Struggling transition from Med-surg Tele to Cardiac-surgical ICU

[fromdusktodawn]

3 months ago I transferred from a med-surg tele/step-down unit to the cardiac-surgical ICU (CSICU), which I heard is the most challenging ICU at my hospital. I worked almost 3.5 years on my old unit and it was my first nursing job.

I felt comfortable at my old job, but I felt my career was stagnant. I found myself doing repetitive mundane tasks and I needed growth. I'm in my mid-20's right now and I feel a bit lost with my career goals. Eventually I want to go back to school but I am not sure what specialty I should pursue. 

I decided to take a challenge and go for an ICU position. I thought it would be a smoother transition going to the CSICU because my med-surg floor shared the same patient population. Once the post-op cardiac patients were stable, they were transferred to my old unit and monitored until discharge. I was familiar with cardiac surgical patients and cardiac devices, such as LVADs and total artificial hearts. I thought if I sink or swim in the ICU, at least I took the initiative. 

I am currently almost off orientation. I have been on days for the majority of my orientation. I had just finished "admit week", which was a week of only admitting patients from the OR and learning about the post-op complications and patient's readiness to extubate. I learned a lot but every night I came home stressed and on the verge of tears. 

I feel very overwhelmed and have this dooming anxiety before every shift. My coworkers and preceptors have been supportive and have been telling me that I am doing well and things will get better. I feel very anxious at work because I do not feel confident in my new role. I try to do as much studying as I can but there's such a big knowledge gap between ICU nursing and floor nursing. I am having a hard time seeing the whole clinical picture and prioritizing care. A lot of the days, I get very scattered brain and I freak out and panic, which is not very good because lives are at stake. I am worry I will easily make a big mistake one day and cause harm. 

Because I have trouble connecting the dots, I find myself having a hard time keeping track of the interventions I have done for the patient for the whole shift. I try to write things down but a lot of times I get so busy that I do not even have a moment to reorient my thoughts. A lot of the nurses don't write anything down and their memory is flawless. One of my preceptors told me not to write anything down because I am an ICU nurse now and I will learn to memorize. That made me even more anxious because I do not trust my memory. I have a hard time talking to the providers as well and I feel intimidated by everyone. 

The worst part is giving report to the oncoming shift. On my old floor, I am so used to writing things down on a report sheet and giving detailed report off my notes. Here, I am forced to know everything and the 89454524626983 interventions I have done without reciting off a script. I get very flustered and nervous in report and I feel stupid. I know some nurses are not kind and will chew me up when I am off orientation. 

I don't have a lot of confidence in my work and have a lot of doubts about my skill level. I do not want to go back to my old unit because I left there for a reason, but I also know that not everyone is cut for the ICU. I'm giving another week or two to reevaluate. 

 

[MunoRN, RN]

If you felt confident at this point then I'd be concerned, that would mean you're not even aware of all the things you still have to learn.

There's certainly an advantage to having experience caring for OHS patients farther out from surgery, but landing open hearts out of the OR will still be daunting.  There's also some benefit from having some experience with other types of ICU patients as well, but it's not critical.  Even among seasoned ICU nurses, fresh open hearts are not everybody's thing.

Thinking is different in caring for fresh open hearts compared to med-surg.  When giving report, typically the next nurse is looking for the story, not necessarily the little details that make up the story or even a systems assessment if there's nothing interesting or pertinent in it.  I'm not really looking for when you titrated each drip, but more the general response and what you noted worked and didn't work.  For instance, when their CI dropped, did you find them more responsive to fluid?  More responsive to upping the inotrope?   More responsive to upping the afterload reducer?  If they had a low CI and borderline bradycardia, did pacing help?  Where are we with analgesia, when does the Doc want to know about that high CT output, etc.  

Even then though, CVICU nurses can have widely varying preferences for report, so don't necessarily assume that your way is the wrong way just because it's not another nurse's style.  

[fromdusktodawn]

23 hours ago, fromdusktodawn said:

3 months ago I transferred from a med-surg tele/step-down unit to the cardiac-surgical ICU (CSICU), which I heard is the most challenging ICU at my hospital. I worked almost 3.5 years on my old unit and it was my first nursing job.

I felt comfortable at my old job, but I felt my career was stagnant. I found myself doing repetitive mundane tasks and I needed growth. I'm in my mid-20's right now and I feel a bit lost with my career goals. Eventually I want to go back to school but I am not sure what specialty I should pursue. 

I decided to take a challenge and go for an ICU position. I thought it would be a smoother transition going to the CSICU because my med-surg floor shared the same patient population. Once the post-op cardiac patients were stable, they were transferred to my old unit and monitored until discharge. I was familiar with cardiac surgical patients and cardiac devices, such as LVADs and total artificial hearts. I thought if I sink or swim in the ICU, at least I took the initiative. 

I am currently almost off orientation. I have been on days for the majority of my orientation. I had just finished "admit week", which was a week of only admitting patients from the OR and learning about the post-op complications and patient's readiness to extubate. I learned a lot but every night I came home stressed and on the verge of tears. 

I feel very overwhelmed and have this dooming anxiety before every shift. My coworkers and preceptors have been supportive and have been telling me that I am doing well and things will get better. I feel very anxious at work because I do not feel confident in my new role. I try to do as much studying as I can but there's such a big knowledge gap between ICU nursing and floor nursing. I am having a hard time seeing the whole clinical picture and prioritizing care. A lot of the days, I get very scattered brain and I freak out and panic, which is not very good because lives are at stake. I am worry I will easily make a big mistake one day and cause harm. 

Because I have trouble connecting the dots, I find myself having a hard time keeping track of the interventions I have done for the patient for the whole shift. I try to write things down but a lot of times I get so busy that I do not even have a moment to reorient my thoughts. A lot of the nurses don't write anything down and their memory is flawless. One of my preceptors told me not to write anything down because I am an ICU nurse now and I will learn to memorize. That made me even more anxious because I do not trust my memory. I have a hard time talking to the providers as well and I feel intimidated by everyone. 

The worst part is giving report to the oncoming shift. On my old floor, I am so used to writing things down on a report sheet and giving detailed report off my notes. Here, I am forced to know everything and the 89454524626983 interventions I have done without reciting off a script. I get very flustered and nervous in report and I feel stupid. I know some nurses are not kind and will chew me up when I am off orientation. 

I don't have a lot of confidence in my work and have a lot of doubts about my skill level. I do not want to go back to my old unit because I left there for a reason, but I also know that not everyone is cut for the ICU. I'm giving another week or two to reevaluate. 

 

Thank you for your advice! Yes a lot of nurses tell me to paint a picture in my head instead of memorizing the little tasks individually. I'm still very task-oriented and get caught up with the not so important things.