Transitioning into ICU from floor nursing, sad and overwhelmed

[CPres2018]

Hello all! 

I have just transitioned from working on a cardiac telemetry floor with a 1:4 ratio, (although it was 1:5 on most days) and now I have taken a job in ICU with 1:2 ratio and MUCH more intense care. I’m very green to it all and feel like a new grad all over again. Almost everything is completely different, I feel like I’m starting from scratch. And to add insult to injury, a lot of the older nurses there make me feel even worse, and there’s times I can tell I am being talked about. I am still on my orientation but I only have 3 shifts left with a preceptor. Any advice for when I’m on my own? It’s all happening so quickly and I’m needing some encouragement or advice for when you were new to ICU and how your flow/time management was and what resources you may have used to grow your knowledge. 
Help!!

Sincerely,

A new, struggling, baby ICU nurse :(

 

 

[stepwintention]

OK, there's a lot to unpack there. 

I've been an ICU RN for 2.5 years.  I was on the tele/stepdown unit for 5 years.  Plus I'm a guy so dynamics are a bit different. Married, kids, not into partying and all that stuff.  Don't expect or look for a social life with them, they may not even be cordial. Just bust your butt and learn. Higher acuity nurses can be elitists and where they phrase nurses "eating their own" come from. 

You're gonna have to believe in yourself.  That's the first thing.  Look at the haters like a pack of hyenas. Don't feed them or show them weakness that they can feed off of. People are gonna talk.  Who cares, believe in you.  If you need help with that, have some confidants and a therapist on stand by, but don't ever feed the hyenas. 

Know ACLS inside out, memorize it so it when the fit hits the Shan you know exactly what to do in what order.  That way your priorities are not questioned. 

Start studying for the CCRN and I mean get Nicole Kupchicks videos because it is the fastest way to get the info in you via lecture. They're videos that helped me get the material much quicker than just reading. Do practice quizzes too.  I should have done this earlier and it held me back. Couple hundred bucks. 

Shore up your weaknesses. IV's foleys, NG tubes, watch vids on Youtube and practice.  Help out other RNS with what you are good at. 

Find mentors who you trust and get a mentor off your unit who doesn't know your coworkers. Reduces the commingling and gossiping. 

Don't worry about fitting in.  You're there for your own reasons and you're an ICU nurse for your own reasons. Some people like the technical skill, others like the adrenaline. I am there to alleviate suffering while people are on their journey.  We all have our strengths. 

It's OK if this unit is not for you.  Look at it to get your skills sharp and then transition over to a more supportive team after a year. Look at it like a short term contract instead of a "this is it".  Once you've done 2 years in ICU, you can go anywhere. It helps with the hard days. 

Go help your neighbors and that is a great way to build trust but don't put yourself so far out there that you appear desperate. Just be Johnny on the Spot.  Someone is in a COVID room, before that RN goes in ask them to Vocera you any supplies they need so you can get them to reduce their time. 

Go IN THE ROOM when someone else is crashing and do something. It's easier to learn when it's not your patient. You can observe and ask questions. 

Get your time management down. 

You're gonna have to learn how to sedate, prioritize pressers, manage a vent.  Learn as much as you can in your course work and also Youtube to fill in the gaps.  Do practice questions to build priorities from practice exams. 

Join a committee for your unit. 

Look, new grads can get anywhere from 6 to 9 months of handholding in the ICU while floor nurses typically get 15 shifts.  That's the difference of about 90 shifts  of experience so you're going to have an uphill battle but you're going to be so much better outside of it after because you'll have worked harder for it and can prioritize better.  Play to your strengths, hide the weaknesses except for those you trust and be open to criticism. 

Maintain an excellent relationship with your charges. Pick up extras and make it known you're putting everything into it. 

Never let the bastards drag you down.  Say that to yourself every time you see a hater or they give you the cold shoulder.  

 

Best of luck. 

 

[newnursewhodiis]

@stepwintention

Hi! I am a older new grad nurse and would love your opinion.

 I recently graduated and I have two offers for grad RN programs. I am torn on which to pick: LLU Murrieta (not main campus so operates more like a community hospital) PCU days, or Arrowhead (county) ICU shift nights. Both are close to the same for the hourly rate. I would love day shift so I like that about LLU but I have heard PCU tele can be med surge on steroids. Arrowhead is nights but ICU, though prefer not to work nights (health issues exaggerated with that) and that's a pretty big delta for me. I feel like since it is a new grad residency that this opportunity for ICU will be amazing and maybe I should suck it up for the 11 months and up the ante for self care. Since you have done both, I would love to hear your thoughts