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.

[Chickenlady]

ICU isn't easy and it isn't something you can learn in 6 months.  The only way you get comfortable in codes and emergent procedures is to have repeated experience doing them and that takes time.  So, it isn't reasonable to have such high expectations of yourself at this point. 

If the job is making you that miserable and you don't see any value sticking it out, then move on.  But realize that this time isn't going to count for much on your future resume other than to demonstrate that critical care isn't your jam.  It you can stick it out to a year, then you can say that you did it, have that experience be of value to future employers and move on to a different specialty.  

Clinic work isn't very demanding skill-wise, and as a new nurse it may be more advantageous to move to another area in the hospital and then go to clinic once you start your NP Program.  

[SmilingBluEyes]

I did not start out in ICU/CVICU but in OB/GYN/newborn nursing. It took 2 solid years to become confident in my chosen specialty (as a new grad). You are being way too hard on yourself. It takes time and experience to be confident like you have noticed your corworkers seem to be.  Experience is a good teacher in nursing. Keep trying for a while longer because I can assure you, wherever you go,  you will go through the angst any new nurse does.

My specialty is now dialysis and it took me a solid year to feel confident and competent even now. I had been a nurse quite a few years when I made the switch. But I had a bit of age, experience and wisdom on my side and was patient with myself. Now I am considered a "foremost expert"  (not bragging, honestly)--- in my specialty. But that did not happen without diligence and persistence. I happen to love it now; hated it at the start. It just took time.

Do you really still want to be a CRNA? If so, staying in the intensive care field will be needed. It's OK to change your dream and go for another advanced practice of nursing.  (or not to do so at all). You have to look at where you TRULY want to be in 5 years or so and decide.

No place is worth getting sick every day over, though. If this goes on after a year or so, it may not be for you and neither will nurse anesthesia.  That's OK. Nursing is a broad field; you can do so many things and find your niche.

Meantime, try exercise, breathing exercises and relaxtion techniques. The internet is full of ideas, e.g. Youtube. Spotify has tons of meditation and relaxation podcasts you can listen to as you go to sleep. They help me. Eat a good diet and try to get plenty of sleep and hydration. When you are off, don't think about work. It will be there when you return. Leave work at work and find  hobbies/things you enjoy doing at home.

Best wishes to you, really.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

FNPs manage patients with all types of conditions of all ages, “cradle to grave” is the saying. Many of my patients are very complex, polypharmacy is the norm, it’s fast paced. Besides DM2/HTN/ Asthma/COPD, peds, women’s health, GI,neuro,  musculoskeletal etc. Consider shadowing a few FNPS before deciding this is what you want. Know the markets are saturated, the new FNP moved from Dallas. Salaries are dropping due to too many new FNPs . Everybody wants to be NP. Some would say you are fortunate to be in CV ICU, but those too are complex patients, do ask about transfer to a medical or surgical ICU, it may allow you to master skills/time management.  You mentioned “sharks” (? Coworkers), we all at one time were brand new green grads. I was 19 y.o. LPN, 21 y.o. RN. 

[TiPPs]

I started as a floor nurse in a busy hospital on a medical/surgical unit. It was extremely difficult for new nurses and it seems as though not much has changed. There were no other options for RNs when I graduated in the 1990s, so it was floor nurse in a hospital or charge nurse in a long term care facility. The latter did not interest me at all, but the former I did love for a while. Do not get me wrong, it was scary and challenging at first, but I loved doing procedures and taking care of that patient type. However, after a while, it wears on you. These are really sick patients, so it is inevitable that there will be many lost lives. I knew, long-term, I would not last, so I pursued a masters so I would be able to care for healthier patients and hopefully keep them out of the hospital. For me:  Best decision ever! Still stressful, but nothing like my experiences on the floor. As an NP, I do more Health and Wellness and it is more rewarding for me and it sounds like this would be more on par with your aspirations. It took me more than 4 years to have some insight into my future prospects. Good for you for considering your options for the future and your willingness to make hard choices in the pursuit of happiness. This is not a failure, but a success. Good Luck!

https://www.thepatientpractitioner.com/

[peach2218, CNA]

I can feel your anxiety through the screen and my heart really goes out to you. I'm an introvert too, and I really struggle sometimes. I'm not even a nurse yet, I'm in nursing school and I've been a CNA for 4 years. I used to have panic attacks, cry, and dread going to work every waking second. I still don't love going to work, but it's much better now. 

In the LTC facility I was at, it was because the job was just soul sucking and awful. At my new hospital job (7 months in), it's because everything is much more intense and I feel like I don't know what I'm doing, just like you. What I've learned is that I can't be afraid to ask for help. Sometimes I'll phrase it like "I know this sounds like a stupid question but I want to make sure I get it right, _______?" That being said, all of the staff on my floor is wonderful and helpful. 

Have you seen a doctor about your anxiety? Sometimes meds and/or therapy help just enough to take the edge off and get you through the day. It's not healthy to stress about work every day of your life. Don't forget that the nurses on your floor who seem like they know it all were in your position once. Ask a supervisor or a more experienced nurse for feedback. Bounce ideas off of them. 

 

[9kidsmomRN]

On 1/11/2021 at 12:38 AM, kale_ said:

constantly worriED that they all know more than I do.

They do... try to learn from them. First realize that you don’t know everything that you will encounter even after orientation and second that you can learn from those “sharks”. Step out of your comfort zone and ask questions. Watch your coworkers and decide which ones you want to be like an make a huge effort to, if not make friends, at least be able to work closely with the nurses that you respect.

Many nurses don’t feel comfortable in the ICU for as long as a year or more. Jot down 2-3 things that you don’t understand each shift. Study up on it at home. There are tons of helpful Youtube videos about hemodynamics, vents, vasoactive drugs, and interventional devices ( I would think trauma, etc also— not what I look for as resources for orientees as it’s not my specialty) I know coming out of school you may not want to study, but this will help you become knowledgeable and comfortable.

Personally I think that with anything new you have to give it time (and effort). Especially if things usually come easy for you and now are confronted with something difficult. Losing patients isn’t easy but also consider that you were there for them at a hard time and did your best for them. I also think that working/ coming out of school during covid is likely very difficult in and of itself. My sympathies to them! 

Considering NP? I really would echo to shadow first. Realize the great assessment skills that you learn taking care of very sick patients will only benefit you if you choose to pursue higher education.