off report could use some fine tuning. I agreed my report could use work, I had a problem remembering the EXACT details, I even agreed my charting could use work. After all, my preceptor probably knew best. My confidence wasn't shot quite yet but I was worrying a little bit because my charting needed so much work in her eyes. ICU is overwhelming. I knew report would get better with time. We would stay over for almost two hours every night day to chart. Through the shift she would even help me chart and we still stayed over that long! I went on vacation for few weeks. When I got back from vacation I was being switched to day shift to finish out my orientation. The rationale for this is that I would get more experiences on day shift. I was fine with this because night shift was wearing on me. I was honestly not sure I could continue on night shift any longer. I was a zombie. My significant other and I worked opposite shifts. We hardly saw each other. Our relationship is strong but it was also wearing on me. I was going to be stuck on nights for at least a few years. Day shift is when I started to get more preceptors. It was like someone flipped a switch as far as my charting went. There were hardly any complaints about my charting. I didn't stay over one time to chart. I was thinking, so my old preceptor must have been nit picking me for some reason? I still don't know exactly. It was on day shift I noticed I wasn't quite as advanced as the other orients. We had a ton of other orients on day shift at this time. My old preceptor was not only helping me catch up on my charting, she was helping me make up for other things I wasn't doing. In the back of my mind I started thinking I wasn't meant for the ICU. A few weeks went by and I wasn't making much progress. Charting was good but my critical thinking was developing a little bit slower than others. I graduated top of my class but applying it to some situations was difficult for me. There were a few days where I didn't have anyone to precept with and I did little hands on training with my CPL(this is the person over seeing my orientation). I didn't really like him. He would never remember my name. We had met numerous times. We would be walking down the hallway and when we would pass other orients he would tell them how exceptional they were doing. He NEVER told me I was doing well. I felt like it was rude honestly to do that right in front of me and it did bug me. Maybe it shouldnt have but it did. What really set me off was when the CPL and my manager pulled me into the office and asked if I wanted to continue on the ICU. I was devastated that they were asking me this. I was trying my best and I started crying right there. I always put on a smile and worked hard and I was confused why they were asking me this. They said some people said I was doing fine but others said I was stressed. No idea where the stressed part of that story came from. If I was showing signs of stress who isn't as a new grad though?! They extended my orientation, which was going to be fourteen weeks now. At the time this happened I was about at week 9/10 of orientation. I was happy for the extension. From this point on while I was still trying to do my best, I was going to quit. I did end up quitting before I made it out of orientation. It was really upsetting to me to quit my job. I was a failure as a nurse. I have wanted to be a nurse all my life. So now I''m jobless. I dont know where to go from here. I have a interview at a clinic as a RN. Has anyone else quit their first nurse job before getting out of orientation? Do you have any advice moving forward? I feel like im seling myself short because I quit. I am not necessarily interested in working on the floor anywhere right now because i'm still upset over what happened. I feel lost. Im continuing my education online, I am working toward a BSN. I kinda felt like working at the clinic would give me good hours, but the pay there is terrible. I am a little bit afraid to set foot in another hospital. Thank you for reading I hope this makes sense. Any advice you have for me is appreciated.

[kaylee.]

Im so sorry you have gone through this. From your story, my own, and all the ones i have read, what is clear to me is that each nurse will get ENTIRELY different experiences, support, opportunities, and feedback —which is not fair.

My experience was like yours—i struggled, got a 2 week extension and put back on days...and my self esteem was so low at that point...then it must have been a miracle because i ended up with an amazing nurse for the last 2 wks. Had I randomly gotten one of the “others”, i may have been out too.

But i dont think the hospital is out of reach for you in this situation—ICU is a hard place to begin, and the fact that it was not for you can be explained in an interview.

You just have to decide if u want to give it another shot, which i think you could—But u will have to decide to get right back on the horse. Try to reframe this not as a failure in you. Just a setback that does not define YOU.

Easier said i know, but after a few wks things will start to look possible again!

[NICU Guy, BSN, RN]

12 hours ago, proudRN2456 said:

It was on day shift I noticed I wasn't quite as advanced as the other orients. We had a ton of other orients on day shift at this time. My old preceptor was not only helping me catch up on my charting, she was helping me make up for other things I wasn't doing. In the back of my mind I started thinking I wasn't meant for the ICU. A few weeks went by and I wasn't making much progress. Charting was good but my critical thinking was developing a little bit slower than others. I graduated top of my class but applying it to some situations was difficult for me.

Your biggest fault is comparing your self to others. Each orientee has their own unique experience coming out of nursing school. Some may have had a Capstone in the ICU in their last semester of nursing school which would give them a big advantage during new grad orientation. There are also awesome preceptors and poor preceptors. They may have had better preceptors than you, it doesn't mean you are a failure. They offered to extend your orientation an extra two weeks, you should have accepted and asked them to assign the best preceptor for those two weeks. After the extension, they will re-evaluate your performance to see if you are ready to be on your own, instead you decided that since you were not excelling in your orientation, that you are a failure and must quit.

["nursy", RN]

Well you've already quit, and you're not excited about going back to the hospital. The clinic gives you good hours, and you are getting your BSN. I hope your BSN program gives you you some good clinical experience. Take the clinic job, when you graduate with your BSN you will be starting fresh. You know your weak spots from working in ICU, pay attention to those, as your doing your BSN program.

I made some errors in judgement early on in my ICU career, and they were ready to boot me out of there, but decided to give me one more chance. Kept in orientation for 6 MONTHS, probably the longest orientation in the history of orientations. It was humiliating, but I ended up one heck of a good ICU nurse. Everyone starts out their experience with different approaches, skills, attitudes, and capabilities. Some take longer than others, but you'll get there.

[SweetBabyJames]

I am just starting in an ICU, and I had basically the same experience. Three months off of orientation, I was called into my manager's office and taken by storm about how other people have shared multiple concerns about me. I broke down and couldn't finish the day at work. They asked me if I wanted to go back on orientation, shadow with another nurse, etc. She asked me if ICU was right for me- and yep, that's what really got me. I thought I was doing okay, progressing, making some friends on the unit slowly... But this meeting contained no positive feedback, whatsoever.

I met with my manager and the assistant manager the next day, to recap about the previous meeting and talk about what could be done. I requested this meeting. I intended just to talk about what could be done moving forward, but spent more time trying to defend myself and wrap my head around the situation. I could have handled the whole situation a lot better. We decided the manager will shadow me and my patients and assess where I need help.

You shouldn't have discouraged yourself like that. Maybe that was your biggest mistake. Yes, your orientation seems to be unfair, with so much inconsistency (one preceptor telling you you're doing great/ no feedback, and another telling you that you suck). I was also on basically only nights for my entire 3-month orientation. Maybe 5 day shifts throughout. I definitely lack in my admission, discharge, going-to-tests, and contacting providers and families skills because of that. Okay- THAT'S A LOT OF THINGS! This is my first job, and starting in the ICU is like being thrown right into the pot. You have to sink or swim. Honestly, maybe you weren't ready, but don't continue to discourage yourself now!!! Just because you weren't ready doesn't mean you can't do GREAT on another floor in the hospital.

My advice to you is to get a job on a step-down floor or something where the patients are a bit less sick and there's a bit less pressure. You'll make better money here than the clinic. You have about 6 months of ICU experience to offer them! You'll do great. Hone your skills and build your confidence, then maybe you can reconsider ICU in a bit of time. The hospital can be a very cutthroat place, and sometimes no one is in your corner but you. Don't let that corner be COMPLETELY empty.

I'm no expert, this is an accumulation of advice I've gotten, mixed with my hopes and theories about how to grow in this profession. Just because I didn't lose my job this week doesn't mean it's I won't. I have 6 months left on my contract. A the end of the day, you probably did a lot of things right, too. You just have to have faith in yourself.