New to SICU and struggling... need advice please

[midnitej]

Hello to all who reads and posts.

First I would like to say is that SICU has been my dream job since I started nursing school however I was not fortunate enough to start in SICU. I have been a nurse for 4 yrs with 2 yrs in the ED(not a level I or II) and 2 years in PCU (level I). I finally got my dream job in the SICU and have been on my own for 4 months however, I am struggling. I heard from a coworker that some people are saying that I am struggling with completing task and not using critical thinking skills however no one has actually told me this so I find this odd. In my other nursing areas, I was the one that new grads asked for help and was one of the go to persons on my unit and got the hard assignments but now I feel like a new grad and was wondering if this is normal or should I just quit. I talked with one of my mentors who use to work in the ICU and who has worked with me in another unit and she told me that it takes time and even though I have 4 yr of experience that ICU is a different type of nursing and that I just need a good mentor to show me the ropes and help me to identify my weakness so that I can regain back my confidence as a nurse.

I know I am not a new grad but what I am experiencing and from what I have read on previous post are what new grads are/have experienced but for my situation is this normal since I do have 4 yrs of experience or do I not have what it takes to be in the ICU? I really want to be here and know that with time I will get better but not sure if my time is up since no one is really telling me what I am doing wrong and quitting is not an option for me.

Also one co-worker did say, "Well don't you have experience" when I came to ask them for help and I was confused because it was a question regarding an ICU skill that I had not performed before. I just think that somehow I have a bad rep of being a horrible RN but not getting any help as to what I am doing wrong even though I have asked and no one seems to be willing to tell me but at certain situations I get facial expressions like I should know how to do certain things or know certain medications. In addition to this, I find myself freezing up when my pt is turning for the worst. I am not totally sure why I am doing this b/c I in the past on the other units that I have worked I am the one helping other coworkers with their pts and I have received compliments from my previous charge RN's and other co-worker's but now that I am here in the ICU I just chock.

I am not sure if my confidence is low b/c I feel like I am doing everything wrong or because of what my-coworker said regarding what others are saying about me behind my back. I have not been a person who cared about what others say in the past however now I am b/c I am vulnerable b/c I am new to the unit and want my co-workers to see that I am truly trying and want to be a team player and an asset and not a liability.

I really want to stick it out b/c I enjoy the SICU which has been my dream job and I enjoy learning. I just don't know how to show my clinical skills or how to improve in other's eyes. I just don't know what to do because I have never struggled with my clinical skills before and for me I just think I have not seen real critical pts like this before after being in nursing for this long which is why I have been trying to get into ICU. I just don't want my unit to give up on me b/c I know I have the potential of becoming a great SICU RN.

One positive comment that I have received from a co-worker was that I should not give up b/c they struggled in the beginning.

Any advice is welcomed.

[Esme12, ASN, BSN, RN]

ICU nursing is a whole new ball game and it takes time. Some ED nurses never make the transition for the attention to detail...that patients hang nail 3 years ago...is not apart of what we do in the ED. In the old days ICU nurses were given 6 months of orientation...new grads about a year.

I have done both. I will admit my ICU came first then the ED. I was a fish out of water....I felt like a complete idiot. Nurses in these areas have little tolerance for fledgling new staff. They soon forget how under informed they were when they started.

Give me examples of what you aren't understanding and I will try to give you the thought process on how I think it through.

Take heart...give it time. IMHO it takes about a year to feel like you aren't drowning.

((HUGS))

[Forever_a_Student]

Don't give up! ICU is certainly a different animal, even for experienced nurses. I began in a level II ED and found that I continually asked "but why?" and "but what's next?" This led me to believe that ED was not for me so I ended up on the complete other end of the spectrum in acute rehab asking "so how did they get here?" and "well what are we up against? How far have they already come?" I was missing crucial information about patient care that I felt led to better outcomes. I consider ED as an appetizer, rehab as dessert, and ICU as the Meat and Potato. Critical care requires intensive thought and practice. There are certainly many 'obvious' results leading to 'obvious' interventions. That being said, there are also many confusing, complex, and simply mind-boggling concepts that will test the most experienced ICU nurse.

What sort of orientation did you receive when beginning: night shifts AND day shifts? Preceptor experience? Does your facility participate in the Essentials of Critical Care Orientation (ECCO) modules offered through AACN? We send our new RNs through ECCO, give them 10-12 weeks of orientation on both shifts, and encourage READING. The motivated new nurse in critical care fully immerses themselves into learning about critical care. The experienced nurse in critical care fully immerses themselves into continued inquiry and preceptorship. ALL (correct me if I'm wrong) critical care nurses read and read and read about what we do and what we need to do to become better, stronger, and more competent at providing patient care. If your problems lie in skills-obtainment, reach out to your service line's clinical educator and your team leader. Your leadership and education teams are there to help you succeed to reach your goal of providing ultimate patient care.

That being said, I maintain that even in my role of team leader, I have questions daily. I get scared. I have days where I feel beaten down and at a loss. This is why we work as a TEAM. If you see a lack of encouragement and education from your team as you transition into the critical care atmosphere, SPEAK UP! Keep it objective, make a list of your short-comings and questions, and come up with an action plan. Seek the help and you will receive the help.

Best of luck!

~S~

[midnitej]

Thank you Forever_a_Student. I now have an action plan as I have been reading disease process; management and outcomes. I have been doing this for about a week now and think that I am on the right track.

To answer your questions I was given 3 mths of orientation with a preceptor who has over 20 yrs of SICU experience. The unit does not participate in the ECCO. I oriented on days and nights however the pt's weren't as sick and the census was low. I was given modules on hemodynamic monitoring; EKG; ABG's and cardiac medications. In addition to this, I had to take the PBDS test.

Now that I am approaching 5 mths on my own I have figured out what I have been doing wrong and hoping I will bridge the learning curve and will get to stay on my unit.

[midnitej]

Thank you Esme12 for your encouragement. I am now approaching 5 mths on my own and just last week developed a plan for myself. I have been using the "PASS CCRN" book and looking up disease processes, understanding the management and outcomes and asking the "why" I am doing task to see the big picture. I think I am on the right track now it just has taking me time to reduce my stress and focus on what I was doing and seeing where I was going wrong. I am hoping that reading to build my knowledge will help me to get to where I need to be.

[Esme12, ASN, BSN, RN]

I hate those stupid tests and I don't think should be administered until a year in.

If you have a question after your day feel free to post it or PM me. I'll be glad to help.