I recently graduated from an accelerated 2nd degree program with my BSN. I was hired at a large NYC hospital in the ICU, and am just finishing up my orientation. Although orientation has taught me a lot and is six months long, whenever I am left to myself I feel extremely insecure. I get sooooo nervous that my face turns bright red and I start shaking. I feel as if somewhat simple tasks get me flustered, like zeroing an a-line or setting up an IV drip. I am really lacking in the self-confidence department, and I wonder if all new nurses feel this way... I know I am somewhat intelligent as I graduated with a 3.94 average, yet when it comes to handling pressure, it seems like I am crumbling. My clinical experiences did not prepare me for the real world as well as I had hoped. I sometimes wonder if I can really do this at all. Please, please, I need some advice from all you "seasoned" nurses. What can I do to improve my skills and boost my deflated ego? Thanks so much...
Struggling In NY
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April 16th, 2009 at 11:02 am
I have been a nurse for over 17 years and can tell you from other nurses I know who are in this speciality area, that ICU nursing along with ER nursing is one of the most STRESSFUL specialty areas of nursing. In fact, there is a high turn over rate because there is a potential to burn out their nurses if the patient-nurse ratios are not reasonable. One nurse once told me that if one could work in ICU, with all its high tech skills, then one could work anywhere! Perhaps, you need more time? Are you able to go back to your preceptor and discuss specifically what you are feeling and what you need? I am sure that they would be happy assist you. I think time and experience will boost your “deflated ego”. Hang in there and give it some more time. If you find that it does not resolve, then start exploring other avenues in nursing–God knows there are many types of nursing out there!! Good luck to you!
April 22nd, 2009 at 5:40 pm
I would purchase a PDA with medical-nursing software on the same. You can purchase a used PDA on EBAY with a $ 1,000 worth of medical-nursing software on the same for between $150-$200. With the same you will have the intellectual tools that you need to do your job at hand. They same will both make you much more competent and relieve you of some of the anxiety associated with this high stress environment.
Also, of course, I would purchase a pulse oximeter.
I would, also, consider purchasing a hand held EKG machine that you could use to screen patients,
OMRON makes one that you can purchase on EBAY for between $300-$400. Other hand held EKG machines very in quality and price.
I am a home health, hospice, and assessment and intervention R.N.. I am not an ICU R.N..
However, I have been in nursing for many years.
Please consider the aforementioned.
Best of luck!
April 22nd, 2009 at 9:26 pm
I am a newer ICU nurse, 24 bed Neuro ICU (traumas, head bleeds, and spinal injuries) just to give you an idea of my style of stress. I feel your pain. I fainted one day on the unit working with a patient during orientation. That was almost 3 years ago now and I’m the one helping people through it now.
Go back to your preceptor, if it was a good one, and make sure to pick assignments next door to theirs so you know they’re close by. Take “easier” or more stable ICU patients to start with and one day a week or so pick a harder one to challenge yourself. Be involved in the care of a harder patient of another nurse when you have the time just to observe. Ask their thought processes when there is a down moment, learning how an ICU nurse comes up with the suggestion to a resident the need to do a bronch, or more lasix, or even potassium replacement really makes a difference. Ask for positive feedback from your management or coworkers. Just remind them you’re new and you need to know what you’re doing right because you already see too much of what’s wrong.
At home get sleep, eat right, and make time to go out and just play. Have a friend to talk to at home, no patient names, but just situations. They will just be impressed with all you do and it’ll remind you how much you really do know.
And this may sound silly but forget your GPA!! Your grades in school now make no difference at all. Grades get you through school they don’t make you a good nurse! The knowledge you learned is what helps. If you have to crack open a book then do it, there might be an area you need to brush up on regardless of if you aced it on a test two years ago.
And don’t be ashamed if the ICU is not for you. Different units have different tones, you might just need a different ICU if you like that kind of unit and if not, then find something you do like. And it may take a few changes to find the right one. Nursing can be so rewarding regardless of the location of employment, so just find one that works for you.
April 24th, 2009 at 12:01 pm
I just finished my 3 month ICU orientation. Even with 3.5 years of progressive care (telemetry/step-down ICU) experience, it is still scary at times as the patients can be so unstable that you don’t have time to think things through. You just have to act – for example, titrating multiple pressors to achieve an adequate blood pressure. At my hospital, we have a “Clinical Coach” who has no patients that day to help the new grads with their patients/thinking process/plan of care for the day. We always have a “Resource Nurse” who does not have patients, but has other duties, and who will assist any nurse in need. The Charge also gives the new grads “easier” patients (which doesn’t always turn out that way). My suggestion is to seek out as much help as you can from your fellow co-workers. Ask why questions, hypothetical questions, see what kinds of patients they are taking and ask what’s going on with them, take classes, read journals, etc. I am lucky I have co-workers with lots of experience and excellent and willing teachers. And yes, you will feel totally incompetent in the beginning, but before you know it, others will come and ask you questions! Hang in there and good luck. It can be done.
April 29th, 2009 at 8:03 am
I have to confess, 15 years of nursing and 5 yrs emergency, and I’m a bit lost in the intensive care unit. I like the ER because even though it’s hectic, crazy, you have a bunch of great people around you.
Don’t be afraid to ask. It doesn’t matter whether you’ve been there six months or six years.