Should I leave the ICU? New grad

Ruby Vee, BSN · Nov 26, 2018

I am a new grad nurse in a large 40 bed cardiac ICU with only 5 months of experience and have been on my own for a month now. I will cut to the chase... I am not sure that ICU is for me. I get extreme anxiety going into work and worry non-stop. My anxiety is so bad that I feel I am on the verge of tears my whole shift because I'm worried something bad will happen or that I will make a mistake. I have been reassured many times that I am doing a good job, but that doesn't help the stress I feel. I find myself in tears crying when I am not at work worrying about my next shift. I sleep horribly and wake up multiple times throughout the day (I work Night shifts) dreaming about work/patients/making mistakes/machine alarms. Everyone I have talked to says it will get better, but all I can think about is how fast I can get out- but I don't want to be labelled as a "quitter" if I do leave. I realize that my high-stress personality may not be a good mesh for such a high-stress environment, but aren't all areas of nursing extremely stressful?
I was thinking about trying to switch to an oncology floor, but then again I am worried that I won't be able to handle 5-7 patient load on the floor. I would like to eventually end up in an outpatient setting, but I want my 1 year acute care experience & most places require 1 year acute care experience as well. All I know is that I can't continue to feel this way for much longer because the stress is wearing me down immensely. I know many new grads would love to start out in the ICU, so I don't want to sound ungrateful in any way. Thank you in advance to anyone who has any advice...

This sounds like what we called in my day "reality shock." The transition from student to nurse is an enormous one, and the reality of nursing is never anything like what we pictured when we signed up for it. Some new nurses have never held a real job before, and that in and of itself is a transition. Of course you feel stressed -- it's a very stressful transition.

I used to cry all the way to work, all the way home from work and in the bathroom AT work. I was afraid I would miss some crucial sign or symptom that would have helped me to prevent a negative outcome, I was afraid that I would make (or had made) mistakes that could harm my patient, I was afraid I looked stupid to the physicians and more senior nurses. I was so afraid of giving injections that I used to throw up or have diarrhea the minute I saw the medication on the MAR, and I don't recall EVER giving an injection on time because I'd be in the bathroom ejecting my last meal before I gave it. I worried about my next shift from the moment I left work -- intermixed with worrying about what fatal mistakes I might have made in my LAST shift. I couldn't sleep unless it was my day off, and then it seemed that all I did was sleep.

"Everyone" is right. It WILL get better. It takes about a year for it to get better. Sometime around that one year mark, you'll feel a "click" as things start sliding into place. You'll realize that you DO know what to do about this, or if you don't, you know how to find out or figure it out. You'll feel comfortable with your role as a nurse. You'll realize that you haven't cried about work in ages and your sleep . . . may or may not improve. Sometimes it takes drugs. Benadryl, Ambien, melatonin, whatever it takes. There's plenty of advice about sleep and dealing with the night shift on this forum.

If you change jobs in your first year, it will just take longer for things to get better. The grass isn't always greener and, having working in both oncology and ICU, I'd say they're both busy. It's just different kinds of busy. Since you've started in ICU, I'd advise you to stick with it. Your first year of nursing is going to be miserable no matter where you work.

twinsmom788 · Nov 28, 2018

Please think about what you came to the ICU for. Stay with it and realize that it a tough assignment. I made it right out of college and so will you.

twinsmom788 · Nov 28, 2018

I was afraid that I would make (or had made) mistakes that could harm my patient, I was afraid I looked stupid to the physicians and more senior nurses. I was so afraid of giving injections that I used to throw up or have diarrhea the minute I saw the medication on the MAR, and I don't recall EVER giving an injection on time because I'd be in the bathroom ejecting my last meal before I gave it.

assigned to me.

To Ruby Vee

YOU criticized ME for taking a job in the SICU after graduating my BSN program? I did an equal/better job compared to my peer hospital diploma nurse as you have commented on previously. I was assigned to be the charge nurse, the day after I received notice that I passed my boards. And yes, I keep bringing this up because you are wrong and it is TRUTH.

I had no trouble with injections, IVs, or any of the other tasks assigned to me. The MDs. and senior nurses were very helpful to me and I had no problem asking them for assistance.

Cowboyardee · Nov 29, 2018

I don't know you, and I don't know what's best for your life, how much stress you can take, etc.

I do know that the first few months after orientation for a new grad are often the most stressful time of their career, and the first few months after orientation to an ICU are typically some of the most stressful months you can find in nursing in general. In other words, barring something seriously bad happening, this is as stressful as it gets. It gets better.

llg, PhD, RN · Nov 29, 2018

Obviously, I can't diagnose what is going on with you for sure ... but it sounds to me as if you are doing well in your job, just very anxious about. It sounds like your problem is anxiety, not work performance. In other words, if you were to switch units and start over somewhere else, you might still suffer from the same anxiety. You could still make a mistake and hurt someone -- and in a non-ICU environment, there would be fewer resources around to support you. You'd be on your own more.

What have you done to deal with your anxiety problem? Maybe you should focus on treating the anxiety -- not just taking it from one workplace to the next. Have you sought counseling? Or spoken to your PCP? etc. Keep the good job for a while longer and focus on treating the anxiety to see if that helps before assuming that it will go away if you get a new job.

tachymurse123 · Dec 10, 2018

You are not alone. I felt the same way. I work on a general ICU that takes everything except ECMO pts so

I had a huge disadvantage trying to learn how to professionally manage all these pt conditions. Unfortuanely, I also had to deal with a third of the staff hating me for getting the job while having no past experience and they constantly tried to find anything wrong that I was doing at the starr. What eased my anxiety and fears the most was learning as much as I could about critical care pts and asking questions no matter how simple or times I had to in order to get things straight. That in turn built my confidence and almost eliminated the anxiety, I would also take propranolol PRN to help keep my anxiety/tremor down without fogging me up and it works believe it or not.

It is the ICU so things are bound to happen so utilize support systems on and off the clock and study for your ccrn because it is a great review for nurses new and old in the ICU setting and if you ask me, when you know your ccrn material well you could be better then some nurses with years more experice that just come to work for the check.

That feeling did also just take time to go away. Now that I have almost two years experice I feel confident most of the time at work and I cannot imagine working anywhere else. (Except in the OR of course as a CRNA) Especially, somewhere where I'd be caring for five patients.

Follow your heart (think about the long term, why did you start on icu and what you said during your interview) not your head (anxieties of what if) and you will know where to go.