I recently started in a new area which is critical care at a large hospital. My background is general medical (the floor) and LTC. I feel that I've been working really hard but apparently my preceptors do not see it. I do recognize I have weak areas but I am constantly working to improve. The learning curve is huge in ICU and I realize that I actually forgot a lot of things I used to know very well because I just didn't need to know it for the floor.
So I'm on a 2 week get better or have a "talk" which is likely being fired due to not being a fit for ICU.
Are you enjoying the work that you're doing? After the orientation that you've been thru so far, do you see yourself liking the job?
Do you think that a different preceptor would help?
Do you have a good "brain" for taking down notes, things that need to be charted, cares, etc?
It is imperative that you are assertive and not passive with the doctors. Your patients are depending on you, but that is something that gets easier with time.
I excelled in the ER and went to work in PICU. I could handle any level 1 trauma, acute MI, CVA, you name it, I was on it. I did not do well with 12 hours straight of intensive care though. I was doing great on nights orientation and when it came for me to orient on days (we were required to orient on both shifts), I had a horrible preceptor and everything just fell apart. I struggled with time managment, struggled with my coworkers, and was put on an improvement plan and was required to extend my orientation an extra month! I can't even tell you what a blow to the self-esteem that was, as I had been such a bad@$$ in my previous environment.
Long story short...it was not for me. When I was put on my improvment plan, both my manager and educator told me to go home and really think about the job and if it was right for me. They swore up and down that they were invested in me and would do whatever they needed to do to see that I was successful, but didn't want me going forward if it was something that wasn't right for me, and would help me find a good fit within the hospital if I wanted to walk away. Of course, caught up in the moment I insisted that PICU was my dream job, I loved it, blah blah blah.
I should have taken the opportunity to transfer while I had it! I stayed for a long time, dreading every day and never really feeling like I was a good ICU nurse. I am pretty hard on myself but I don't blame myself for anything or think that I'm less than adequate, a bad nurse, have poor critical thinking skills, etc...it just was not my niche, and I have no desire to ever work in an ICU again. I think my biggest problem was that I do not have the type A personality that a lot of ICU nurses have. I tried to force myself into type A mode, thinking it would help. It didn't. I just wasn't wired that way.
Sometimes you just don't have the right preceptor. Sometimes it's the shift. Sometimes it's just not a good fit. Will they let you try working with a different preceptor?
Working "really hard" counts for squat in most ICUs. Even if you are doing your best and working hard, if you don't have the critical thinking skills, and knowlage base to provide safe care and pull your weight, you are going to kill someone. I don't say there isn't a learning curve in the first year in a critical care area, but basic ICU skills need to be there before you are off orientation. Hospitals today can't spend 3-6mos re-teaching you your critical care skills, and then teach you the particulars of the unit you are orienting to for another mos or two. I don't mean to sound harsh, but I'm sure you don't want to endanger patients. It may be best you work acute care for 6-mos to a year to refresh your acute care skills, and try to brush up on critical care basics at a slower pace. Take ACLS, look into some critical care CEs . I hope you make it, but if you don't- it isn't that you are lazy, stupid or a bad nurse, it is just ICU requires a lot of judgement from a nurse, and if you don't have enough of the knowlage base, on what do you base your good judgement.
Yes I do want to work in the ICU but it may not be my niche.
According to my eval...time management and multi tasking are my issues. They also said I need to be more aggressive when communicating with the MDs. I never had this problem before but I came from a much smaller hospital. This is a teaching hospital and very busy.
ICU may not be a fit for me but I would like it to be that I made the choice instead of it being made for me. I definitely excelled as a floor nurse.
icu needs a lot of multi tasking and time management...thoses area are crucial in mnaging ur patients i can see why they are questioning you on those fields,,ur exprience backgrounds also showed that multi tasking and time management is not so much of a problem so ithink in my opinion the reason why u are in a little bit of trouble.the best thing to do is gather up all ur acts and show them that u can change and be able to handle situation safely in timely manner..with regards to being aggresive to consultants thats also important in icu,,u are the observer if u think something needs to be done and if your not so confident/convincing them add/stop some tx ur patients are recieving then thats a NEGATIVE- to ur management.and thats a NO NO to ICU.but i can understand why.every new staff tent to be alittle shy and apprehensive to MDs to start,, my advice is try ur best and voice put what u think is best to be implemented..
ALL MY EXTREMITIES ARE CROSS FOR YOU GOODLUCK:nurse:
yes i do want to work in the icu but it may not be my niche.
according to my eval...time management and multi tasking are my issues. they also said i need to be more aggressive when communicating with the mds. i never had this problem before but i came from a much smaller hospital. this is a teaching hospital and very busy.
icu may not be a fit for me but i would like it to be that i made the choice instead of it being made for me. i definitely excelled as a floor nurse.
maybe not yet :) you're still relatively new at this- and it takes time to bring all you've learned and apply it to patients - school doesn't always focus on all of a patients' issues- but as a nurse, you have to pull it all together- and that takes time. :)
if you don't stay in icu, it's not the end of that dream...just need more time to get ready for it- and you'll be better when you do get there
I really dispise the way we are expected to perform like an experienced nurse even though evidence based practice states new graduates/nurses to new specialties need structured orientation, constant support, and about a year on the job before one can begin to be compared to the experienced nurses on the floor.
After I got let go, because I "Could not handle 7 med surg pts, had to write everything down, and did not see the big picture", I sent my employer several evidence based articles regarding this very issue. I doubt it changed anything. Good luck to you.
I really dispise the way we are expected to perform like an experienced nurse even though evidence based practice states new graduates/nurses to new specialties need structured orientation, constant support, and about a year on the job before one can begin to be compared to the experienced nurses on the floor.
After I got let go, because I "Could not handle 7 med surg pts, had to write everything down, and did not see the big picture", I sent my employer several evidence based articles regarding this very issue. I doubt it changed anything. Good luck to you.
It's not fair that you're expected to act like an experienced nurse... Us old farts got thrown in, too... and had to do stuff that nobody would tolerate now. And it wasn't right back then either- just nobody cared.
It seems that some places do offer orientation where you get to have input about how you think it's going. Even with 17 years experience, I got 6 LONG weeks when I moved back here from TX..... I was so ready to get it over with- but was glad it was available for those who wanted the time :)
Sorry you're not having a good experience. Please let me ask a few questions.
First, how much experience do you have? Did you want ICU? How long are you there?
With that being said, and I know this will not go over with many people...............be careful what you wish for. There is absolutely nothing wrong with working on a Med/Surg unit. You will gain a ton of varied experience.
I have 2.5 years experience on a medical floor as an RN and I was a charge nurse also for over a year during that time. Before that I worked in LTC. I enjoyed my floor a lot but I decided to relocate and wanted to branch out.
I would question the quality of the orientation you are getting. Time management on the floor and in the ICU are very different. Is your preceptor helping you with that issue? Do you find your organizational tool needs to be different (the sheet you work off of)? What insight can your preceptor give you as to how you can improve?
ICU is a very scary, high-paced environment. It may not be your niche..but please DON'T think it means that you've failed. Maybe progressive care would be a better fit, you get a bit of the ICU but at a different pace with a different ratio. I've told many that I've precepted over the years...that is one thing that makes nursing so great.So many areas to explore and try....if you've been precepted adequately then maybe it is time to consider something else. I'd encourage you to be proactive in initiating the discussion with your management/education team to figure out what's best for you. Don't wait for them to come to you to "have the talk", go to them. Work together to come up with a plan to set you up for success. Good luck to you.
My preceptor is helping me a lot with the organization and speed. I worked last night and she wrote in my orientation booklet that I am improving. I definitely don't feel like she or anybody wants me to fail.
What EMR are you using?
We use Soarian.
How long is your orientation? How long have you been on orientation?
It was supposed to be 8 weeks since I have nursing experience however they will extend me if I show some improvement. I've been in for 6 weeks.
Are you enjoying the work that you're doing? After the orientation that you've been thru so far, do you see yourself liking the job? It's hard to say when I feel that I'm doing so poorly. I'm stressed going into work because I'm not up to par. I like the job but I don't love it yet.
Do you think that a different preceptor would help?I've had 3 preceptors. 1 on days and 2 on nights (because my main preceptor was out sick another staff was able to do it)
Do you have a good "brain" for taking down notes, things that need to be charted, cares, etc? I write everything in a notebook. As far as charting goes, that is the thing I get complimented on for keeping up with and doing well.
It is imperative that you are assertive and not passive with the doctors. Your patients are depending on you, but that is something that gets easier with time.
I excelled in the ER and went to work in PICU. I could handle any level 1 trauma, acute MI, CVA, you name it, I was on it. I did not do well with 12 hours straight of intensive care though. I was doing great on nights orientation and when it came for me to orient on days (we were required to orient on both shifts), I had a horrible preceptor and everything just fell apart. I struggled with time managment, struggled with my coworkers, and was put on an improvement plan and was required to extend my orientation an extra month! I can't even tell you what a blow to the self-esteem that was, as I had been such a bad@$$ in my previous environment.
Long story short...it was not for me. When I was put on my improvment plan, both my manager and educator told me to go home and really think about the job and if it was right for me. They swore up and down that they were invested in me and would do whatever they needed to do to see that I was successful, but didn't want me going forward if it was something that wasn't right for me, and would help me find a good fit within the hospital if I wanted to walk away. Of course, caught up in the moment I insisted that PICU was my dream job, I loved it, blah blah blah.
I should have taken the opportunity to transfer while I had it! I stayed for a long time, dreading every day and never really feeling like I was a good ICU nurse. I am pretty hard on myself but I don't blame myself for anything or think that I'm less than adequate, a bad nurse, have poor critical thinking skills, etc...it just was not my niche, and I have no desire to ever work in an ICU again. I think my biggest problem was that I do not have the type A personality that a lot of ICU nurses have. I tried to force myself into type A mode, thinking it would help. It didn't. I just wasn't wired that way.
Sometimes you just don't have the right preceptor. Sometimes it's the shift. Sometimes it's just not a good fit. Will they let you try working with a different preceptor? I don't feel like changing preceptors would help. Everyone is so unique in the way they operate. My preceptor has an excellent knowledge base and approach.
Good luck.
Thanks to all for the replies. I tried to answer the questions. I am just off another shift. I did very well but I had two stable patients.
OK, if it was EPIC I have a "brain" for ICU I'd give ya. It's still got it's training wheels with the intent on forcing prep for a newbie to "look good" in interdisciplinary report. I've given it two a few as I am not in ICU, it's well received with customization to your facility by you. Just trying to help.
Us old farts got thrown in, too... and had to do stuff that nobody would tolerate now. And it wasn't right back then either- just nobody cared. 
Not_A_Hat_Person, RN
2,900 Posts
That's the thing with "sink or swim;" some people learn to swim, some don't, and some develop a lifelong fear of water.