Newbie nurse, 2nd day precepting in ICU. I cried. Will I make it?

[Guest1158260]

Ever since I started my critical care rotations at school, I knew I wanted to be an ICU nurse. I loved the detail that the nurses were able to have with their patients (and needed to have, really) and how you really needed to know about pathophysiology and... I just loved it. But even from the beginning of school,  I fell in love with nursing and medicine and graduated as valedictorian of my class spending countless hours studying. I am confident in my knowledge base especially as a new nurse......I feel in that aspect I did everything necessary to prepare myself well....but with skills. Well that’s a different story.  
 

So, I had interviewed in February and shortly after their was a hiring pause...but it resumed in August the next residency cohort so I began. I was really excited and had refused every other job that came my way in anticipation of this one.  I was hired into a trauma/neuro and now covid MICU (separate wings ofcourse). I went through this whole residency program. There were skills day and I did awful. I am so clumsy with that stuff and take so long to learn hands on skills...I also felt I didn’t get much clinical exposure at school. I was quite shy so it was probably my fault and in all honesty we didn’t have many clinical days a week and they had a hands off approach with students. In other words, I feel like I have two left hands and take so long to learn stuff like IV insertion, setting up IV meds, blood transfusion, everything basic. I am so slow and take forever.

The difference in my skill level was so evident that the instructors were shocked when I went to simulation lab. Simulation lab was more about figuring out what the patient has or is experiencing , thinking of correct treatment to implement etc. I excelled in that and solved most simulation and patient problems after they gave us report and before the simulation even started. So needless to say there was a huge gap in both things..... 

And then after the lengthy training... I had a really bad day. The first day with my preceptor was good, and then by the second day they were annoyed by having to tell me the same instructions with some hands on stuff. On top of that they had really intense patients and I felt totally useless. I thought I was sooo ready and yet I even was awkward emptying a urometer......In the morning I even overheard someone who precepted me for ONE DAY prior say that I was “slow”.

 

Im really so worried that I’m not going to make it. I really wanted to be a great nurse and I love it so much it feels like it’s a part of who I am but at this point it feels like everyone new has an edge on me in that sense.......even if they don’t have previous medical or working experience. Does anyone have tips on this or has experienced this before? Just being clumsy and awkward with hands on stuff?  

[Nunya, BSN]

Thirty-eight years ago this month I started in a Level 2 NICU. When my preceptor told me to start with VS/HR on my baby I asked how?  Because I'd never taken care of a baby in school and how do you do a radial pulse on a baby?  She looked at me and said "with your stethoscope".  LOL, oh yeah!  I tell you this to tell you I obviously started way behind you in the academic department, and working with preemie babies I was pretty slow and clumsy too!  Even after years of experience learning new equipment is sometimes challenging.  But I got better, and smarter, and you will too.  Tell your preceptor this, tell them about your lack of hands-on experience, ask them to give you extra tasks if they can.  Everyone learns at their own rate, everyone comes in with different experiences.  If you could do everything off the bat you wouldn't need an orientation.  You can do this!

[RNperdiem, RN]

I was new in ICU and disappointed at my lack of skill. My preceptor said "you gotta crawl before you can walk".

She was right.

Would you expect to be a swimming champion because you took classes in hydrodynamics, swim theory and sport physiology, spent little actual time in the water and when it was time- was thrown in the deep end of the pool and expected to excel?

Building skill, experience and confidence takes time, effort and determination. But it can be done. Nursing school has become more of a theoretical education, and most of the real education we get we learn on the job.

[WestCoastSunRN, MSN, CNS]

I am a fairly accomplished ICU nurse.  I'm still a bit fumbly, awkward, and slow sometimes, dexterity-wise.  I remember when I first started nursing, it was comical - me priming and setting up tubing, or getting ready to put in a foley, checking all my meds, mixing meds... but it got better relatively quickly just because at work (unlike school) I was constantly doing these things.

Now, I graduated school in the dark ages, and "orientation" looked a lot different then - so there wasn't someone hovering (though there should have been) to see me bumbling about - so I saved face that way.  But, really, don't sweat it, and don't worry about what others are thinking/saying right now.  I know it's not fun to think that anyone on your team might be annoyed or impatient with your learning curve, but in new grad nursing (esp. ICU) the curve is steep and it's to be expected and the more veteran nurses are going to have to get a grip (they know this).  You WILL get better and faster.  

Also, look at this time in your career as a way to learn how to do things safely and efficiently - the habits you develop now will be hard to break later.

[LibraNurse27, BSN, RN]

I felt clumsy when I first started, but repetition helps! Be honest with your preceptors about your worries and lack of hands on experience. Also demonstrate how strong your clinical judgement and critical thinking are. I think ICU is hard as a new grad because there is complicated equipment to learn on top of basic skills. Are you open to starting your training on a lower acuity floor where the stakes are not so high?

Med/Surg is really busy but I didn't feel as pressured to be speedy since there were not as many life and death situations where drawing up meds, etc was time sensitive. Being slow only caused me to stay late charting at first, not harm anyone. But if ICU is your dream, I say go for it! Take advantage of the time you have with a preceptor backing you up and picking up the slack (at first), so you can take your time and gain a foundation. One good thing about ICU is you have fewer patients so you can focus on the one or two you have and practice all the associated tasks. I only mention Med/Surg because it teaches time management. I find Stepdown easier than Med/Surg because the amount of patients was what was most stressful for me, but I am grateful for the time management skills I gained and the opportunities to practice hands on skills in lower pressure situations. But, as corny as it sounds, follow your heart! LOL good luck, wish you the best! Taking deep breaths helps to center when you're frazzled = )

[NightNerd, MSN, RN]

Probably every single person on this board spent the first bit of their career feeling slow and behind. It's not a bad thing! It just is what it is. If you have all that critical thinking behind you, trust me, you will catch up soon enough on the skills and be pretty much unstoppable.

Definitely confide in your preceptor about your worries, and set some mutually agreeable goals for how you can get more confident and experienced. They know a lot of this stuff is new and will take time and repetition to stick. I personally found see one, do one, teach one to be a helpful approach for many skills, but some of them just take a looooot of practice, such as IVs and phlebotomy (at least they did for me; now that I'm at a hospital with no IV therapy or phlebotomy teams I've gotten pretty darn good at both).

Are there any particular skills that are on your mind? In addition to just getting the practice in, we might be able to offer some tips. Youtube is also helpful if you just need to review the steps to a procedure quietly on your own; you'r hospital also probably has its own online resources that you can look at. My coworker and I used this the other day after getting a patient with a chest tube, which neither of us had worked with in years.

You got this!

[Corey Narry, MSN, RN, NP]

3 hours ago, newbienurse__ said:

Does anyone have tips on this or has experienced this before? Just being clumsy and awkward with hands on stuff?  

It's not unusual to be slow when you're new.  I once did clinical teaching in a nursing program where we had a clinical skills lab and the students would return demonstrate priming an IV line and spiking IV bags, trach care and suctioning, etc.  I can see the students' hands trembling and this is not even an actual patient.  It will improve as you become familiar with the equipment.  Could it be possible for you to gather together some of these supplies (maybe expired items) to practice with when you're not busy?

[Been there,done that, ASN, RN]

Been there, done that. I also excelled in academics, but fumbled through the hands on skills. My brain is just not wired for the mechanical applications, but I learned through repetition. I found that if I could do something three times in a row, I got it!

Hopefully you will have weekly reviews and will explain that you need extra help with hands on skills. " Someone who precepted me for ONE DAY prior say that I was “slow". Of course you are.. and that's okay. 

P.S I hope you didn't cry at work. My motto is " Never let them see you cry". 

[Guest1158260]

Wow, can't thank you all enough for responding the way you guys did. Thank you for making me feel less alone on this journey and being candid and relatable. It's actually surprising how many people seem to forget where they started, but all of you are the type of nurses I aspire to be when I have the amount of experience you all have, to remember where I started from like all of you have expressed on this post. And no I didn't cry in front of them ? thankfully!! That's a good mantra! I just swallowed the lump in my throat and carried along until I got into my car and let it ALL out.

[RoundAbout33, BSN, RN]

Also, celebrate your small wins! I'm also a new grad and was thrilled on Monday when I could stop a pt's IV, unhook said pt from it, put the pump on standby, and then re-hook him up and start back the fluids when he came back. I DID THAT! -and proud of it! I still couldn't set up a blood transfusion independently but I know how to go grab the blood from lab and do the identifier and information checks with them - that's a win! We're going to be slow, and we're going to need things repeated and re-demonstrated to us multiple times. Ask other nurses on the floor to let you know when they do x,y,z because you want more practice. If you overhear someone needing to do something you want to learn or practice more, ask if you can join/do. I would say try not to worry about what others think about you, but we do and we will, especially while we're in this newbie phase. I will say, don't let what you think others think about you change how you know you need to approach something. You know how you learn and know if someone else's way of teaching does not work for you. That is OK, you just need to have a conversation that you need something presented or taught in a different manner. I had to do that during my capstone with my preceptor and it scared the crap out of me to have that conversation with him. But it helped and allowed us to work much better together and allowed me to get so much more from that experience.

You've got this! Give yourself some grace and celebrate your wins girl! Our careers will always have new wins on the horizon!

[HiddencatBSN, BSN]

I cried on my first day in the peds er as a new grad. I’m coming up on 10 years in the peds ED now.

It is tough in the beginning especially in a high acuity setting. I agree to talk to your preceptor. How long is your orientation, how used to precepting new grads are they? Some new grads come in with great skills and are fast to learn but most are so slow especially in the beginning. Needing to work on and learn lots of technical skills in the beginning is so, so common and doesn’t mean you won’t be up to speed by the end of orientation.