Wrong decision to enter critical care

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Hi Everyone,

I'm hoping to get some advice and feedback about my recent journey into the ICU. I've spent the last few years in an academic teaching center with an acute care med/surg float pool that went to 13 different units within my old facility. Naturally, after being in charge and having a good rapport with many of the various floors that I went to, I felt comfortable with med/surg and I wanted to take the next step and enter the world of critical care as it has always intrigued me.

I was craving change, so I left my beloved work place of 11 years and recently located to a new state, new institution, and entered an intense training consortium for acute care nurses to critical care. It's week 3 and I already feel completely overwhelmed. In reading this forum for awhile, I know it's not uncommon to feel like a new grad again as the learning curve from acute care to critical care is very steep. The time that I have spent on the floor has been so humbling and when I leave for home at the end of the day, I can't help but feel deflated and wondering if I made the right choice. I feel like I'm always playing catch up and my time management has been a mess, which was never really an issue for me in med-surg. Overall, I just feel incompetent. Since this is a new facility, there's always that added pressure that no one knows me, or my work ethic, so my feelings are also compounded by the fact that I'm the newbie that looks inept. I just feel embarrassed at my lack of proficiency. My preceptors have been supportive and told me to cut myself some slack, but I met with management yesterday with my preceptors and we all agreed that I'm behind where I should be for week 3. We came up with a plan for me to succeed, but now I'm torn and wondering if I made the right decision.

I tell myself that it's the culture shock of learning a new specialty in a new facility, so it's not only learning ICU, but also learning the nuances of charting and how the culture of the new hospital is. I also realize that 3 weeks is really not that much time in the grand scheme of things and that I should persevere, but I feel like I usually have a good intuition and I'm starting to think that critical care isn't for me. I always feel anxious and on edge, which I attributed to being in a high acuity and unfamiliar environment, but I think it's more that I'm just unhappy with my switch. While certain parts of my disposition are compatible with the ICU, I think other parts of me aren't and I don't think that's going to change in the next few weeks. This is why I'm having a hard time to see if should stick it out or if I should recognize my limitations (which I think is important) and graciously tell my new management that this isn't for me.

Since I moved out of state for this job and to be closer to my significant other, I can't just transfer back to my old job which is hundreds of miles away. I've reached out to nursing recruitment and see if they can find a better home for me within my new facility, which I'm awaiting for an answer. I just can't help but feel bad as I know this position was competitive. I know me leaving is not a sign of failure, but i want to be respectful of my current management and staff's time and not prolong this if I'm not fully invested in it. Going into this, I was not naive to the differences of acute care and critical care, but I guess hindsight is always 20/20 and I wish I would have shadowed my friends in the ICU first. I've had a few heart-to-heart conversations with my friends and I'm doing a lot of soul-searching, but I'm hoping others may be able to shed some light on my predicament as well. Thank you!

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Specializes in ICU.

Finish the consortium Critical Care course as that will open a lot of doors for you should you decide to try ER or PACU at some point in the future. If Med Surg is your jam that course will sharpen those judgement skills.

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Specializes in Clinical Research, Outpt Women's Health.

You are experiencing a lot of changes. Ride it out for a while before you make any more changes.

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Thanks for the response! I appreciate your input. Moving forward, I think I have to look at my future goals and I realize that I don't need ICU experience for the things that I'm interested in nursing. I think I have to be fair to myself, my patients, and my co-workers that the ICU is not for me...and realize that there's no shame in saying that. I don't doubt that I can do ICU, but the big picture is if I'll be happy in the long run - which is the key to sustainability.

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It sounds like you made a lot of significant life changes. A new locale, new hospital, new unit, new speciality. 3 weeks isn't a lot of time. Give yourself a break and some time to adjust. It will be painful for a few months but 3 weeks doesn't seem like enough time. Best of luck in finding your groove.

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Specializes in Critical Care, Capacity/Bed Management.

Entering a new specialty is always difficult, compounded by the fact that you have moved to a new state, new facility, new home.

Like other people have mentioned three weeks is hardly enough time to make a decision on whether critical care is right for you. Give it some time, eventually things will click into place and you will realize that the basics of nursing apply everywhere, its just the application and technology that changes. You will adapt and if at the end of your program you truly feel that critical care isn't for you then you can move on.

Word to the wise though, I am a new graduate nurse working in a medical/surgical ICU and only now am I starting to feel comfortable with my practice. It has been a year since I began, I have been told that this is not unusual.

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Thanks! Many people have been telling me to stick it out and I'm inclined to try, but in addition to the big change, I've also begun to realize things that don't appeal to me in ICU and I'm not sure it will change with time. I just wish I had done more research before I took the leap. I found an old post on here from nurseman78 and it echoes my sentiments perfectly:

It is true that working in the ICU you can learn a lot. Getting the patient with multiple drips, dialysis machines, VADs, vents and all that technical stuff is pretty intriguing... at least for awhile. But it's definitely not everyone's cup of tea, and it can be very grueling.

You do have a lot more autonomy in critical care (ICU and ED), to a degree. But I can understand what the OP is trying to say. There are a lot of "tasks" that need to be done in an ICU. Hourly I's and O's, bladder pressures, zeroing lines, suctioning, oral care, flushing lines, measuring waveforms, printing strips, head to toe assessments every four hours, tons of meds, titrating drips, wedging PA catheters, labs labs labs, calculating how much fluid you're pulling off a patient with CVVHD, rounds, q hour neuro checks, q 30 minute lumbar drains, all the meanwhile trying to make sure the patient and family know what's going on, all the while trying to make sure YOU know what's going on and trying to anticipate any potential problems.

Of course, I think it's like any type of nursing: it is what you make of it. You can go through the motions, or you can dive into it and become very, very good at it. For me, being a floater, a lot of times I am trying to keep up with everything I need to do on top of thinking about what is going on and anticipating the patient's needs.

It's a lot to take in, and I think you have to really enjoy taking care of really sick people. I for one am learning that this isn't me. While I enjoy the critical thinking aspect of the ICU, I find aspects of it very depressing, among them:

· sitting on some patients for days and days without making any changes to their plan, wondering if the docs are even bothering to think about your patient

· thinking about all the technology available, and then realizing that a lot of it "has been proven to not statistically improve patient outcomes" (i.e. swans)

· seeing people there for months on end with no progress in sight

· watching people waste away and die despite your best efforts (although the opposite happens just as often, namely bringing a patient from the brink of death back to health)

· having to coordinate confilcting orders between 2 to 4 different teams who all are involved in the patient's care

Frankly, I am looking to get away from ICU and get into outpatient work or home health, ultimately going back for my FNP to work in primary care. I think it's just my style. The constant alarms get to me, too. I kind of miss working with patients who can actually answer me when I talk to them or carry on a conversation (i.e. not sedated or delerious).

And there are a lot of egos in the ICU, especially surgical ICU (surgeons AND anesthesiologists? Oy vey!) And that's not counting the nurses, who can be very type A.

But that's the beauty of nursing: you aren't stuck with one type of work. There are a lot of options out there.

If I've come to realize the aforementioned now, will it really change 6 or 12 months from now? I know I can only answer that question and ultimately I got to make the best decision for myself. I just feel unprofessional accepting this job and now potentially leaving after only a month.

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You are going through a lot of changes in every aspect of your life and it sounds like all that stress is showing up on those feelings of being incompetent. That is a normal thing when you step out of your comfort zone in such manner.

Breathe, you sure got this, you are competent, you've conquered previous challenges and Im sure you'll conquer this one too.

Be gentle on yourself, I think you are really trying to "swallow a very big bite" and had the expectation of everything being very smooth and the truth is all your reality is 180 degrees different from what it used to be. Worst case scenario, you'll learn this particular job is not your ideal one and that is fine, is part of your professional journey and it's a challenge with a solution too.

Hang in there, you've got this!

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hang in there and work with your preceptor, I believe there is at least 2 different skill sets and time management tools for both the ICU and med/surg. Each speciality has their own strengths and weakness. I did one year of med/surg and went into critical care, after 15 years in critical care I was pulled to the med/surg floor. I had no idea how to organize my day, I felt lost and inadequate, but I made it through the day with a LOT of HELP from the med/surg nurses. Try following one preceptor and ask how they manage all the critical values, and areas you should focus on. Just think of it as on med/surg the nurses know a lot about 8 patients, but critical care nurses know everything on just 2-3 patients.

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Specializes in Supervisor.

Trust your gut, the beauty in nursing is, you can find something you love. There is a difference in feeling stressed and anxious or challenged. As a nurse who has practiced in multiple disciplines, (some I hated and some I loved), I have never wanted to go to that job "I dread" going to every day. When you get up, get ready and are on your way, are you looking forward to the job or dreading it?

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Specializes in Cardiac/Transplant ICU, Critical Care.

Thank you for sharing your experience with us, I know it is not easy, but that's what we are here for :yes:.

I came from a CVT stepdown and within a year's time quickly rose up through the ranks and learned just about everything that I could and was bored and annoyed, that's when I knew it was time for the switch. I was a young, hot shot and a lot of The Unit nurses already knew about me before I even came down and I was chomping at the bit for a challenge and a new adventure.

I will be honest with you, I wanted to quit every day for the first 3 months I worked in my Cardiac/Transplant ICU. It was just so much information and so much more to think about and things were so much more serious and critical and it freaked me out. But I thought to myself just stick it out for 1 year so I can put it on my resume, open doors, and then I can GTFO of Dodge.

Fast forward 4 years later and I am one of the best ICU RNs our organization has and have proven time and time again throughout all 5 Units why I am. All of the OGs 10-20+ years of experience know me, my caliber, and what I am capable of. Because of this I am part of the Unofficial High Council :specs: where the smartest of us get together to talk out game plans for extremely critically ill patients and bounce of ideas, weigh pros and cons, and then decide courses of action.

From someone who was in similar shoes as you, I would say just to stick it out for 1 year, IF you can. But know that pressure can absolutely cripple the best of us, but if you stick it out long enough, and channel it, that pressure CAN turn you into a diamond (Rock Star ICU Nurse as it did for me). As Michael Jordan said "I can accept failure, everyone fails at something, but I can't accept not trying". If you truly figure out that The Critical Care game is not for you, then it is okay and I applaud you for knowing your limitations.

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Specializes in Critical Care; Recovery.

ICU can be stressful for a while, but it gets better. I was feeling similar when I first started, but I started in the same facility I was already working at. That made it easier to transition, because I was already familiar with the charting, and many of the coworkers. After a while I couldn't imagine transferring back to the floor. I love the fact that I can focus on 1 or 2 patients. No matter how sick they are or what is going on, I know I'm not alone, because my coworkers will jump in and start helping out. It is never just your abilities that you have to rely on. Keep that in mind. However, it sounds like you've already made your decision. Good luck to you.

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