lizdimi54873

Would love some advice! I have been in a level 2 ICU since early this year. I transferred from a specialized ICU in a different state where I worked 1 year. Before that I had 2.5 years of med surg experience. The ICU I'm in now is mixed. We get cardiac surgery, open hearts, trauma, GI, dka, pulm, neuro/stroke, pretty much everything. It's been challenging because I'm per diem and also because a lot of what I'm seeing is new to me, especially in the ICU setting. My old ICU was trauma/surg/tranplant; any cardiac or neuro we sent to other icus. Basically, I'm wondering if it's normal for me to be struggling or if possibly I need to rethink my speciality. Things I love about the job are that we have a lot of experienced nurses around who are a wealth of knowledge. Also, the per diem flexibility has been exactly what I need. However, I feel like being there once a week makes it difficult to have rapport with members of the health care team especially providers. I also don't know all the nurses super well, though I do ask questions, I feel like someone's impression of my can be made very quickly and possibly not give the whole picture of my ability. For example, I was having a really bad day, I wasn't feeling well, and it was a busy shift, but I was doing my job and I felt competent but tired. The nurse I handed off to wasn't super friendly and caught that I hadn't used the electrolyte protocol to replete afternoon labs, which for me was a super dumb mistake and also I partially blame their emr because the way it's formatted makes it so easy to miss certain orders. it wasn't critical but I felt bad missing it. I had extubated 2 patients so it was a little hectic. Then, I didn't ask the team about CIWA, but they also didn't address it or put orders in so I didn't address it, maybe I should have. my patient didn't show any signs of withdrawal. Lastly, this is very dumb, but I've had lots of heparin drips and never had to bolus. So stupidly, I looked at the tb syringe and was like how the heck do I push this as an IV. I was so tired I asked the RN coming on and she showed me the syringe to use. I felt sooooo dumb when I left that day, but also know my patients were safe. I've also had great days where ii've caught early cardiac surg complications and done everything to address them. I'm also remediating at home with knowledge I feel like I'm missing. I'm doing lecturly and ccrn classes to increase my knowledge. Also, the areas I'm most nervous about are codes and rsi's. It sounds crazy but I've never been in an actual cardiac code. It has just never happened to one of my patients. I've had airway issues mostly but never cardiac arrest, never seen the ACLS algorithm in real life. I had one RSI but someone else drew the meds and didn't show me. I really want to get hands on and use the meds because that is what I'm most nervous about doing in a quick situation. How do I know if this is not the right fit for me? is it okay to be a slower learner as long as I'm safe? Thanks!

Yes! There is some surgery here too, a mixed bag !

Hello, I recently started an ICU job at a new hospital. I was working in a SICU for 1 year and the new job I took is a very mixed ICU. I was a floor nurse before so I'm going into this job with only 1 year of ICU experience. I felt pretty confident at my last job. I think because I was a floor nurse there before I went to the ICU so I was already comfortable with the hospital and policies and environment. This new job has me feeling very unsure of myself and my skills/critical thinking. I want to take some kind of ICU RN course that could help me fill in some of the areas I feel like I'm struggling in. I've been watching some YouTube videos and reading, but I'd love to know if anyone has any suggestions for a course? Thank you !

Hi, just wanted some feedback and maybe examples of how other units work. Been new in the ICU for about 8 months, floor nurse before this. I've become comfortable taking care of patients here, of course I still have questions and double check myself, but I am feeling better in this environment. We take the cvvh education pretty early on in our training and after I took it I had 2 patients on cvvh. Since then, I haven't had any and see that they always go to the same nurses, over and over. I understand they want competent nurses taking care of sick patients, however, if the unit is going to be stronger, the rest of us need to become competent as well. That won't happen without taking these patients. Our policy is to take the class and then take the patients with resource as back up. I've been studying on my own and also just met with my manager to tell her how I feel and that I really want to learn. She agreed with me and said she can help it work out. to add to it I'm pregnant and can't take certain patient types due to meds etc. however lately we have had patients I'm able to take with cvvh and I'm still not getting them. (Also, feeling fully capable and healthy to still work and take patients) I told my manager I feel like this is my window to learn and it's not happening. I don't get many of the super sick patients, even with a drip or two. Lately the most of done is levo. I'm just feeling frustrated that us newer nurses are losing out on training and learning because the senior ones always want the 1:1 and sick ones. do any units have this problem? Am I crazy to want to learn in my first year? Or unrealistic ? thanks !

Hello Im a new ICU RN and about a month off orientation. I just found out I’m pregnant, super excited, but not sure how to navigate through work. I spoke to My manager and educator so that they would know in case I can’t take certain patients or give certain meds. They both told me I could give these certain meds as long as I’m in full PPE. Then I spoke with some seasoned nurses on the floor and they told me not to give the meds and to avoid that type of patient all together. Also to avoid Covid. So I’ve been doing this, coming in early to tell resource or asking someone to help, but I also feel bad putting this on other people. I’m just not sure how to navigate it all. I want to keep myself and baby safe but at the same time not overreact and be a team player. Any advice ? I also couldn’t find much online about what is or isn’t safe to administer or be around during pregnancy.

Hello, I’ve posted a few times and gotten such great support! This time I’m just looking for some advice about work, positivity, and anything that would help! I just got off orientation and had 3 shifts this week, in the ICU. My first two days went well. My third, things got shaky. I had two floor patients, basically, no drips or vents. They were pretty manageable and comparable to patients I had med surg. Everything went well, until I had a bed side procedure for one patient. I haven’t really experienced many procedures yet that I’ve had to be present and a part of. So the team was in there, felt like 50 people, they got everything ready and then the attending came in. I had my ketamine that was a one time order, small dose, on hand in a Syringe that had a larger dose then was needed. The attending came in and asked how much was ordered, I told him and he questioned it to his residents. He did ask if I had more than I needed and I said yes. Then he went and ordered dilauded and I got that in hand to. Then they went to start the procedure, I wasted my ketamine so I only had what I needed and we started. When he told me to push it, I did, and then they did a few more things. The patient started to get uncomfortable so he asked me to push more. I didn’t have any and then realized my mistake. I ran to get more tubed up from pharmacy. It was a whole fiasco, I started to get super nervous and flustered. Then I finally got it, pushed a little more, verbal order. Then he wanted the dilaudid, so I pushed a verbal dose, was shaking at this point, I still had some left but it wasted onto the floor when I was shakily trying to administer meds. He wanted another so I had to run to the pixus, have a nurse help me override to get more. Then my resource who was also my preceptor saw me in my slight panic and came and helped. She was amazing so calm and collected, got everything in order. But she was very upset that they had started this without adequate pain meds + knowing I was new/teaching hospital, it should have been more clear. She talked with the attending after and gave him a “talking to”. After all my nursing coworkers reassured me it was okay and not to beat myself up. Also, I’m aware of the fact that I needed to have the meds on standby and not to waste in the future until it’s complete. I haven’t really been in that situation before so I just didn’t understand how it worked. long story short I’m just having a hard time not overthinking it. I also want the doctors to be able to trust me and feel like I’m a competent nurse. I just feel like I blew it my first week. I really didn’t think I’d lose my cool this early and on something that shouldn’t be too stressful.. Thanks for any advice !

@ThePrincessBride I have thought about the masters first and then DNP after. I looked into some programs and I do like that some of them are online or hybrid. But then I got into this program that is competitive and supposed to be very good so I have been wrestling with the decision. Also the idea of getting it all done in 1 shot sounds great. But I think I should reconsider how the masters program will allow me to finish and practice sooner as well as be a little more manageable for me. I do appreciate your input about family planning, I definitely am going to consider how difficult the programs will be and what type of flexibility I want. I appreciate all your help!

@AlwaysTiredNP Thanks for your input! I really appreciate you bringing up the saturated NP market bit because I hear so much about it but then when I research more it says the profession is due to grow by like 20% so it never made sense to me. And I definitely agree with not listening to the negativity! I will definitely take that into consideration. Thank you so much for your help!

@ThePrincessBride I appreciate your response! First, I should clarify, I thought I did in my prior post, that money is not my ultimate goal. However, it is a huge part of weighing out whether I want to purse a higher level degree or not. Not to mention the cost of tuition, I need to justify that with the payback rate of my new career if I decide to pursue. The main reason I bring up money is because so many long term RNs have told me they make more than nps and that is their reason to not go back to school. It's hard to find out if that is really true but like you said, comparing a 20 + year career with a new grad NP doesn't make a whole lot of sense. I want to bee educated, whether I stay as an RN or whether I'm an NP. My biggest problem with my "teaching hospital" that I work at is that they don't care about RN's getting higher education. There is no incentive to stay in the role of RN and go get more education such as bachelor's or master's. It's a shame because I think we should all want to learn more and ALSO be paid according to the amount of work we put into continuing education. Me starting a family is a personal choice. I've thought about it alot, believe me I'm not rushing into this. I'm 28 looking at a 4 year program. We have some fertility issues, so I want to be younger and healthy starting out my family. I don't believe this should impact other's opinions about my career choice, I just wanted some input about people who have had to balance work and kids and school. I appreciate what you said about having a difficult pregnancy though, that is definitely something to consider. I will definitely take into consideration what you said about the school I pick as well! I agree that the education is important and I do want to take pride in where and how I was educated. Thanks so much for taking the time to respond!

I can tell you after being in this new position for 9 months now I'm feeling much better ! I feel alot more confident about my skills and knowledge and ability to care for all types of patients. I think being a float requires a specific set up skills especially being able to think on your feet and being okay with being "an outsider" but also being confident. People have gotten to know me a little bit so that has helped, the ones who know me and know how I work have come to treat me as a peer rather than a "newbie" which helps alot. But I still go to units where they are very careful around me and watching me more or hesitant to trust me. I used to take more of an offense to it but now I understand it more of them being protective of their patients and unit. Which is endearing in a way. I truthfully have never had a day at this hospital as bad as the days I had at rehab. Nothing compares to the chaos and totally lack of safety at a rehab. I would definitely suggest getting to know people more and asking questions! I was very quiet and reserved my first few months but the more I reach out the better I feel. Also, be that person who offers help to others. Even with just turning a patient. It helps establish a report with others and they will come to trust you. Just don't be hard on yourself! I was so anxious the first few months, couldn't even sleep well, and it wasn't worth it. We are all on a learning curve and it is impossible to know everything from the beginning. Trust that the work you put in to learn will be worth it. Hope that helps !

I know there are other threads regarding this topic, I've looked through some of them but didn't find any life changing answers. I'm just looking for some advice because I don't have many people in my circle who understand the healthcare field or who can really give me any educated advice. First off, I was accepted into a BSN-DNP program 20 mins away from where I currently live. I'm so happy to have been accepted, but now I have some real life questions holding me back from moving forward. I Need to give my answer in 2 days. First off, it is mostly on campus. I think there may be one or 2 classes online but as far as I know, 100% campus. I have to move about an hour or more away due to my husbands new job, which will be next year. in this program I probably won't be able to work after the first year or 2 so commuting only to school isn't a huge deal but still will be rough. Also, I talk to coworkers here and there and it seems there is a big group of people that feel you can make more as an RN and there isn't a huge need to push into a higher level career. it isn't all about money for me, but I do want a career that is sustainable for my lifetime and in my mind as an NP, financially as well as career wise it seems that once you achieve the terminal degree you are set in terms of a solid career. I know some people who went back to school later in life and now are NP but don't even make what they are making as an RN so it's almost backwards. The other thing is starting a family. I don't want to wait 4 years so I will end up with a child during the program. I have read some really uplifting stories of people making it work with children and school, and though no-one can tell me what I can handle, I just wanted to know if others have had this dilemma of when to start school vs when to start a family or doing both. And finally, part of why I'm so torn is that this is a really good program and I work for the hospital that is attached to the school so I have very good reasons to pick this program. I'm afraid if I turn it down and then choose say an online school or something more convenient, I may be doing a disservice to my education. Are there really "good" and "bad" schools? Do they care when you finish NP school (I should specify, I'm going into an acute care NP Program), which one you went to? Some of us need cheaper options and I can't imagine every NP is going to the top schools or can afford to. I appreciate any and all advice. Also, added info about me, I'm in the acute care float pool at a level 1 trauma hospital, starting a job in the trauma ICU this month to add to my experience. Thanks !

I can’t tell you how much I appreciate all your posts and feedback!! It’s so heartening to hear that I’m not alone and that there’s is some credit to my feelings. I think part of my dilemma has been going from a job where I had coworkers that I worked with daily and who knew me and my work ethic to a job where I have to prove that daily in order to get some credit as a nurse on my own. I actually think t will be good for me in the long run! your advice about taking tasks one at a time and being confident but having a healthy bit of anxiety is really good! I’m so grateful for this feedback!! I’m going to go into this shift tonight being a little kinder to myself and taking time to think instead of lettting my anxious thoughts take over

Hi, I just wanted to ask some questions and relieve my anxiety a bit around my new job. I’ve been a nurse for a year in rehab. Turned into a horrible job by the end, but I got my experience and got into a hospital. Acute care float. I love it so far, but sometimes I feel so lost. I was so used to my old job and being on top of everything. I’m very detail oriented and I write everything down, and usually it saves me. But I’m not sure if it’s the new job or having to float and taking new patients everyday, but I feel like at the end of the shift I haven’t “run a tight ship” if that makes sense. last night I was in peds for the first time and let my anxiety overwhelm me. I didn’t look into certain things that had been left over from the shift before, I never got a response back from a provider I needed. It’s a much bigger hospital than I’m used to and when I don’t hear back, it’s hard to know what to do next besides continue to page. The oncoming nurse held me a accountable for these things and I felt utterly incompetent. I’ve only been off a very short orientation for a few weeks, and sometimes I feel like I miss things I shouldn’t and don’t tie up lose ends I should. My patients are safe and I know that’s most important, but how can I do better and shake this feeling? I want to be confident and have everything in order! I don’t want to feel like a bad nurse Any advice would be welcome!