I'm in my 5th week in an ICU orientation. My preceptor turned around said that she thinks that I'm not ready for the ICU. I knew she was thinking that I was too slow.I was very slow, as I wasn't comfortable with all the different lines, PA, Central, arterial etc. But I read up on them and thanks to some of the people in this forum, I was able to get a better understanding. Anyway my manager is going to assign another preceptor and she said that she will asses me and if I'm making progress then they can extend my orientation by a couple of weeks.
I thought ICU would be a great place because I have really good patho and critical thinking skills. But I know I'm weak on technical skills.I have always done very well in theory(3.8GPA) but not as well in clinicals. Because I was always hesitant and unsure of myself, I always felt clumsy! But I was hoping these will come with practice and time.
I was wondering what I should do. Should I stick it out in the ICU or go to MedSurg? I could really use some advice.
I am not trying to be mean. But I highlighted that part of your post that jumped out to me. The ICU environment is very hands on and very technical. If you never felt comfortable doing hands on care even at the student level after several years of clinical practice then the ICU might be too much of a jump for you at this time.
Work with your new preceptor and please listen to him/her as to where then think you are in relationship to where you should be in your orientation. Take the advice of the other posters and ask if you can help other nurses with the tasks that you are uncomfortable with. Wishing you the best.
I respectfully disagree with ukstudent: our friend's original post said she was hesitant and unsure of herself during clinicals in nursing school. Don't we all remember how it was to be a nursing student? Because I'm only out a year, myself, and it's REALLY fresh in my mind how hesitant and unsure of myself I was throughout nursing school clinicals, particularly treating ICU patients. I don't think she's necessarily in a questionable-fit just because she was timid in nursing school. though ukstudent's advice to get her preceptor's opinions is good.
It seems like a toxic environment if an experienced nurse "reams out" an orientee in front of others. How disrespectful! You do not deserve this no matter what. I also think it's impossible to learn when something like that is coming at you. Brains work best in open, encouraging environments.
I have been in my ICU for awhile now and I think I must still have some track marks on my back from my orientation! I worked for 4 years in Med/Surg first but I can still remember nursing school and being a new RN (scary). When I joined the ICU, I noticed people acted like I was just born and did not have a brain. They also felt it was okay to make disrespectful remarks about 'floor nurses'. I have stood up to people on this and it has at least helped them not make these remarks if I am around.
Good luck and you are most likely more than capable of succeeding in your ICU. I think we just need to figure out is whether or not it is for us long term.
Specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.
I have some things to add... since I was in your shoes... I lived through one heinous orientation... My second week I was told, "As long as I'm your preceptor...you're going to be my b*tch!!!" It went downhill from there...and the comments stayed the same... I could have actually sued her and the hospital for a clear cut hostile work environment. I finally, after a year and a half, left my unit and went to another ICU. I put up with it but cried many nights, hated going into work, wanted to quit all the time. I knew it wasn't me. In the last six months, 7 day-shift nurses have left the unit. I snagged another critical care job in our hospital on a unit where a day-shift slot only becomes available every three years...yet there's a "nursing shortage" down the hall on my old unit... administration hasn't ever questioned this... go figure... I was afraid I'd lose my job if I reported her... I found many errors on my orientation (like autotransfusions running directly without a filter...) We have an error reporting system that is anonymous... I was told if I reported anything "they" would find out who did and it would be the quickest way for me to lose my job. I was told perform MRSA swabbing "very lightly" so my preceptor wouldn't "have to wear plastic all day..." I was told "You can't multitask... but don't worry, you'll never be able to because men CAN'T multitask..." I took a scholarship from the hospital and wanted to fulfill my contract, although I could have had it null and voided because of the experience had I engaged an attorney...I probably could have retired on that. But I didn't want to take that route. I can't say I recommend sticking it out in a toxic environment. I can say you are not the only one having a terrible first nursing experience. I plugged away and dealt with it. In under two years I had my CCRN, and then my CSC and my CMC and I am now the only nurse in the hospital who is CCRN-CMC-CSC. I am going to get the last laugh because I just found out two days ago that I was accepted to anesthesia school at one of the country's top programs. "Ciaoskis" former preceptor!:chuckle "I'll be seeing you layta!"
You are not alone in your experience. My issue was this... it is hard to get anywhere being in the position of putting anyone else down. I felt that if I tried to interview for another job I would have to say "why" in an interview... and then I would have to disclose my situation... and in doing so, I thought it would just make me look bad...leaving the interviewer to worry if it were me or if it were really the hospital (maybe I'd be seen as a complainer or problem)...so I figured I'd wait and then have my experience and a clear cut transfer/exit strategy after being off orientation. Then when I got off orientation everything changed. I still had problems with her... but they were minimized because I had my own patients and developed strong alliances with other supportive nurses who served as my resource. Then I started working my schedule opposite hers so I could minimize my contact with her. That made a huge difference.
Because of the poor quality of my orientation and my strong desire to learn I did a lot of the orienation myself. Make a list of all your equipment and manufacturers of such... we use Edwards swans and arterial line sets, we use Datascope IABPs, we use NxStage CRRT, we use Atrium chest tube set-ups. Go to all the manufacturer's websites. Example: edwards.com, atriummed.org, datascope.com, nxstage.com...These companies all have inservice audiovisual training via the web... go to pacep.org, atriumuniversity.com... You will learn more from the manufacturers than any preceptor. A lot of nurses do things the way they were taught because that's how "we always did it." However, you will find a lot of manufacturer's recommendations are different. I do it the way the manufacturer recommends. Soon I had the sane nurses asking me about equipment. I was teaching them. I made a habit of everytime I opened a piece of equipment, whether an autotransfusion pack or an ETT hollister, of putting the manufacturer's pamphlet in my scrub pocket, keepin it in my bag with other resources and taking it to and from work with me. I'd read them thoroughly at home. You'll find no one on the unit has ever read them... and chances are you will learn something about the device that is unknown to other nurses on the unit. It all comes down to how good you want to be.
You are in a terrible position. That resonates with me because I was in the same position. If you want this bad enough and are not going to another unit or hospital...you will need to take responsibility to educate yourself to make up for the inadequacies of your hospital's culture. You'll end up a better nurse in the end.
Finally, in January, JCAHO is requiring that there be in place, at all accredited facilities, a disciplinary plan for toxic behavior among healthcare team members whether horizontal violence among or between nurses or anyone else up and down the medical food chain. You can find this on JCAHO's website. You may want to float this by the CEO of the hospital... maybe they don't know about it yet. They will not have a choice in compliance if they want to keep their JCAHO status. Enforcing it is another story... but at least you can make sure the hospital is ramping up to deal with it.
Best of luck to you. You have my support whatever you decide. But if you stay...just know this orientation process is going to be, in the scheme of things, a very short time during a hopefully long and successful career...I chose to get the experience I needed and then moved on. You may move on earlier... but ABSOLUTELY DO NOT let a nasty nurse or toxic unit pollute your enthusiasm for the art and craft of nursing and/or critical care itself. Know it is not the norm, and when ready, seek out another unit... despite what they tell you... it is NOT the same everywhere!!!!
novice-toexpert, what is the CSC and CMC portions of your credentials? What do they stand for? I'm a new ICU nurse, planningon going for the CCRN, but I dont' know about these other. thanks!
Specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.
The CMC and the CSC are cardiac subspecialty certifications... they stand for, respectively, cardiac medicine certification and cardiac surgery certification. They are separate examinations that have different criteria for eligibility. You can find information on AACN.org for all of this. There are presently under 500 CMCs in the United States and under 700 CSCs in the United States. I believe for those taking the subspecialty examinations in this area of expertise the pass rate is about 80%. You must be CCRN certified to take these exams and also meet the clinical practice criteria as well. Thanks for asking!
I am in a new grad orientation in an MICU and I found that talking with other nurses on the floor helped me get a bearing on what was me versus my preceptor. I was an EMT for 7 years so technical confidence is on my side but the ICU is hugely overwhelming and very demanding, especially lines, pumps and drugs. My EMT clinical experience is out the window at this point!
I went out to dinner with one of the nurses who has been there a while and she made me feel so much better about the big picture and the culture of the orientation process in my unit.
It sounds like your manager is doing the right thing.
My only 'advice" is that you have to be swift and sure when implementing a task, there is a point where you really have to just do it and know you can..IV's, foleys, tubing set up, CVP readings etc..
Lastly, practice skills on expired equipment, it helps alot to just hold it and fumble around with it without the stress of having a pt attached to it..
Good luck and dont leave five minutes befor ethe miracle.
Pupnurse, thanks for posting this and updating us. You sound like you could be me in a few months if I get that first job in an ICU. Not that I feel so unconfident now after an externship where I had a fantastic preceptor, but I can lose confidence and I'm weak technically compared to my strengths in critical thinking and pathophys. I think I'd do much better keeping track of a lot with two patients, than less with eight patients on med-surge.
good luck and keep us posted! And thanks to you, too, NovicetoExpert - inspiring story.
Because of the poor quality of my orientation and my strong desire to learn I did a lot of the orienation myself. Make a list of all your equipment and manufacturers of such... we use Edwards swans and arterial line sets, we use Datascope IABPs, we use NxStage CRRT, we use Atrium chest tube set-ups. Go to all the manufacturer's websites. Example: edwards.com, atriummed.org, datascope.com, nxstage.com...These companies all have inservice audiovisual training via the web... go to pacep.org, atriumuniversity.com... You will learn more from the manufacturers than any preceptor. A lot of nurses do things the way they were taught because that's how "we always did it." However, you will find a lot of manufacturer's recommendations are different. I do it the way the manufacturer recommends. Soon I had the sane nurses asking me about equipment. I was teaching them. I made a habit of everytime I opened a piece of equipment, whether an autotransfusion pack or an ETT hollister, of putting the manufacturer's pamphlet in my scrub pocket, keepin it in my bag with other resources and taking it to and from work with me. I'd read them thorougy at home. You'll find no one on the unit has ever read them... and chances are you will learn something about the device that is unknown to other nurses on the unit. It all comes down to how good you want to be.
This is fantastic info!! Thank you for sharing. As a soon to be new graduate nurse currently completing my senior practicum on an med/surg ICU this is something I can start doing now, so hopefully when I get hired onto an ICU I will have a good knowledge base of the equipment and supplies used.
I hope things are looking up for you now!
My question for all of you new ICU nurses is how long is your orientation program? At the hospital where I hopefully will be working upon graduation, the ICU residency program is 6 months rotating through all the various units and then an additional 4 week re-orienting to the unit in which you are hired. I can't imagine trying to work in the ICU without such a lengthy orientation.
3-4months for me. But I will advice you to speak to some of the nurses on the floor to confirm. My sister was promised 6months, but only after 6 weeks on the floor and 6 weeks in the classroom, she was asked to start taking 2-3 ICU pts . She left... everywhere is different, make your choice carefully and make sure they are willing to extend your orientation past the established time if you don't feel ready. Good luck
My question for all of you new ICU nurses is how long is your orientation program? At the hospital where I hopefully will be working upon graduation, the ICU residency program is 6 months rotating through all the various units and then an additional 4 week re-orienting to the unit in which you are hired. I can't imagine trying to work in the ICU without such a lengthy orientation.
I've been flying solo for almost 2 months - I started in an ICU as a new nurse. My orientation was 3 months, but I was given the option to continue my orientation if I felt not ready (I declined the extension)...two other nurses started with me, and they are still on orientation - nearly 6 months. I can't tell if they're milking the system, or genuinely "not ready"...it seems like a long time. However, I took lots of classes before I got hired into my unit, so there wasn't any academic work for me to do (12-Lead EKG, ACLS, etc.)...another nurse on my unit who was also hired as a new RN did the orientation in 3 months like I did.
....I must add, that I did four days on my unit extra, without pay, following other very strong nurses who I knew were good but weren't on board as preceptors. Helped me immensely, and the boss loved it. :wink2:
. She left... everywhere is different, make your choice carefully and make sure they are willing to extend your orientation past the established time if you don't feel ready. Good luck
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185 Posts
I respectfully disagree with ukstudent: our friend's original post said she was hesitant and unsure of herself during clinicals in nursing school. Don't we all remember how it was to be a nursing student? Because I'm only out a year, myself, and it's REALLY fresh in my mind how hesitant and unsure of myself I was throughout nursing school clinicals, particularly treating ICU patients. I don't think she's necessarily in a questionable-fit just because she was timid in nursing school. though ukstudent's advice to get her preceptor's opinions is good.
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