midnitej

Thank you Esme12 for your encouragement. I am now approaching 5 mths on my own and just last week developed a plan for myself. I have been using the "PASS CCRN" book and looking up disease processes, understanding the management and outcomes and asking the "why" I am doing task to see the big picture. I think I am on the right track now it just has taking me time to reduce my stress and focus on what I was doing and seeing where I was going wrong. I am hoping that reading to build my knowledge will help me to get to where I need to be.

Thank you Forever_a_Student. I now have an action plan as I have been reading disease process; management and outcomes. I have been doing this for about a week now and think that I am on the right track. To answer your questions I was given 3 mths of orientation with a preceptor who has over 20 yrs of SICU experience. The unit does not participate in the ECCO. I oriented on days and nights however the pt's weren't as sick and the census was low. I was given modules on hemodynamic monitoring; EKG; ABG's and cardiac medications. In addition to this, I had to take the PBDS test. Now that I am approaching 5 mths on my own I have figured out what I have been doing wrong and hoping I will bridge the learning curve and will get to stay on my unit.

Thank you Esme12 for your advice. I have in the past went in early to look at my assignment but stopped because the assignments were not always done and at the time I didn't realize that I could have been violating HIPPA so I will speak to my manager and get permission because now that I realize my mistakes and understand that having the time to read over the pt's H&P and notes from the MD's and ancillary staff would help me to focus on the whole picture until I get the hang of organizing my time to incorporate this without having to come in early. Also since I didn't fully understand the importance of looking at the whole picture to understand the management of the pt and started being "task" focused and not realizing and understanding the "why" I was doing the "task." In addition to this, I would be frustrated that I could not articulate to the CN or when giving report which I was all over the place because I was so scattered brain and would have my co-workers and CN be annoyed with me. You are absolutely correct as I was in "survival" mode and reverted back to my ED ways of being "task" focused and not taking the time to breathe and relax and think about the whole picture as to why the pt was here and what would I expect the management to be in order to fix the pt and understand why I was doing these "task." I just think that it has taken me longer than my counterparts who have gotten their groove early than I did but in my opinion they had more direction and help than I did. Please don't take that last statement like I am making excuses because I know that it's my responsibility to facilitate and take charge of my learning which is what I have done over the last week now that I finally see where I was lacking and have been reviewing disease processes and what to expect the management and complications so I am hoping to bridge the learning curve in the ICU and improve my critical thinking and knowledge and keep working on managing my time while focusing on the whole picture. Your statement about "stressing out" is absolutely correct because I was in this mode for about 3 weeks trying to figure out what I was doing wrong and frustrated about not having any feedback as well. I also could not focus because of the fear of being asked to leave the unit however after talking to friends I was able to communicate what I was doing, how I didn't have the time to see the whole picture and was behind because I was just trying to do "task" and not being able to communicate what was going on with the pt or the POC and how I would get frustrated and didn't have a plan and that's how it came about starting over like a new grad and reviewing disease processes and looking at the whole picture and taking it a step further by seeing things as a provider would as some of my friends are in NP school and explained to me how they had to make this same transition from RN to provider. I realized my previous RN experience I didn't look at the whole picture for example in the ED I just focused on the primary issue and understand that one issue and knew the "task" or management of that pt. In the PCU, I must admit that I didn't think as a provider but I think because I was able to make the transition and take care of the pt's I didn't have the same pressure like I am experiencing in the ICU. Now that I have stopped stressing and being fearful of being asked to leave. I am now focusing on my plan with looking at the whole picture like you mentioned and hopefully I will bridge the "you're way behind" that has been mentioned to me and will show great improvement on my unit.

Thank you for your advice Da_Milk_of_Amnesia. I agree with your post and I have been doing just what you have mentioned over the last week. I am in the process of finding ways to improve my knowledge to help improve my critical thinking skills with reviewing disease process and management. I Just think it has taken me a long while to try to figure this out on my own and my unit has the opinion that I am "behind the times" as it was stated. In my opinion, I just think I need more time to develop and from reading different posts it seems reasonable that 6 mths - 1 yr to get my groove and that it will take another yr to be more comfortable. I guess with being on the unit for 7 mths (3 months of orientation and 4 months on my own) I have not proved myself to the unit but I have been working to expedite the learning curve to help facilitate being a better ICU nurse. It has been tough because no one told me what I was doing so I had to figure things out on my own and develop my own plan. Please don't get me wrong as I am not trying to make excuses and I know that it is my responsibility to facilitate my own learning and take charge it was just confusing to think I was performing well and then being told otherwise without having any specifics.

I am having problems with being "task" focused while trying to develop ICU critical thinking and clinical skills. I have been in the SICU for 4 months and still struggling. At first I was told that I was struggling with completing task and using critical thinking skills and now I am being told that I am "task" focused; lack knowledge and do not use critical thinking skills. I have been trying to figure out where I am going wrong without having any constructive criticism or examples whereby I am exhibiting these behaviors. What I have been doing is reading the Pass CCRN book that has been mention so much on this site and reviewing disease processes; interventions and outcome to improve my knowledge base in hopes of improving my critical thinking and clinical skills. Being "task" focus I think is due to my ER background and that is why I wanted to be in the ICU because I have always thought I lacked critical thinking and associated this with lack of knowledge that in ED our main goal is to stabilize; treat and street our patients but in ICU I have observed that it's about understanding the patho and what am I going to do to keep this pt stable and fix the reason why they are in the ICU. I have PCU experience and just realizing I did not utilize my time to help my transition into ICU and now I am playing catch up with pressure of being moved out of ICU and I really need some advice as to how to show that I am improving and capable of becoming a competent and safe ICU nurse. I don't want to go back to PCU because I don't feel like this will help me because I already have been in this setting. I just feel like I need more time but not sure how to improve faster and get up to speed because I am so behind as I have been told on my unit. I feel very overwhelmed when I am at work because I do focus on the "task" that I need to complete like : I need to assess my pt; I need to chart my assessment; I need to pass my meds; I need to change IV tubing; dressing changes; bathe my patient; chart VS: chart my q2's. I find that I run out of time and always charting 30-45 min after my shift is over which is viewed bad in my unit because of overtime. I find myself not being able to grasp the whole picture as to why my patient is here and why am I doing these "task." I also feel like my time management is lacking and that I am not always so organize even though I use a brain sheet to help keep me on track. I have tried different ways to organize my time but nothing seems to work. For example; I get report; look at my orders then assess my pt; try to chart; bathe pt; give meds then when I look up it's about 11 and I don't even really have the full picture of my pt; have not read in detail the MD not or what has been written on my pt and then am not able to communicate when the CN comes to ask about my pt. I feel like I am just running the whole shift and not really know what's going on with my pt. I have asked some co-workers how they plan and in theory I have the same plan but I am not executing the plan that I have in my head when I start my shift. Please give me some advice no matter how simple or harsh as I am trying to expedite and get to where I need to be so I can stay in ICU. Any suggestions will be helpful with time management; organization; planning my day; how to have the whole picture and move away from being "task" focused.

Hello Apple71286, I am experiencing the same thing and also posted a similar post in hopes of getting some advice. The difference between you and I is that I have 4 yrs of nursing experience working 2 yrs in the ED (not a level I or II facility) and 2 yrs in PCU (level 1 facility). In the ED I have stabilized pt's but since it was not a high acuity ED I did not have really sick pt's and in the PCU there were some sick pt's but not what I have experienced in the SICU. I am wondering the same if things will get better. I think you are in a better place then I am b/c you only have 2 yrs whereas I have 4 yrs and think my skills are subpar and the expectation are higher for me. I am just hoping my unit does not give up on me because SICU has been my dream job since I started nursing school. I hope things get better for you. All I can say is to keep giving it your best and don't give up. I hope this helps although not sure how much since I am in a similar situation as you. Hopefully we will get some good advice from some of the seasoned ICU RN's. :)

Hello to all who reads and posts. First I would like to say is that SICU has been my dream job since I started nursing school however I was not fortunate enough to start in SICU. I have been a nurse for 4 yrs with 2 yrs in the ED(not a level I or II) and 2 years in PCU (level I). I finally got my dream job in the SICU and have been on my own for 4 months however, I am struggling. I heard from a coworker that some people are saying that I am struggling with completing task and not using critical thinking skills however no one has actually told me this so I find this odd. In my other nursing areas, I was the one that new grads asked for help and was one of the go to persons on my unit and got the hard assignments but now I feel like a new grad and was wondering if this is normal or should I just quit. I talked with one of my mentors who use to work in the ICU and who has worked with me in another unit and she told me that it takes time and even though I have 4 yr of experience that ICU is a different type of nursing and that I just need a good mentor to show me the ropes and help me to identify my weakness so that I can regain back my confidence as a nurse. I know I am not a new grad but what I am experiencing and from what I have read on previous post are what new grads are/have experienced but for my situation is this normal since I do have 4 yrs of experience or do I not have what it takes to be in the ICU? I really want to be here and know that with time I will get better but not sure if my time is up since no one is really telling me what I am doing wrong and quitting is not an option for me. Also one co-worker did say, "Well don't you have experience" when I came to ask them for help and I was confused because it was a question regarding an ICU skill that I had not performed before. I just think that somehow I have a bad rep of being a horrible RN but not getting any help as to what I am doing wrong even though I have asked and no one seems to be willing to tell me but at certain situations I get facial expressions like I should know how to do certain things or know certain medications. In addition to this, I find myself freezing up when my pt is turning for the worst. I am not totally sure why I am doing this b/c I in the past on the other units that I have worked I am the one helping other coworkers with their pts and I have received compliments from my previous charge RN's and other co-worker's but now that I am here in the ICU I just chock. I am not sure if my confidence is low b/c I feel like I am doing everything wrong or because of what my-coworker said regarding what others are saying about me behind my back. I have not been a person who cared about what others say in the past however now I am b/c I am vulnerable b/c I am new to the unit and want my co-workers to see that I am truly trying and want to be a team player and an asset and not a liability. I really want to stick it out b/c I enjoy the SICU which has been my dream job and I enjoy learning. I just don't know how to show my clinical skills or how to improve in other's eyes. I just don't know what to do because I have never struggled with my clinical skills before and for me I just think I have not seen real critical pts like this before after being in nursing for this long which is why I have been trying to get into ICU. I just don't want my unit to give up on me b/c I know I have the potential of becoming a great SICU RN. One positive comment that I have received from a co-worker was that I should not give up b/c they struggled in the beginning. Any advice is welcomed.