RNnur

to add also I feel your pain about the duplicate degrees...I have a MS degree too but despite it being in the medical field I think it might be a hindrance as when I apply for jobs in that area of health....they would have to pay me more because of the RN license...AND I feel it puts a target on my back as well being a new RN (I don't go telling people about it but I do keep it on my resume in hopes that an organization/management looks at it in a positive light). Point is chin up....I would be frustrated if I did not pass but in knowing what I know now.... you might be in a better position then those of us that did pass....

Actually you might not be in too bad of shape...I often regret passing the NCLEX actually...once you pass you're unable to work as an aide anymore (there are TONs of jobs for aides and not many jobs out here for recent graduates). I was a therapy aide for 4 years or so prior to nursing school....it was a good experience for me. I was able to be in the medical field, helped people with their exercises, cleaned equipment instead of peoples bottoms etc. It was hard work but fun at the same time. I think someone posted about a tech (like an ekg tech) that's also a position that seems to be in need and if you would have passed the NCLEX you could not apply. Honestly this might be a blessing for you...I passed the nclex the first time...graduated with honors... but the job market is rough right now for new nurses (grass is not greener) and once you pass that NCLEX you're then overqualified for jobs that are in real need and that still make a meaningful difference in other people's lives!

How was your orientation experience in ICU? Did you feel confident to take care of patient's having a higher acuity? How is the team of nurses you will be working with? Are they open to working with a newbie in a supportive way? What will the orientation process be like? I was in the same position however, the organization I worked for had an extremely high turnover rate (68%,although I only found this out later), they were not supportive to a new nurse. I thought I was hired at this facility because I had a solid academic background, was top of my class in nursing school...later I found out it was because "new grad's were all we had to choose from at the time". I am not saying that all ICU's are like this...I did my schools preceptorship at a different hospital that had an awesome orientation program specifically for new graduate nurses (although this facility rarely hired them as they knew it was an investment/ if this is your case than this is a GOOD sign). Personally if I could do it over I would be much more selective about where I started out for my first job (it's about protecting yourself/your license/your patient's) know the team you will be on...talk to newbies that have been successful on the floor. If I could do it again I would start med surg but this is simply because I know the icu's around my location do not have the resources to set a new grad up for success in the critical setting (it was a rural hospital they had 1 nurse with a CCRN but she had taken the cert. exam several times in order to pass), and I feel many med surg unit's are used to newer nurses. But like I said... maybe this ICU is different....maybe they are being selective and are hiring you (red flag for me would be that they are hiring other new graduate nurses)...although if you take the job protect yourself...listen to your gut if you feel you are not getting the right guidance. Be prepared to do a lot of outside learning/reading but again if you get any inclination that you can't trust the team you are working with or that you're not feeling support despite your efforts... listen to your instincts...if you on the other hand are feeling comfortable/safe in your environment and with the majority of your co-workers...you will know you made the right decision and you can be successful in your new job!

It's sad in a way though that I have to rely on the internet to find an intelligent answer....the manager and supervisor of the floor (both RN's) were upset that I did not make it a priority to get this pt an additional IV dose before leaving (they mentioned customer service and yes he was being dc'd home with a prescription for PO pain medications). This particular hospital also does not have a written policy on IV narcotics...this made it even more of a challenge for me as I did not have anything concrete to go by. I appreciate all the responses...

Yes I agree....that however, is a pretty challenging skill to master for all patients (not allowing yourself to be emotionally attached) but I agree. With the statement made in regards to "it could be worse"...I still believe that was somewhat terrible wording...

In response to this ignorant comment: akulahawk Yes. There are things that people can do that are worse. So bad, in fact, that they must be segregated from all other prisoners for their own safety. Just ask a cop, or better yet, a prison corrections officer. -Honestly I do not think I could care for this patient without detaching myself completely emotionally...I don't know. I'm wicked glad I'm not in such a predicament though...

If I understand you correctly you are saying that this person could have done "worse" and just ask a cop? Is that sarcasm or are you being serious?? If you are serious that's extremely ignorant... wow it's almost sickening to read. I myself am an avid runner...I had many friends there that were extremely devastated by witnessing such violence. Think about it. Marathoners pay money to run 26.2miles and donate their time/money to charity. The people at the Boston marathon were probably the most philanthropic individuals around....and to have your limbs ripped off of you...or lose an 8 year old cheering for his mother.... I mean come on people have a freakin heart!

Thank you all for your input...receiving feedback from nurses experienced and have no motive besides wanting to help makes me feel a lot better about things.... and the profession in general... as the feedback I received from the manager/supervisor just did not sit right with me...I kind of felt like I was in the twilight zone with how things were handled. Anyway I feel better knowing that it did make sense to prioritize a post op...although I know that everything is a learning experience

And there in lies the problem.... this attitude of egocentrism that some have...I just feel somewhat sorry as a bar of perfection is set for everyone else and yet the one with this attitude does not necessarily hold themselves to such standards. What I understand from your post is that every one of your patient's was completely satisfied with the quality of your care and has never criticized your efforts? "Caringfornurses" there's a bit of irony in that don't you think? I'm not mean enough to tell you that you should rethink your career choice though....just saying

I disagree with this statement as well. I understand that every patient we take care of is important however, we are humans. Despite working as nurses we are NOT perfect nor can we be at two places at one time. Some nurses I have seen are very chummy with management...very good at fitting in with "the in crowd" however they will watch co-workers drown in work...refuse to work as a team (which directly enhances patient care) and can get away with it because they are absolutely brilliant with communication. I am a firm believer in equality. That means treating each person be they are a coworker, a patient, your boss etc. equally...being nice and supportive EQUALLY not picking and choosing. Although obviously this is not how the world works....

The IV med was dilaudid actually and the pt wanted an additional dose....they also had PO oxycodone which was the prn dose that I was not in to give right away because I was focused on the other post op screaming and again concerned since the site was continually having more shadowing...the thing that bothers me though is the supervisor walked by the room I was in after talking to the pt c/o not having the prn dose...she never bothered to see what was going on or ask me if I needed help...she just walked by and talked to me a few shifts later that I did not handle the d/c'd patients pain well.... Thank you for the advice about thinking ahead...although I think this might take practice and times. Things were really happening fast and being a new nurse I guess I was not expecting the crap to hit the fan all at once and to ultimately get canned because it did.

Is it common practice to write a patient's PRN pain medication schedule down for them? Lets say you have a pt that has several PRN pain medications and also scheduled pain meds. The nurse from the previous shift tells you that they have been writing down this pt's PRN pain medications for him/her since this pt "constantly rings for pain medication" and "gets upset if you are even a minute late with the medication". Is that common practice I guess to treat PRN med's like scheduled pain meds (or should you wait for the pt to ring if they are starting to be in pain/offer PRN dose if they are complaining of pain?) Also lets say the day of d/c this same pt asks for an additional dose of IV pain medication. You have already given the PRN IV med but they are requesting another dose (they are not complaining of pain at this time) but they want you to talk to the Dr. to have an additional IV medication as they say this is the only thing that works and they don't want to be in pain once they get home. You tell them that you will try to touch bases with the Dr, but usually you remove the iv on the day of dc. At the same time another one of your patient's is coming back from surgery and is screaming in pain....you immediately go to assess this pt, he's screaming and swearing in pain but there is nothing ordered for pain med's ...he's screaming and youre trying to touch bases with the surgeon to get something ordered for him. Meanwhile the other patient is ****** because you are late with the the final PRN pain med for him, another nurse d/c's this pt without this pt getting the IV med they wanted, and they end up complaining to your supervisor (that's the way you find out about it...nobody bothers to peak their head in the room with the screaming pt to let you know the other pt is requesting their medication...in fact the supervisor walks by without any regard to the fact that this pt is also in severe pain)... and all this is happening while your trying to get the second pt settled whose still screaming. Youre a bit concerned because this pt's site is bleeding more and more. A few days later the supervisor fires you saying you did not adequately control the d/c'd pt's pain and purposely made them wait, accused you of calling this pt a drug seeker, (which you did not) and it should not be another nurse's responsibility to have given this pt the PRN dose and to have d/c them for you. I guess being new to this career... is this fair? What should have been done differently? One suggestion another nurse made was to just give the pt the pain med without scanning it and run back to the screaming pt's room (but I would not have been comfortable with this as what if I would have made a mistake with the med also I did not realize the pt wanted the PRN med at that time since I was never paged that they were requesting it or in pain).

As we are all new to ICU...I am curious to how everyone's orientation is setup? How is your progress being measured/evaluated? Have you worked with several different preceptors or basically just one? Are you establishing goals each week? Are you working right along side your preceptor or does he/she just let you off to figure things out? Basically what has the structure of your orientation been like and do you feel prepared to be on your own (if your near the end of your preceptorship)?

Thank you for the insight!

Thank you. This is valuable feedback!