Forever_a_Student

Don't give up! ICU is certainly a different animal, even for experienced nurses. I began in a level II ED and found that I continually asked "but why?" and "but what's next?" This led me to believe that ED was not for me so I ended up on the complete other end of the spectrum in acute rehab asking "so how did they get here?" and "well what are we up against? How far have they already come?" I was missing crucial information about patient care that I felt led to better outcomes. I consider ED as an appetizer, rehab as dessert, and ICU as the Meat and Potato. Critical care requires intensive thought and practice. There are certainly many 'obvious' results leading to 'obvious' interventions. That being said, there are also many confusing, complex, and simply mind-boggling concepts that will test the most experienced ICU nurse. What sort of orientation did you receive when beginning: night shifts AND day shifts? Preceptor experience? Does your facility participate in the Essentials of Critical Care Orientation (ECCO) modules offered through AACN? We send our new RNs through ECCO, give them 10-12 weeks of orientation on both shifts, and encourage READING. The motivated new nurse in critical care fully immerses themselves into learning about critical care. The experienced nurse in critical care fully immerses themselves into continued inquiry and preceptorship. ALL (correct me if I'm wrong) critical care nurses read and read and read about what we do and what we need to do to become better, stronger, and more competent at providing patient care. If your problems lie in skills-obtainment, reach out to your service line's clinical educator and your team leader. Your leadership and education teams are there to help you succeed to reach your goal of providing ultimate patient care. That being said, I maintain that even in my role of team leader, I have questions daily. I get scared. I have days where I feel beaten down and at a loss. This is why we work as a TEAM. If you see a lack of encouragement and education from your team as you transition into the critical care atmosphere, SPEAK UP! Keep it objective, make a list of your short-comings and questions, and come up with an action plan. Seek the help and you will receive the help. Best of luck! ~S~

As the Team Leader for a 13 bed MSICU I have to wonder-how many ICUs maintain their leadership/charge nurses in staffing with a patient assignment? In my current role I have 2 12 hour shifts out of staffing for administrative duties and the other 4 shifts are required in staffing as charge nurse, maintaining a 'full' patient load of 2 (unfortunately sometimes 3). While this works great for PI, I'm sure...it is often difficult to maintain the sense of leadership that I feel a charge nurse should have. On a side note I am also the only Clinical Nurse Leader MSN student in our region and I'm frequently attempting to find ways to improve our microsystem for staff and patients. It just makes sense to me to have the charge nurse (whether the team leader or not) be out of staffing to address patient and staff concerns, maintain appropriate flow into and out of the unit, and participate in patient rounding (i.e. take ownership of HCAHPS initiatives) on the unit. What are your thoughts? ~S~