struggling,wk 16 ICU orientation

TruvyNurse · Mar 14, 2018

Ask for specific feedback. Is it your time management? Not grasping concepts? Ask for advice on how they do things and how you can improve to what they are needing. Show initiative. It will go a long way.

Triddin · Mar 14, 2018

The ocd will come with time. It took about a year before I had completely adjusted. I would suggest making a learning plan with your perceived weaknesses and how you would work towards improving them

Cat365 · Mar 14, 2018

I'm not ICU, actually vents creep me out and the sound of suction makes me want to puke. Having said that I think you need to dissect what's going wrong. Is it your time management? Your knowledge of how to care for the patient? Are you too nervous and getting in your own way?

I would make two lists. One of what you do well. What you know and what you bring to the job. List two is what you don't know, what you need to work on, and what's going wrong with your day. Make a plan to address issues with list two. Consult with your preceptor. As you get better and learn those things check them off. When your feeling down look at list one you rock those items and try to move everything to list one.

allnurses Guide · Mar 14, 2018

You need to sit down with your management and preceptor and do some case reviews. What parts went awry and what should you have done? It is difficult to tell from your post where your problems are, as mentioned above. If you aren't detail oriented you will have to become so or accept ICU isn't safe for you. You can cultivate this through a good brain sheet. Are you using one? Your shift should be a series of ongoing questions you are asking yourself along with a routine timeline for task-oriented things. Time management is key to allow the brain to advance into critical thinking skills. If you are focused solely on getting tasks done you will be missing the big picture items.

Here.I.Stand, BSN, RN · Mar 14, 2018

1) Unstable neuro pts are extremely time-consuming! Between the multiple focused assessments, medical management of the high ICPs, shiver management (uncontrolled shivering creates the metabolic state that the cooling is supposed to prevent), rechecking the ICP, oh **** the ICP is 40 -- what's going on?? -- grab some 23% NaCl, then pack up for a stat HCT (AND summon the RRT, if pt is vented)........ talking to the TERRIFIED FAMILY.............

During an acute emergency you have so many things to take care of, all the while knowing that time is brain, and that ICP needs to come down already! It's okay that you don't feel ready for it. Like not.done.yet said, it should help to sit down and analyze your performance. I would take notes on how it SHOULD go, and review those notes frequently.

2) Caring for stepdown pts can be deceptively busy. One would think a critical and an intermediate pt would be easier.... except it's not. Stepdown pts are sick enough to need frequent assessment/intervention, but well enough to be VERY needy.

singleye · Mar 14, 2018

Thanks everyone so far for the comments. I have wonderful management and they kept someone for 20 weeks but I realized that they think I might not be a good fit for ICU.

This is what happened. The attending dr. went to talk to my manager because I missed to collect 3 hour urine output for a pt who has low urine output overnight and the doctor found that I clamped the EVD ( my other pt had V-tach, I must have forgot to unclamp it before I went to check the other pt. He happened to found out about it right after). Also I got a incident report for a infiltrated IV.

I'm not sure why I was not thinking. Maybe I'm taking on too much (school and work and new baby) and the stress dulls my mind.

They set clear goals for me: recognize VS changes, make sure meds and labs are on time, follow formula for AM rounds.

I need to make sure I need to make these daily goals, take care pts independently and make no more mistakes. Mostly I need to clear my mind and think!

Here.I.Stand, BSN, RN · Mar 15, 2018

I think we've all left an EVD clamped. :no: What I did was got into the habit of looking at the monitor before leaving the room -- is there a telltale pulsatile waveform, indicating that it was still clamped? (Obviously that doesn't work if the pt has a craniectomy, but we tend to be extra careful with those pts anyway)

And an infiltrated IV?? Unless you infused a bag of IV fluid into the tissues (or otherwise obvious that it had been used for hours but not assessed), how is an infiltrated IV an incident report? PIVs infiltrate. It's a tradeoff risk, vs putting a central line in everyone.

allnurses Guide · Mar 15, 2018

Sounds a little harsh to me.