New Nurse Needing Advice: Should it be this bad?

[kale_]

Hi there! I hope you all are well and thanks in advance for any advice - I could really use it.

I am a new nurse working in the cvicu at a very large hospital. I hate it. I took this position because I thought I wanted to become a CRNA, but now that I see what that actually entails, I don’t think I am cut out for it. I graduated in May 2020 and started in July, so I have only been working for about 6 mos, but I really think I hate it. I feel that I can keep my head above the water for most of my shifts. I feel that I am truly doing my best. I think I am a good nurse. My preceptors have told me that I am a good nurse. But I also haven’t handled super critical patients yet. And the anxiety that this position causes me is crippling. I cry before every shift, and on my off days. I love to hike, I love to cook, I love to read, I love to be with my friends and family but lately I do not enjoy anything bc of the thought of going to work. I am not sleeping well. I sometimes break out in hives all over my body before my shift or even during my shift. 

I should have known I wouldn’t fit in well in the ICU. I am very detail oriented and I am very driven, which is why I thought I would enjoy this job. However, I am a fairly shy person and I have realized that I don’t work super well under pressure. It’s like my brain freezes. My personality type does not mesh well with all of the sharks on my unit. I get along with everyone just fine, but I have no true friends on the unit because I’m not as outgoing/confident and I am constantly worried that they all know more than I do. I know that all new nurses feel uncomfortable at first and all of the advice I’ve seen is to stick it out. But I don’t know, I feel that I don’t get any joy from this position. I don’t like going to codes because I don’t know what I’m doing. I don’t enjoy the emergent bedside procedures because I don’t feel like I can keep up.  Part of this may come from the fact that my orientation was only 3 months, when they promised us 4 months with lots of feedback. I received no feedback other than “I am doing well.” But I don’t feel that I am doing well.  I hate that my patients are so unstable, because I feel like when things do go south, I won’t know what to do. I also hate knowing that I put in all of this work, and then I show up next week to see my patient has died. I really love interacting with the patients who are getting better, I like getting task-y stuff done and I love learning the pathophysiology/medications but that’s about it.

I have been considering going back to school to become an FNP in the primary care setting, so I’m tempted to apply for a position in a family or pediatric office/clinic. I think this will be more my speed. I think I will like the variety, I think I will like the interaction with patients, and I know I will like the hours. But I’m worried that if I quit now, I will think of myself as a failure, and I’m worried that I’ll always just quit when things get especially hard. 

I know being a new nurse is a very hard transition for most. But should it feel this bad? 

I guess my question is - is this new grad anxiety or is this more? Should I stick it out or should I move on? But then my question is, why should I stick it out?? I know that everything will work out eventually, but any advice from another nurse would be so greatly appreciated. I just feel very alone.

[Nunya, BSN]

Speaking from experience with this very thing, if you're crying all the time, not enjoying what you used to enjoy and breaking out in hives (thanks goodness THAT one didn't happen to me) then you need to quit.  You could have a situational depression and anti-depressants might help but you'll need to get an appointment and then wait at least 2 weeks for them to kick in.  However, if you want to become a FNP I don't think a doctor's office is the way to go because you won't really learn that much to give you a good background.  You'll learn some, but you won't really be able to sit in on appointments with the providers because you'll be doing other stuff.  They may be able to explain things here and there but unless you get a provider who LOVES to teach and doesn't really care what time they finish at work you just won't have time.  And whatever you do, don't quit before you have another job.  I think your best bet would be to transfer in hospital (if possible) to a general med-surg floor.  Good luck!

[JKL33]

@kale_

Sorry to hear you are struggling.

You are in a huge time of growth and transition with regard to learning new things, learning to apply what you have already learned and having it all come together to advance towards competency and feeling a bit more comfortable. Your environment does have a lot  of pressure and in general it often just doesn't feel good to be on this part of a learning curve.

That said, based on the bit of feedback from others that you have shared, I would be surprised if you are performing as poorly as what you think you are. I would guess your internal feelings are coloring your perception of your own performance to some extent. I think you should first discuss all of this with your PCP; it sounds like difficulty coping. You could also speak with a trusted close friend or loved one...and then also possibly a therapist.

6 hours ago, kale_ said:

I have been considering going back to school to become an FNP in the primary care setting, so I’m tempted to apply for a position in a family or pediatric office/clinic. I think this will be more my speed. I think I will like the variety, I think I will like the interaction with patients, and I know I will like the hours. But I’m worried that if I quit now, I will think of myself as a failure, and I’m worried that I’ll always just quit when things get especially hard. 

I would strongly advise against any drastic moves. You are holding your own in CVICU even if it doesn't feel good right now. Give yourself a chance to get the coping part better in hand; it would be preferable to be in a stronger position (mental health-wise) before deciding your next move.

You yourself have verbalized part of my concern: If you make big moves and there is some underlying issue that has been unaddressed, you stand the risk of not feeling any better about yourself. It's possible to go through life making a series of decisions that each end up reinforcing inappropriate feelings of inadequacy; it can become a cycle.

Please think about hanging in there while you seek professional advice.

Take good care of yourself. ?

[Emergent, RN]

Have you considered transferring to a unit where the patients are more stable? It sounds like critical care isn't for you.

[TheMoonisMyLantern, ADN, LPN, RN]

4 hours ago, JKL33 said:

@kale_

Sorry to hear you are struggling.

You are in a huge time of growth and transition with regard to learning new things, learning to apply what you have already learned and having it all come together to advance towards competency and feeling a bit more comfortable. Your environment does have a lot  of pressure and in general it often just doesn't feel good to be on this part of a learning curve.

That said, based on the bit of feedback from others that you have shared, I would be surprised if you are performing as poorly as what you think you are. I would guess your internal feelings are coloring your perception of your own performance to some extent. I think you should first discuss all of this with your PCP; it sounds like difficulty coping. You could also speak with a trusted close friend or loved one...and then also possibly a therapist.

I would strongly advise against any drastic moves. You are holding your own in CVICU even if it doesn't feel good right now. Give yourself a chance to get the coping part better in hand; it would be preferable to be in a stronger position (mental health-wise) before deciding your next move.

You yourself have verbalized part of my concern: If you make big moves and there is some underlying issue that has been unaddressed, you stand the risk of not feeling any better about yourself. It's possible to go through life making a series of decisions that each end up reinforcing inappropriate feelings of inadequacy; it can become a cycle.

Please think about hanging in there while you seek professional advice.

Take good care of yourself. ?

I pretty much agree with everything JKL33 says in every thread they post in LOL. Until you are in a better place mentally, refrain from making a big decision such as employment change. There's a lot more evidence that you're hanging in there versus floundering. If they thought you sucked you likely wouldn't have made it out of orientation. Don't sweat the fact you haven't had overly acute patients yet, it's good that they are building you up to be able to take patients like that instead of just assigning you to them and hoping you fail. Many of the insecurities you're feeling about being a good nurse, fitting in, feeling competent are extremely normal for a new grad no matter where you start. That being said, having anxiety so intense that your body is erupting with hives, is not normal and it needs to be a high priority that you start addressing that. There are MANY telehealth options now for counseling/therapy that have no wait times and you can easily get a same day appointment. Don't feel you have to suffer in silence while waiting for a MD appointment.

In the event that the stress is just too much to bear,(and there is no shame in that) I would actually recommend working on a PCU or stepdown unit, the acuity is less than ICU but higher than Med/surg, they are typically busy units that nurses learn and do a lot on. That might be a good alternative to ICU if you need to go that route. 

Be well and be good to yourself.

[JBMmom, MSN, NP]

Obviously only you can really understand your feelings, but it sounds from my side of the screen like most of your anxiety stems from still being new to the environment. As others have pointed out, if you're getting positive feedback you're doing just fine (we're not a bunch to dole out false praise in the units- haha). You sound like just the type of person that will thrive in an intensive care environment, when you feel comfortable. Being detail oriented and conscientious are good traits for unit nurses. It sounds like you are dealing with some extreme anxiety, and if you can get that under control, you may be able to evaluate your job situation with more clarity. Try to find a counselor, a psychiatrist, or even start with your work's employee assistance line, to get some recommendations on where to start. You're in the middle of a very difficult time in your career at the same time the world in the middle of a difficult year- so many challenges all at once, if you have ANY thoughts that you want to work in ICU, don't give it up until you've given it a fair shot. Good luck. 

[Been there,done that, ASN, RN]

I feel going to CVICU as a new grad is a set up for failure. Any nurse needs to build their skills first. You are experiencing significant anxiety symptoms. Please consult your PCP.

You might do very well in a med- surg, or step down environment. Let your manager know you feel it's not a good fit. Request a transfer.  But do NOT let on about the level of your anxiety. 

Best wishes, let us know how it's going

 

[LovingLife123]

Let me let you in on a little secret.  Not one single new grad in the ICU feels comfortable after 6 months.  It literally takes at the very least a solid year.

Second, it is not your sole responsibility to keep that patient alive.  There are other nurses, doctors, nps.......  A whole team of people assessing that one patient.  
 

Take a step back and a few deep breaths amd stop being so hard on yourself.  My advice is to stick it out.  It does get better.

[MiladyMalarkey, ASN, BSN]

I started on a tele floor, the first year I hated it, but pretty sure I would've hated any floor.  I think it's because we are new, don't know what we are doing and for me it was a mini anxiety attack every shift I had to go in.  And that was on the tele floor for me, so I can imagine any ICU is slightly more intense for a newbie.  Then somewhere just pass year 1, something clicked.  I know I don't know everything, I'm okay with it, but I'd go into work and think, well, if I don't know, I'll ask, I can only do what I can do and stopped beating myself up for not knowing what I didn't know.

Man, the first year...or maybe more of nursing is a trial by fire.  They told us that in school, but you think it'll be fine, I adjust well to other adverse situations.  Nope, for many it really is a hot mess of learning.  It's intense, we are caring for sick people and we feel responsible for them and worry about messing up or not knowing what we don't know.  The pressure is pretty intense.  Then suddenly, for a good amount, something just clicks, you go in and you think, well, this patient load will be a challenge, but I will do what I can do and I will ask for help if I need it.

I understand your anxiety.  But if it is getting crippling, consider moving to a different unit, somewhere you will be happier and see a doc, there is no shame in asking for help.  Just know each unit has it's challenges.  I would say try to hang in there till you hit that year mark, but if you can't, you can't and that's okay.  Just remember with your ICU experience, even if it is just a year, you will be a hot commodity down the road when you would like to move elsewhere. If you can hang tough in ICU, it qualifies you to be able to do nursing almost anywhere.  

[RNperdiem, RN]

The stress and anxiety comes through loud and clear. If you are detail oriented, ICU is probably a good fit for you. If you were really doing poorly, you would be seeing the inside of the manager's office for a talk. Nobody is a fantastic nurse at first. My first preceptor told me that you have to crawl before you can walk.

Even though you describe your coworkers as confident and bold, they were once new like you. Unless they are actively undermining your progress, don't be afraid to ask them questions; many people like sharing what they know. If you pay attention, there are plenty of us milder, shyer types in ICU. Most of my coworkers are the confident and outgoing types, and they do things their way and I do things my way. While you don't need to become actual friends with your coworkers, you do need to get along with them. 

I hope you are using all the coping mechanisms you can and taking care of yourself. Say no to overtime if you can. Prioritize good nutrition, enough sleep(difficult for some), exercise, fresh air and keeping up with old friends and people who give you emotional support. I kept a journal my first year as a nurse. I would rank my first year (mainly the first six months) as a nurse as one of the most stressful times in my life. I rank it up there with my first year as a parent, my spouse's cancer treatments, my child's health crises, and other big life events in terms of stress level.

[0.9%NormalSarah, BSN, RN]

The first year can be really terrible and even if you change your environment you are likely to continue to suffer from anxiety and feelings of inadequacy. Absolutely I agree your anxiety sounds out of control and you need to address it, talk to your doctor and get on a schedule with a mental health practitioner or therapist! But also, if you are receiving good feedback, I’d try and stick it out at least a few more months. Critical care may not be for you, but it’s too early to know that for sure. Also you don’t know what you’re doing in codes because hello, you’ve been on the floor for 6 months. Those sharks on your unit have at least a few years of experience, that’s why they’re so awesome. You will be there in time! Don’t give up, you sound like a conscientious and dedicated nurse. 

[Corey Narry, MSN, RN, NP]

I've not worked in all kinds of ICU's as a bedside nurse but as an ACNP with experience in Critical Care, I've rotated in all of the specialized Adult ICU's as part of my role. To me, CVICU is the most challenging for a nurse, novice or experienced.  This is where the sickest and most unstable of all patients in the hospital are housed.  This is where the most stressed-out and understandably, strong personalities work.  This is the unit where the most difficult surgeons with a strong God complex affliction admit their patients to.  Certain people thrive in this environment but it's not for everyone.  OP, it's time to assess whether you can be one of these people and if you feel you aren't cut out for it, there's no shame in admitting that.