Scary Situation

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Okay so here goes, I was at clinical the other day and had overheard that an ICU nurse had been "relieved of her duties". I did find out that it was because they weren't a safe nurse for the critical care setting and that they may have an opportunity to work on a lower acuity floor if there was opportunity. Now here is the scary part! I am going to be starting in the ICU out of school at said facility and I am terrified I may be deemed unsafe. I have no intentions of this happening, but still the sirens were screaming in my head after I heard this. So has anyone heard of/seen this happen before? are there usually more that one instance that gets someone moved from the icu setting or is it one really bad mistake? I mean what kinds of things deem an icu nurse unsafe? any help is greatly appreciated!

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Are you going into a residency program? I highly recommend that for a new nurse because it is very focused for the job you will be working, if it is not an option I wish you luck and use icufaqs.org as much as you can.

I have also seen nurses let go from their ICU positions because they didnt catch on fast enough or werent a good fit. I really hope you make it, but try not to let it get you too down if you dont because you already know of this situation.

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Thanks for your input! There is not a residency program but orientation is 15 to 16 weeks. So by not catching on fast enough you mean out of orientation? And let go you mean fired completely or reassigned

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Specializes in Family Nurse Practitioner.

I think this is fairly common in ICUs, even those that participate in nurse residency programs, for 1 or 2 nurses to not make it.

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Thanks for your input! There is not a residency program but orientation is 15 to 16 weeks. So by not catching on fast enough you mean out of orientation? And let go you mean fired completely or reassigned

There was no residency at this facility as well, and the supervisors were talking about this person after he had left. They said that he was "not a good fit" and that he would be off the floor this week. I am not sure what that means as far as if he was reassigned or not but I felt terrible for him. I think a long orientation will help you gain your skills, just be steadfast!

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Specializes in Pediatrics, Emergency, Trauma.

I agree with Lev...I was in a CC residency and got slapped with a "not a good fit;" it was disheartening, but I dusted myself off, and now I am an ER nurse.

Life goes on... :cool:

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Some nurses just are a good fit for ICU, and some are not. I've seen some new grads do exceptionally well in my ICU, and nurses with decades of acute care experience not pan out. Please don't allow yourself to worry about why this other nurse was transferred. It has nothing to do with you or your abilities. Focus on your learning and don't hesitate to ask questions, even if you think you *should* know the answer. In my experience, the most unsafe nurses are the ones who try to wing it when they shouldn't.

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One of the things about working in healthcare and being human in general is you really have to recognize that you are human and individual. Not everyone learns the same way or at the same rate, so *please* don't judge yourself based on peers or just on others' assessments. I am giving you this advice because I struggled with this a lot, I am my own worst critic. I compared myself to others when there was no reason to do so. Objective feedback from others about the safe or "per policy" way to do something is one thing and that is helpful, but try not to pick yourself apart. Suggestions to make your routine more fluid or manageable are good too - but don't assume you're less because someone else did something better the first time they tried it.

One of the suggestions I have is to take care of yourself, even just starting. Make it part of your overall routine. One idea is to write down one thing you could improve on or several things you learned. Not only that, write down three things you did well or are thankful for every day (three good things). Especially the three good things - do that at/close to bed time. There is research on resiliency that shows that this has a huge lasting effect (better if you do it consistently but good if you do it for just two weeks even - there are lasting effects months later). By doing the three good things thing right before bed you're priming your mind to subconsciously think positively overnight and it affects your overall outlook. There is research showing that ICU nurses (and other nurses - ED, OR, etc) have a high rate of PTSD and other similar diagnoses. I've done the three good things thing intermittently since attending a conference last year, and it's helped tremendously. If you don't do this - please make sure that while there is a lot to learn as a new grad that you take care of yourself.

Now, reeling myself back in from my believe in and take care of yourself tangent...any job in healthcare will have behaviors/standards/expectations that you have to meet to be safe and competent. You'll add responsibility throughout orientation and add confidence even after orientation.

Some people are good fits for certain patient care environments, others are not. If they give you a fair shake and a good orientation and it doesn't work - no harm in that. Things will work out in the best way possible. You might find something you love more. I didn't get my dream job, found a job that paid the bills and wasn't happy despite learning a lot, and moved on. I happen to love most things about my job on most days. We had a nurse in one of our nurse residency classes, we gave them every chance we could, put them with the most patient, calm, thorough nurses - and they just didn't pick it up or get a routine down. Worse, they thought they knew everything and were beyond any suggestions for grown, etc. Ultimately that nurse was let go, but we tried everything before getting to that point. Literally everything.

One of my good friends started on a medical stepdown floor. She hated it (much like I hated the anxiety with working neuro stepdown - it was my choice to leave, as it was my friend's choice to leave her first job). I went to a procedure area, ended up in the OR, and my friend found she loves working in an outpatient clinic. There are so many things in nursing, nothing is really a lost opportunity even if it isn't the fit for you in the end. Learn what you can, do the best you can, try to improve wherever possible and that's really all you can do. People may judge you for "not making it" in a specific setting, but none of that matters in the end. If you're truly being unsafe - yeah, they might have a reason to judge, but otherwise, just remember that some people have nothing better to do in life.

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Specializes in Critical Care.

There's no reason you should concern yourself with the performance of one of your coworkers.

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Specializes in Cardiac/Transplant ICU, Critical Care.
There's no reason you should concern yourself with the performance of one of your coworkers.

I respectfully disagree. If there is an issue with incompetence in one of my coworkers, it affects us all, and is something that needs to be addressed immediately. In times of high stress, which happens quite often, I need to know that my teammates will be able to function at a bare minimum level. One part of that bare minimum level is NOT physically locking up and being able to move in a high stress, intense situation.

I watch my new nurses very closely during our rather intense codes and many times I have seen them at one time or another mentally lock up where there mind is filled with so much information and they are critically thinking so hard that all of a sudden the "Out of Service" sign goes on :confused:. But even if their mind is locked up but they are still physically moving, getting tasks done, and still being a productive member of the code then they have reached a certain mile stone and have definitely hit that bare minimum level.

When I get worried is when they physically lock up and even with prompting and guidance are unable to be an effective part of the code and become a rather expensive wall flower. That is when I know they need more time, they need more experience with the intense situations, and they need more coaching.

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Specializes in Cardiac/Transplant ICU, Critical Care.
So has anyone heard of/seen this happen before? are there usually more that one instance that gets someone moved from the icu setting or is it one really bad mistake? I mean what kinds of things deem an icu nurse unsafe? any help is greatly appreciated!

I have seen it and have been part of the decision to move people to the CVT step down from my Cardiac/Transplant ICU. First and foremost our patients come first and if an RN shows an inability to competently practice safe ICU nursing even with guidance, coaching, and constructive criticism, then they need to work on the basic parts to build up to it.

More often that not, it is not just one mistake but a continuous showcase of incompetence, indecision, and inability to manage time and tasks in an appropriate manner.

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