Womp, womp, womp...

[TheBlackDogWaits]

So, I'm not really sure what my dilemma is. But I'm going to try to give y'all a crack at it the best I can describe....

I've been wanting to be a CRNA since before school. My entire direction has been focused on this idea. There are many reasons why, and they aren't really pertinent so I'll jump ahead. Got hired into an 18-month residency program before I even graduated, and got hired into an ICU before that was over. So This is where I am right now....

There are a few dynamics at play here. The first being that I honestly don't feel like my residency prepared me AT ALL for my current position. I currently work for a large magnet corporation/teaching hospital. I am very excited about this just because I feel like as a new nurse, teaching hospitals are the best way to go for a comfortable learning environment. Having said that, I often find that there are also a lot of new doctors drawn to this system as well, and more often than not they are expecting me to give them suggestions for orders, or just outright expecting me to put in the orders. HUH??? So, there's that.

I've been in orientation for a bit of time, and my first preceptor was not a good teacher by any stretch. You know, generally I have shadowed a preceptor for a couple days and then start taking my own patients, prior to now. I've rotated through a few different units in my previous position, and learned a lot. This time, though, I felt like I was shadowing this preceptor for an entire month. Control issues. She didn't know how to articulate what she was seeing, looking for, how she came to conclusions about care, etc.... so I didn't have a lot of direction. She was super friendly but I had to eventually address that I felt I needed another preceptor, and she turned into a different person. She started talking to me about how she didn't think I'd make it in this unit, and I'm not getting this or that, and she feels like I am always just waiting for her to do everything. I really was laughing to myself, because I feel like for the most part my development is a direct reflection of her. Needless to say, I am with another preceptor who is pretty great, and I've really started feeling less panicky about my learning opportunities. She actually let's me do my job, which I am beyond thankful for. I learn better and I learn more this way.

I don't know that I like this job though. It's completely different than I thought it would be. And I've read so many posts about this feeling, and for some reason, I never felt like it would apply to me. I have zero passion for this unit or even for this job. Most of my patients are nursing home complications, whose families refuse to DNR them. Most of them are contact precaution for the sheer fact that they're from community living, and I spend day in and day out eyeballing their lytes and cardiac function. Even though they are clearly at the end of the line.

On the one hand, it's tough because I'm still trying to connect all the dots and figure out the big picture, but on the other hand I almost feel like I am not learning about all the million things I should be learning, that I could be learning if I were t a different hospital. I'm stuck between feeling like I am not good enough (because of my experience with my previous preceptor) and also like I could be so much better if I were in a different environment.

I don't know at which point I should be owning my experience here. I hear a lot of people saying, "Stay the year..." but am I wasting my time and my boss' time? Am I wasting my preceptor's time?

I feel like I want to stay and take advantage of this opportunity, because if I were a student reading this or a nurse without a lot of opportunity reading this I'd be green with envy and/or bitter about a possible lack of appreciation or insight on my part, but I also feel like all I'm doing by staying is being a nuisance to the unit because I am moving through preceptors and haven't been picking up info at the expected rate. At the same time.... I'm learning that I don't like acute care. I don't like trying to figure out the big picture. I like teaching, and I like patients who can talk to me in their right mind. I like chill environments. I like patients who are engaged in their care. Most of these patients are poor historians, with no family to advocate for them - and there are a lot of nurses who enjoy taking on that role, but I don't believe I am one of them.

I'd like to make a decision that benefits everyone here. I don't really know what to do. There must be a few of you who have weathered similar events and made it through with a lot of regrets - or no regrets at all.

Care to share your thoughts?

[TheBlackDogWaits]

I am in a 19-bed unit, with a 1:2 load ratio, fresh hearts are 1:1 and rare, but my campus is probably the smallest acute care facility in the system, and all the trauma gets diverted to another campus, where they have specialty ICUs. I've jumped from a 4-week observation type situation, to an actual orientation and I am currently taking two patients. I've been with my current preceptor for three shifts. My strongest skill set is ortho/neuro, and I think I would really love wound care or burn, but there are currently no neurologists on my campus (so those are also diverted), and our system doesn't have a burn unit that I'm aware of. Just some background info.

[Thedevinestman]

Unfortunately, if you enjoy talking to patients than a CRNA career probably isn't right for you. Unless of course you're doing it for the money, in which case keep on trucking. I was a surg tech before going to nursing school and the OR is really a different environment compared to ICU. There are more ego's and more alpha's. But if you enjoy talking to patients and having a consistently relaxed environment than get your nurse practitioner and head to the clinic. There's considerably less money, but who cares if your happy! :)

[JustBeachyNurse, LPN]

You realize teaching hospitals have nothing to do with educating/training nurses. The focus is on physician training/residence hence why the new residents are looking to nurses for guidance, suggestions and more input from the nursing team who are already licensed and theoretically completed their training. Of course new physicians are drawn to teaching hospitals they have to start there to complete their medical training.

It's a common misconception that teaching hospitals are to train all sorts of healthcare workers when really it only refers to physician education/residencies and the facility is affiliated with a medical school.

If you don't like acute care and want to develop relationships in "chill environments" with patients in their "right mind" consider outpatient care with healthy patients or perhaps endoscopy or same day surgery. If you are miserable and/or struggling with the care of the whole patient in an acute care setting then sit down and discuss your challenges with your manager and unit educator. Perhaps if you approach first they may find a more suitable role in the system. If you are seeking chill & patients in their "right mind" that you can talk to then don't bother with CRNA

[TheBlackDogWaits]

Thanks for the replies. Yes, CRNA is definitely off the table for me. I'm an adrenaline junkie, and thought I may enjoy it, but I'm starting to realize I prefer to take my risks outside of a professional health care setting. I enjoy seeing gross things, and have considered OR work as well, but at the end of the day, just staying where I am looks like the best option. As I am moving further into orientation with the right person, I am realizing that this really is a great team and I am already pulling the pieces together, albeit a little at a time, and this process won't happen overnight.

I never expected to feel comfortable right away, I just didn't expect the environment to be as different as it is. And as far as chill environments go, the ICU I work in pales in comparison to a trauma center, so it seems like I'm in a good place to get my bearings, when I look at this more rationally.

JBN, thanks for the clarification..... I actually didn't realize that. lol On the bright side though, aside from the medical students, there are a couple of really phenomenal MDs who also use opportunities to teach me while they are teaching their students, and it's really nice to have their perspective; I'm super grateful for it. Sometimes I feel so silly because I work with nurses who've been doing this for 15-30 years, and I have this insecurity that they all think I haven't put my time in and I don't deserve to be there -- but not a single one of them has been ugly to me. Not to my face, anyway.... I'm starting to get the feeling like the team is glad I am not under the tutelage of my first preceptor, and everyone is pulling me everywhere to show me all the awesome things.

Anyway, it's a process. Thanks, again.

[Axgrinder]

The first year is one big learning curve - so is the rest of our nursing career.

ICU is a lot to take in - you can't eat a whole turkey in one big bite, so it stands to reason it is going to take a bit of time to get comfortable in an ICU - any ICU. It seems to me there is a whole lot of unrealistic expectations being placed upon your shoulders. As a new grad you have much to get used to and learn. Many RN's may take for granted all that got them to their present level of competency. There is no magic wand that takes a new grad and turns them into a seasoned ICU RN over night, making them instantly competent to handle ICU level pt's all on their own without guidance. It just can't happen - there is too much to know.

I remember a coworker becoming annoyed with me because it took a while to understand a balloon pump. She just wanted to sit on her rear end and read magazines all day, or chat with the other nurses, and got very upset that I didn't feel comfortable in two in person instructions sessions. I felt ackward - but I'm sure the pt would have thanked me (if he was conscious).

I remember another job where I was told to go pull the a-line of a pt - only to discover it was a femoral cath lab sheath! ("Here's your C-clamp … now go do it!"). Geez …

Another job I got a fresh AAA repair straight from PACU - swan gantz and all, and told, "Dr. Rosado doesn't like his pt's wedged!", and no other explantation. This was my first couple of months on my own. No way I had developed all the competencies I needed to safely practice on my own yet.

My point is that perhaps you are being a wee but hard on yourself? You need mentoring really for at least a year - someone you feel comfortable going to with questions when you feel out of your element.

Sometimes it can be forgotten a new nurse - even a seasoned nurse transferring from the floor to ICU - has to develop a repertoire of skill sets, and that just plain takes time. There is no rushing it.

I had a clinical instructor years ago that pounded into our head how unsafe it can be to pretend you know how to do something when you don't. With that in mind I never had shame admitting I didn't know something - because let's face it, there is an awful lot to know in nursing, and we can't know everything even up to the time we retire.

Maybe you should give yourself a break, even if no one else does. After all, you graduated from a rigourous nursing program, and passed your state boards. You're not stupid by any stretch of the imagination. Nurse love thy self.

[PANYNP]

It sounds as though you have a bias against older patients - listen up, Gero is where it's at. And where it's going to stay for the next 35-40 years.

Whether your patients are nursing home residents "whose families refuse to DNR them", or you feel inconvenienced by reviewing lab results for patients who are at "the end of the line", these individuals deserve the very best nursing care you can deliver.

Your dismissive attitude is distressing. Imagine how dismayed you will feel if your Grandma or Grampa, or one of your parents, and one day, your spouse, are treated as though they are less important or less deserving of aggressive care.

It's not clear where your attitude comes from, whether you picked it up from co-workers or arrived at this age bias on your own, but an effort toward adjustment will benefit both your patients/families and your own heart.

One of the best attributes a nurse can bring to his/her practice environment is humility. It's not all about you and what makes you happy at every moment; it's about using your nursing talents - if you have them - to respond to patients' unmet needs. Nursing is a gift. It's a privilege to participate in others' lives and to move with them through difficult moments.

If you find a patient care setting that is chill, please let the rest of us know.

[TheBlackDogWaits]

Hi, PANYNP.....

I can very clearly see your point.

It sounds to you like I have a bias against "Gero," and it sounds to me like you have a bias towards them. And that's ok. Really. It's ok. It doesn't mean I take less pride in my work. Is it less exciting? Of course it is. Does that make me less passionate about nursing in general? Of course it doesn't.

You speak as though aggressive care is something I dismiss for the sake of not providing compassionate care. It's the opposite of that. Sometimes, aggressive care for most of these patients (who are AMS/frail/can't bounce back from aggressive care, despite the care) is the very opposite of compassionate care.

Also, I'm not trying to be happy 'every moment' - where is that coming from? I'm not really sure how you came to that conclusion. I'm trying to find my niche in nursing, which is a phase I'm sure you are familiar with. The message I was trying to convey is that as a new ICU nurse, I really think it's imperative to have a varied patient load to learn as much as I possibly can about intensive care. My implication wasn't that I am "inconvenienced" by my patients. The implication is that I have a lot of opportunity for growth here, and am I learning what I need to learn(?), and what is the best direction for me to move in(?).

Did you read my post? Are you reading too much into something, or projecting some of your unsavory experiences into my intentions here? My attitude in my OP was anything but dismissive. Maybe 'chill' was an inappropriate word to use. I think the sentiment is there, though. There are high stress environments and low stress environments to consider, and that's different for everyone, and I've not decided what direction I want to move quite yet with regard to a work environment.

Maybe "Gero" is where it's at *for you*. If I'm following the AACN correctly, that's about half of the acute care population, right? Great, so there's a whole other half for me to choose where my niche is. How awesome for me, and how awesome for you.

[TheBlackDogWaits]

The first year is one big learning curve - so is the rest of our nursing career.

ICU is a lot to take in - you can't eat a whole turkey in one big bite, so it stands to reason it is going to take a bit of time to get comfortable in an ICU - any ICU. It seems to me there is a whole lot of unrealistic expectations being placed upon your shoulders. As a new grad you have much to get used to and learn. Many RN's may take for granted all that got them to their present level of competency. There is no magic wand that takes a new grad and turns them into a seasoned ICU RN over night, making them instantly competent to handle ICU level pt's all on their own without guidance. It just can't happen - there is too much to know.

I remember a coworker becoming annoyed with me because it took a while to understand a balloon pump. She just wanted to sit on her rear end and read magazines all day, or chat with the other nurses, and got very upset that I didn't feel comfortable in two in person instructions sessions. I felt ackward - but I'm sure the pt would have thanked me (if he was conscious).

I remember another job where I was told to go pull the a-line of a pt - only to discover it was a femoral cath lab sheath! ("Here's your C-clamp … now go do it!"). Geez …

Another job I got a fresh AAA repair straight from PACU - swan gantz and all, and told, "Dr. Rosado doesn't like his pt's wedged!", and no other explantation. This was my first couple of months on my own. No way I had developed all the competencies I needed to safely practice on my own yet.

My point is that perhaps you are being a wee but hard on yourself? You need mentoring really for at least a year - someone you feel comfortable going to with questions when you feel out of your element.

Sometimes it can be forgotten a new nurse - even a seasoned nurse transferring from the floor to ICU - has to develop a repertoire of skill sets, and that just plain takes time. There is no rushing it.

I had a clinical instructor years ago that pounded into our head how unsafe it can be to pretend you know how to do something when you don't. With that in mind I never had shame admitting I didn't know something - because let's face it, there is an awful lot to know in nursing, and we can't know everything even up to the time we retire.

Maybe you should give yourself a break, even if no one else does. After all, you graduated from a rigourous nursing program, and passed your state boards. You're not stupid by any stretch of the imagination. Nurse love thy self.

Thank you..... I really needed to hear this. My new preceptor is phenomenal and she is sharing this with me as well, that this doesn't happen overnight, etc. I really am starting to feel like I am in the right place at the right time. I suspect that I might be here for a little while.

[Axgrinder]

Thank you..... I really needed to hear this. My new preceptor is phenomenal and she is sharing this with me as well, that this doesn't happen overnight, etc. I really am starting to feel like I am in the right place at the right time. I suspect that I might be here for a little while.

Go get em girl - you'll blow their socks off!

Time is the tinture to all that ails us. You'll be incredible. I just know it. :)

[sugarmagnolia3]

My suggestion is, put in at least a full year, two if you can bare it, and get your CCRN as soon as you have worked enough hours. (I thought you needed a full 2 years, but just read about others taking it after a year). Once you have a year under your belt (or two) combined with a certification, you will be able to transfer to any ICU job you want.

[8-ball, BSN]

I can tell you I at one time felt the same way a bad preceptor or bad hospital can ruin you...however I also wanted to do CRNA. I now have 6 years ICU environment, the right hospital makes all the difference. I learned I didn't like MICU so I moved to SICU then into Trauma which I love. I was working towards the CRNA route so I decided to shadow a CRNA for a week. I hated it. It was boring and even when it was on edge I felt like Trauma was 100% better, but I really wanted to make more so here lies the delimma. Do I do NP or CRNA or something else. Finally I decided to do travel nursing. I am now doing every type of ICU but only for 13weeks at a time and I am making as much as a CRNA and I am getting paid to travel and see the world. I set my own vacations and take off when I want (as long as I am not in contract). I am not trying to sell you on it but what I am saying is expand your horizons some. Sometimes you do need a change in environment. There are other options. I will add that to be a traveler you need 2 years of ICU experience at least, that's if you want to continue ICU.