Went from PCU to ICU. Is it normal to feel like a new nurse?

MunoRN, RN · Jun 20, 2022

A nurse who is new to the ICU who doesn't feel how you do is the nurse that isn't cut out for the ICU.

Even for a nurse from PCU / Intermediate care / Step down the switch to critical care is still sort of drastic.

I would say that 90% of precepting a new ICU nurse is helping them understand what they don't yet know, since you can't really pursue that progression to intuitive practice until you can understand what the full potential of a nurse, in any setting, could be.

The new nurse's I worry about the most are the ones that are never behind, but only because they aren't even recognizing all the things they should be doing but aren't. Their practice seems fine based on how managers will often evaluate them; they get their fall risk scoring done in the first two hours without fail, their Braden is always done, etc, but that's such a small portion of what a good ICU nurse should be recognizing that needs to be done.

Hoosier_RN, MSN · Jun 20, 2022

5 hours ago, MunoRN said:

A nurse who is new to the ICU who doesn't feel how you do is the nurse that isn't cut out for the ICU.

Even for a nurse from PCU / Intermediate care / Step down the switch to critical care is still sort of drastic.

I would say that 90% of precepting a new ICU nurse is helping them understand what they don't yet know, since you can't really pursue that progression to intuitive practice until you can understand what the full potential of a nurse, in any setting, could be.

The new nurse's I worry about the most are the ones that are never behind, but only because they aren't even recognizing all the things they should be doing but aren't. Their practice seems fine based on how managers will often evaluate them; they get their fall risk scoring done in the first two hours without fail, their Braden is always done, etc, but that's such a small portion of what a good ICU nurse should be recognizing that needs to be done.

That's actually true of any specialty. Any new nurse that is bored, or knows it all, scares the bejeezus out of me!

kbrn2002, ADN, RN · Jun 22, 2022

Not the same transition but I feel you. I changed specialties after 25 years. I'm an experienced, smart nurse with a broad base of knowledge. I was warned when I started this new chapter in dialysis nursing that it would take up to a year before I felt comfortable. They weren't kidding, LOL! I felt like a rookie nurse that knew pretty much nothing for at least the first six months and didn't start to feel like I might have a handle on this for at least a year. I'm finally gaining a little confidence after a couple of years but I still have a ton to learn, and that's OK. At least I recognize I still have a lot to learn, it's the nurses that think they know everything that terrify me.

You're right where you should be in my opinion, aware that there's a lot about your new role that you don't know. That's a better approach than being overconfident.

JJinTheBay · Jun 23, 2022

I just wanted to thank you both for your responses. It helps to know that I'm not alone and that even with my previous experience it should take time to make this transition. I'm looking forward to the challenge though. Thanks again! ?

DrNurseCNS · Jun 24, 2022

It is totally normal to feel like a novice again and to be frustrated by that feeling when you were "the expert" in your previous position. I have seen (and guided) dozens of nurses through the process of transitioning from Med-Surg, Tele, and PCU into ICU/CCU. You have skills and knowledge that will serve you well and you will ask different questions than a new graduate nurse would ask, so it helps if you have a preceptor who is comfortable with that sort of situation. It's a good opportunity for new grads to learn from you, and preceptors too! Don't discount the knowledge and experience you bring with you going into a new area, but give yourself some grace as you transition into being an ICU nurse.

LonghornChic, BSN · Jun 25, 2022

I worked in IMC full time 4-5 yrs ago before going back PRN last year. I filled the other years with outpatient nursing (street medicine and school nursing). I got a full time ICU job this year, received 8 weeks of orientation and have been on my own for the last 4 months.
it’s been an eye opener for sure. I’m finally stating to feel a little comfortable with most procedures and learn something new everyday. I’m always afraid of what I don’t know but rely on my colleagues to continue to help guide me in this aspect.

PMFB-RN, RN · Jun 28, 2022

Your feelings are 100% normal and appropriate. Ide be worried if you didn't feel like that. In my unit we don't really start to considering a nurse a "can handle anything" critical care RN until about their 3rd year. Longer for some.

hypnotizer90, BSN, RN · Jun 29, 2022

I came from med-surg out of state and started fresh at a teaching hospital which uses EPIC. I had 5months of ICU oriention catered to Surgical/Trauma/Neuro. At first, learning EPIC & ICU stuff was too overwhelming but I feel supported every shift and I could easily ask my neigbours for help. I had 2 different preceptors and my first preceptor said at least 6months ish to feel comfortable and that other staffs would not trust me yet.

I'm working for almost a year now and for sure lots of new vocabularies, abrupt changes requiring intubation and scans, learning through Day Rounds and different Residents often so communication is a key. Rounds takes a while so sometimes behind with tasks - it's excruciatingly stressful even with how much multitasking you do so I usually delegate tasks to the Resource RN/LNA.

I always try to help with admissions to get comfortable with that aspect. The Supervisors supported their staffs but sometimes the dynamic changes with different Travel nurses.

You get 2 ICU patients/shift or either stepdown/floor patients but that comes down to the floor units being full so no mov't with patient transfers. At 1 year, we are recommended to get our advance competencies so we could do CRRT, join committees, and working on getting CCRN.