NEW TO ICU

[Nola504]

Hi,

I have been working in ICU for 7 weeks. My first 5 weeks was spent at facility being "trained" by a preceptor on ICU nursing. I say "trained" because most of the patients were

floor status and we got them as overflow patients. 5 weeks later I was sent to my main

facility and began to work there. I was given one shift orientation during the day ( I am a night shifter) by a nurse who is a great nurse but is a self admitted "terrible teacher". She was, I didn't learn anything because she would just do things without showing me and then just say oh, I probably should have showed you that. She was very scattered, meaning there was organization and it she was difficult to follow (she later told me because she had ADHD and had not taken her medication in a few days).

When I came in the next night I had a patient who's blood pressure was bottoming out and needed an art-line placed....Ive never had a patient with an art line, I was unaware of how to put the art line on the monitoring system, exactly what equipment was needed and how to set it all up (I remember a few things from nursing school but I don't remember everything in detail ;/). The more experienced nurses helped me but they were very nasty about it and they made ugly comments to me in front of the doctor, and patient's family, I felt like a fool and so embarrassed! I just jumped in with both feet and did as instructed and wrote everything down afterwards so I would have a guide in case it happened again. I had lots of questions but one of the nurses put her hand up and said "I already helped as much as I'm going to already, so I'm done with that, I have my own patients to deal with." I always keep reference books with me so I spent most of the night reading, and texting my old preceptor for help.

It was a hectic night and the house supervisor simply wasn't available and I already felt I could not go to the other nurses for help. Eventually when the next supervisor came on to duty I told him that I wanted a preceptor. I felt I was being put with patients that I had no experience with and that I felt like I was being put in situations that could turn out to be VERY bad and I didn't feel like I had any real support. I was afraid that I would do something that would jeopardize my license and that I needed help...NOW! He said he understood and that he would work hard at getting a preceptor for me....fast forward to next week.

I got a brand new vent patient (teach placed 24 hours prior)...I just told ya'll I don't have any experience with vent patients!! At the same time we had one admit, 2 discharges, and frazzled day shift nurses. I jumped in and helped where I could. I assisted with discharge, talked to the family of the transferring patient, got paperwork ready and gave report to transport team and got report from day shift for the new vent patient. At 2230 I went in to give the new vent patient a bath, a shave got him all cleaned up after a very large BM and he desated and crashed. We got him back. I called family, The tech called the doctor and handed me the phone....the doctor had no idea that the patient had been admitted at 1430...I came in at 1830 it was 2300 when I called him...he was NOT happy! The paperwork was not done completely, the transfer chart was all over the place, and I had to scramble..and I was all over the place. I had just come out of code...my first one and I was scared, shaky and off balance so when the doctor started asking questions I was scrambling for an answer ( I felt so stupid and again embarrassed). It didn't help the monitor tech laughed at me and told me that it was obvious I was new I looked scared and was shaking. I got very angry and told her I didn't find anything about what happened to be funny..at all!

He was a vent patient but respiratory didn't place him on a vent, he was on a trach collar, pulmonary hadn't been called, the primary hadn't been called, the paperwork was only half done, they put 2 new unexperienced nurses on the unit by ourselves, the other new nurse was from India and had a language barrier so that also added to the problem and....

in the end I got written up for giving a vent patient a bath (but at this time he was not on the vent) by myself. I was told that it was policy to have 2 people in the room to turn and bathe u have a vent patient...he probably had a mucus plug and desated when I was cleaning him.

I again spoke to my supervisor about a preceptor, about taking any critical care classes they offered and to please not place me with another inexperienced nurse by myself in ICU.

I signed the write up, I spent the rest of the night on the phone talking to the house doctor about his unusable blood pressure, my suspicion that he was septic, putting in new order for antibiotics, asking the house doc for pressers in case it became necessary since in the chart I read that he had been on them in the previous facility, I finished all my lab work for my patient, I cleaned his room and made sure he was comfortable, I finished the chart, I gave report to the oncoming shift. I clocked out....I sat in my car and I balled my eyes out. I drove home and took a shower....and I balled my eyes out....I laid down and stared at the wall for a long time, passed out, woke up crying...opened up the all nurses.com tab and as I'm writing this...I'm balling my eyes out.

I feel defeated an stupid and I am wondering if I am in the wrong field. I don't know if I'll make it as an ICU nurse, maybe I won't make it as a nurse at all. I feel horrible and inept. I don't want to go back to work anymore, I can't eat and I replay all the wrong things I did in my head over and over again. How could I have not called for help to turn a new vent patient?? that's basic stuff isn't it?? if i can't do basic things...how can I think I can handle ICU? I made a mistake and it could have cost someone their life.

[SierraMoon, ADN, BSN, RN]

Your training is terrible, just completely inadequate. I would go find another job. I am serious. Everything about it sounds unsafe.

[loveSBK]

ICU is very tough and you need adequate training. It's great to have a preceptor but I'm finding out that most stuff you learn when you are on your own but with that said, you should have the ability to ask questions when in doubt. The only way to learn is by asking and getting insight from more experienced nurses but seems like they are of no help to you for whatever reason. Definitely try to see if you can get a preceptor, if not then maybe find a different job with a better training program. Don't beat yourself up, we all make mistakes, no matter how small or big, we all do especially when we're new and we are developing our critical thinking skills. Keep your head up and hopefully things will get better.

[TheCommuter, BSN, RN]

Hi, there. Thank you for making your first post.

Your thread has been moved to the Critical Care Nursing forum to elicit more responses. We wish you the best of luck.

[angelique.obrie]

Hi Nola. Thankyou for sharing your very upsetting experiences. It's very hard to begin working in ICU and you sound like you have learnt so much already! I guess it's your decision weather to continue in this position. But you also need to be very stern and refuse to care for any patients that are not within your scope of practice. Seek out a mentor that you can rely on and help guide you. In years to come you will look back on this challenging time and remember exactly what you have learnt from this experience. Don't let anyone tell you you are not worthy. Keep up all your hard work you have done so far.

[SallyRN15]

my heart goes out to you! the fact that you took action and did your best with the lack of training they offered you shows to me you will have success in this. this was such an emotional post i started crying near the end cause i too will be starting on the icu as a new grad ahh i just dont even know what to say all i can think of is to tell you what i would want to hear from my colleague and its that you did your best and the mistake that happened isnt cause of you alone so dont bear all the weight. learn, act and move on. Love you I think your a rock star !

[Trauma_drama14, BSN, MSN, RN, APRN, NP]

Awww you poor thing. Please keep us updated. Honestly it sounds like poor training on their part, they should never ever give you some type of patient you have never had before. This made me a bit nervous since I will be switchingn to SICU in the next two weeks. If they do not give you a preceptor, you really should consider a new job. Hugs to you lady, cheer up. Not all places and people are like that. I really hope everything works out for you! And you are awesome, remember that! You are an ICU nurse!!

[hawaiicarl, BSN, RN]

Aloha!

Your post is an excellent example of how NOT to orient new critical care nurses. In addition to a critical care course of some kind, which it seems you have not completed; there should be a 6 week orientation, followed by a 1 year mentorship. I am sorry your facility is lacking the minimal training necessary. I agree with the other posts, if you want to continue in critical care it may be necessary to switch hospitals.

Cheers

Carl

[calivianya, BSN, RN]

Holy crap, your facility is terrible and you should leave ASAP. Really. Start putting applications in elsewhere immediately.

Your orientation was terribly inadequate. Five weeks is NOT enough for a new ICU nurse - and only one shift in the facility you are actually working in? And on the wrong shift?! That's awful! I got twelve weeks when I came into my current ICU job, and that was with previous ICU experience. We orient new grads for six months.

You have NOTHING to feel bad about. It's not your fault your facility screwed you over. Get out of there!!

[weirdscience]

Second the MANY posters who've said your orientation was terribly inadequate. I came into ICU with 18 months floor experience, and I still got 12 weeks orientation. Not to mention the more seasoned ICU nurses are ALWAYS willing to jump in and help if you tell them you haven't done something in awhile or want a second opinion. If your experienced nurses are THAT busy with their patients, something's off. Even as a relative newbie of nearly a year, I generally have (or MAKE) time to help coworkers nearly every shift, unless I have an unstable one-to-one. Where was your charge or resource in the code situation??

If you can't negotiate a preceptor, RUN, don't walk. If you can, sounds like this situation could be a trial by fire and you'll definitely learn a lot. But don't do it if inadequate support puts patients at risk. There's a difference between super high acuity and a **** show.