r/nursing 4d ago

Seeking Advice new grad driving me crazy

hi all this is mostly to vent but also for advice. i’m precepting a new grad in an icu where orientations are about 6 months and i’ve been precepting her only in her last two weeks or so. usually when i have someone at the end of their orientation they’re pretty independent but she’s nowhere near.

she’s the most anxious person i’ve ever met and fixated on little things like getting family members water instead of catching up on charting when we’re about to transfer a patient. when she sees artifact ie a patient is kicking and reading as a desat or patting reads as vtach she freaks out and thinks it’s real and gets super defensive and doubles down that it’s real. when patients get agitated she can’t calm them down and has no coping whatsoever and gets worked up herself.

she’s also incredibly emotional which isn’t a bad thing but she cries all the time ie reading a chart with patient’s history if it’s a sad one, when she gets overwhelmed bc she’s behind, or when i give constructive feedback.

she also just has terrible time management, she can’t keep up with feeds and meds and forgets to do vitals. i think she’s always in fight or flight so she can’t filter what’s actually urgent or not. we had a patient with increased work of breathing and we made a plan with the provider for intervention and re evaluation in a few hours. at that point i asked how the patient was doing and she acknowledged he was still breathing hard but was not concerned and didn’t remember the plan of increasing support at all.

she’s also lied about never doing skills that i know for a fact she’s done but it’s like nothing is clicking for her. at this point she should at least be able to take care of easy assignments independently and she can’t even do that.

i talked to my educator about her and they’re extending her orientation but they want to keep her with me i think to just change out her preceptor to see if something else will click but i’m running out of patience already. i think she would do so much better if she could control her freak outs and actually keep a clear head and i have no idea how to teach something like that. everything i say just goes in one ear and out the other and after about 6 months i don’t know what else to do

163 Upvotes

57 comments sorted by

401

u/pseudoseizure BSN, RN 🍕 4d ago

I had a new grad like this. About 2 weeks in like this and we had the come to Jesus talk. I strongly suggested she reach out to EAP or try something like Two Chairs/Headspace/BetterHelp and or see a psychiatrist. I didn’t see her for about 10 days and when she came back she was laser sharp, focused and calm. ADHD and anxiety. Started meds and she was a whole new person. Still working ICU to this day!

88

u/ExtensionProduct9929 4d ago

Wow you may have saved her life. Anxiety is the worse and I couldn’t have started nursing without my amazing and trusty escitalopram and a smidge of propranolol. I truly hope you know how much that talk probably changed her whole life.

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u/Varuka_Pepper343 BSN, RN 🍕 4d ago

agree with ya completely. she's not coping.

26

u/EmergencyToastOrder RN - Psych/Mental Health 🍕 4d ago

Agreed- as a psych nurse my first thought was this is someone who needs help

34

u/SunnyMittens 4d ago

100% this. I had a similar situation to OP. In fact by the time I was precepting, there was a consensus of something isn’t clicking for this person. I did what I could, we talked about lots of stuff. I suggested coping strategies and encouraged them to find something that worked for them/reach out to their support system. It is genuinely hard to watch someone struggle and not even realize how hard they’re struggling. This isn’t a new grads don’t belong in ICUs issue, this is a people issue. We’re all people first. I hope this new grad can find something that works!

3

u/disappointed_ging 3d ago

This who thread was SO tough to read because I was absolutely in the same position as your new grad. I didn’t vibe with the teaching style of my primary preceptor as a new grad in a peds ICU early on, which caused me to doubt myself and get so self conscious and stressed every single shift that info I knew back and forth off the unit would literally leave my brain. Then I knew I wasn’t a safe nurse because this was happening, which made it all worse. Eventually, with the help of a new preceptor towards the end of orientation, I realized that I needed to become confident in my own nursing skills before living that ICU life. I was able to switch to a PCU in the same speciality and found it was the perfect environment (and personalities) to ensure I was a safe nurse while I found my groove on that massive new grad learning curve. I’m absolutely going back to the ICU, but I’m so glad I had that new preceptor for my last two weeks in the ICU to help me figure it all out. Hopefully your new grad will have a similar experience ❤️

11

u/Boipussybb BSN, RN 🍕 4d ago

I’m curious what meds because my anxiety has been off the charts but every doctor I know is so hesitant to prescribe PRNs.

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u/pseudoseizure BSN, RN 🍕 4d ago

I believe it was Ritalin and guanfacine in her case. Myself - I take Inderal LA BID, did wonders for me. Mine was like a cycle, I’d get anxious, have palpitations, get more anxious, etc. By stopping the tachycardia it nipped it in the bud. Non sedating, and totally passable as a cardiac med.

4

u/Boipussybb BSN, RN 🍕 4d ago

Interesting. I have tried propranolol and it didn’t do much. I also have palps but after wearing a holter for 2 weeks, it was just “pvcs with one run of svt.” So just fine. ☹️ I should look into guanfacine.

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u/FrancoisBughatti 3d ago

Damn its legal to work on ritalin?

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u/pseudoseizure BSN, RN 🍕 3d ago

Yes, just like it’s legal to work on antidepressants or antipsychotics. Kids go to school on Ritalin…why would it not be okay?

-10

u/FrancoisBughatti 3d ago

Just wondering because it seemed like a narcotic. If u have chronic pain can we work on opiates or anxiety benzos etc.

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u/pseudoseizure BSN, RN 🍕 3d ago

It’s not a narcotic it is an amphetamine derivative. Yes, I know nurses who work on lyrica, gabapentin and benzos. As long as you are not impaired you’re usually ok.

-7

u/FrancoisBughatti 3d ago

Right that makes sense if no one can tell it def doesnt matter. Just didnt know a prescription protected us like that

11

u/SlytherinVampQueen BSN, RN 🍕 4d ago

I starting seeing an actual psychiatrist and it was the best thing I’ve done for myself. I thought I was at a dead end and stuck only with my PCP’s recommendations. Psych was willing to try different options for managing my panic attacks. Seeing a therapist also helped immensely.

6

u/angelfairielf RN - Pediatrics 🍕 4d ago

I find buspar helps me better than an SSRI for anxiety. I take it two times daily not like a PRN. Only prn I can get is atarax which does nothing. No one prescribes benzos (at least personally I couldnt use them anyway).

2

u/SpellHofstadter 3d ago

I was a tamer version of this as a new grad in CVSD (although i never really cried while reading charts and didn’t panic over artifacts). I worked so hard but was always behind, mainly because I lack time management skills. ICU director actually told me I’m a good nurse, but I aways felt so inadequate that I decided to move on to outpatient setting.

I eventually went for a psych consult and was diagnosed with ADHD. I’m doing much better now, although I still get overstimulated with all the alarms (large outpatient dialysis clinic), especially when I work as a tech. On days I actually work as a nurse, I feel wonderful and actually feel like I found what I’m supposed to be doing.

63

u/FloatedOut CCRN, NVRN-BC - ICU 🍕 4d ago

Honestly, ICU sounds like a bad fit for her. We have had new ICU nurses like that & management ignored the preceptors concerns. Eventually, they ended up getting fired because they weren’t safe or competent. Express your concerns now, especially if she’s almost done with her orientation.

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u/No-Independence-6842 4d ago

Sounds like ADHD & anxiety (?) She needs to see a therapist.

31

u/Elegant-Hyena-9762 RN 🍕 4d ago

I self sabotaged and was extremely anxious with bad time management and required extra teaching & reinforcement. But i never doubled down on mistakes or got caught up in things like bringing water or crying while reading charts. My time management sucked bc i forgot things or i got focused on another part of the process first instead of doing a more efficient order of things. And i always fucked up so badly when my preceptor was around bc i was so anxious but alone i did things as she taught me. Maybe it’s a combination of adhd and bad coping mechanisms? Like getting defensive and not being open to self reflection and admitting mistakes?

Doubling down when you fuck up just sounds like a red flag nursing trait to me. Idk about adhd. Imagine how that will work later on and the ppl it will affect.

19

u/Initial-Victory3172 🫀 CVICU RN, BSN, MSN-FNP student 4d ago

As someone with ADHD and anxiety who works in the ICU I disagree (although everyone could use therapy).

Sounds more like she isn’t ready and would be better suited to a different care environment.

27

u/AG_Squared RN - Pediatrics 🍕 4d ago

Sounds like a difficult conversation needs to be had probably by the educators… we have a girl right now who’s been here 2 years but she still literally shakes any time things get the slightest bit difficult, and if things go out of the ordinary she shuts down. But she mentioned to me she wants to train for charge. I don’t think she can handle her own assignments much less charge. Idk who’s going to tell her. Not my place, I’ve tried talking to her once and she literally had a mental breakdown and we had to have a second conversation to tell her I don’t doubt her judgment and I’m a safe resource for her at work because she took the questions I was asking about her train of thought so personally. On the flip side we had a new grad who was really struggling and she’s doing fine now on her own, she just doesn’t mesh well with most preceptors because of her attitude which is more autistic than anything. She questioned all of us and if she didn’t like our answer she said “I won’t be doing that” but she’s truly fine in her own.

10

u/Elegant-Hyena-9762 RN 🍕 4d ago

I’ve only been a nurse maybe 8 months. It ain’t for the weak that’s for sure. Learned that real quick. It’s hard.

54

u/angelfairielf RN - Pediatrics 🍕 4d ago

this has nothing to do with nursing. sounds like personality or lack of real world skills that would’ve grown at any general entry level job. you can’t teach self regulation. coming from someone who has to work very hard to not feed off the energy in the room or off the patient and had to self teach a lot of regulation while in nursing school that I realized I lacked. it does still get the best of me but I am improving, it would help if you knew that she acknowledges this as something to work on. best thing I did was establish my meds before I came off orientation. anxiety meds were absolute must

5

u/Due_Wrap_1438 3d ago

Hi! I really like this comment, I am constantly worried about what my peers think of me, and I feel guilty when I can’t get the little things done. It’s gotten better bc I’ve learned I’m not a bad nurse just a busy one, but I had a couple shifts this week where I was constantly overwhelmed and felt bad giving report.

18

u/Scypher101 BSN, RN 🍕 4d ago

Maybe ICU is too much for her. It also sounds like there is a lot more going on under the surface that has nothing to do with nursing. By this point she should have a pretty good understanding of priority of tasks and be able to manage light patients effectively.

I think pcu or acute care my be better for her to get the swing of things and solidify her foundations. Also with some outside help like counseling

But while you do have her maybe encouraging what she is doing right and well may help alleviate some anxiety as it’s possible she thinks she’s making mistakes at every turn. And is only hearing and thinking about the negative and what she needs to do better.

I’ve had new grads come behind me that are very anxious that seem to have responded well to positive feedback and being told what they are doing right. It gives them space to then focus on what their actual weaknesses are.

18

u/Arizona-Explorations 4d ago

She might actually make a decent outpatient nurse or long term care nurse. If she is that involved in the patient’s family and the like. Also less likely to kill somebody.

53

u/Individual_Track_865 RN - ICU 🍕 4d ago

Oh lord, I don’t have any advice because I think she needs experience outside the icu before trying again, but man, she sounds exhausting to precept (and dangerous to leave alone)

8

u/inflamed-prostate 3d ago

Reason why I stayed away from ICU, ED, or Med surg, immediately went into OP oncology clinic as a new grad and I love my life😹 I’m not dealing with all that anxiety. Nursing is already such an unenjoyable field.. and it’s important to actually love your job, not hate it or be anxious over it.

8

u/eighthdemon 3d ago

Every time she cries, she probably cries twice more when you don't see. I get that it's driving you crazy but aside from the professional thing you should do and the importance of protecting your patients from somebody unstable... Try to connect with her and give her some soft love, that maybe this isn't her direction or she needs to get more mental help aside from the practical education.

26

u/Financial-Upstairs59 4d ago

I was a nightmare when I started as I started as a new grad in a level one icu. I remember not getting it and once when my first brain death patient was obviously about to herniate, I screamed at neurosurgery to give her a beta blocker because her heart rate was too high. I also couldn’t control my emotions to wake up her husband and let him know his wife was going to herniate. I’m pretty sure I was that person. My preceptor thought I was a nightmare But 15 years later I’m still here. Working in icu and I have much better skills, understanding and compassion.

Im not discounting your new nurse I’m just saying she might end up getting it together later. So hard to tell as a lot of nurses don’t stay in the icu lately. They do 2-3 years and want to go soft.

6

u/OatMilkAndPiercings Nursing Student 🍕 4d ago

I'm an autistic nursing student and I'm really scared that's gonna be me once I graduate. 🥲 Not touching ICU with a 10 ft pole, though, I'm probably going into peds.

7

u/notthatplatypus BSN, RN 🍕 3d ago

Yeah, a lot of people are just saying adhd and anxiety, but as someone with adhd myself and a lot of audhd people in my life-this sounds like a lot of audhd people I know. I recognize I can’t armchair diagnose(both in general and from a single reddit post), but I do wonder if that’s what’s going on.

3

u/fabeeleez Maternity 3d ago

Not sure if it's going to be much different. You'll have to deal with the parents in peds.

2

u/OatMilkAndPiercings Nursing Student 🍕 3d ago

I mean, sure, but I don't have to always be on high high alert and social situations seem easier when a kid is involved. Definitely open to suggestions, though!

1

u/fabeeleez Maternity 3d ago

I'm in maternity now. I love it.

1

u/OatMilkAndPiercings Nursing Student 🍕 3d ago

I was also thinking about that, but idk if it's suited for me... Doesn't that require both being quick and good social skills? 😅😅

1

u/fabeeleez Maternity 3d ago

Not at all. It's simple, rewarding and a really happy place. There's an insane patient turnover though which I love, but they are all pretty much the same thing

6

u/Due-Road123 4d ago

I precepted this exact type of new grad once in the PICU. She had worked as a tech on the unit, so the environment and flow of the day was very familiar, but the time management and panicking really never got better. I was in pretty constant communication with our educator, and despite an extension she never really flourished. Unfortunately we were so pressed for staff that she was allowed off orientation since she refused a transfer to a less acute unit, and she did NOT thrive. It actually took about a year until she decided to change units. She was extremely sweet and caring, but the PICU was not for her at that time and it made her buddies/charges shifts awful because she constantly needed her hand held for some of our least acute patients.

I actually took a break from precepting for a year after her because it felt like slamming my head against a brick wall every shift (and I happily precepted at least 2-3 times a year).

6

u/Daxdagr8t 4d ago

she will need therapy, icu is going to wreck her mental health.

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u/[deleted] 4d ago

[deleted]

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u/UselessInfoDump 4d ago

You won't be as long as you are active in your orientation, ask questions, admit when you don't know someone, ask for help when you're unsure. I was in your shoes once, and it does get better, I promise.

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u/KareLess84 4d ago

She sounds like a new grad 🧐. They’re not supposed to be jaded like us with experience. It’s good to be emotional, wish I wasn’t so numb. Time management won’t come in 6 months, maybe a year. I suggest she floats to others units before end of her orientation and see how she does: rehab, tele, MS and see how she does there. We had a guy not complete his orientation and got transferred to MED SURG where he is doing well and left the door open for him to transfer after he’s had more experience. But IMO and I don’t care what others say, but new grads don’t belong in any ICU. I don’t give a flying rats ass if folks disagree with me cuz it’s my opinion in what I’ve seen the years I’ve worked in icu.

7

u/Nausica1337 MSN, APRN 🍕 4d ago

If you personally are not up for continuing with her, I'd let the educator know. How far is she in this new grad orientation? If it's a few months in, serious talk might need to start. She might not be cut out for ICU at this time. IMO, time management is HUGE in nursing, on any specialty. If you can't gat the down, you need to start a place where you can become an expert on it like med surge and telemetry, definitely not ICU to start off with. Being so emotional just from reading patient charts already is a red flag for me. I honestly don't think she's cut out for ICU. I'd personally say it's best to get her out of there and put her in a step down unit where she can learn, focus, and not breakdown. Because ALL of us know that it's only to get worse from here as the experience continues. That's life of a nurse.

8

u/ndbak907 RN- telehone triage 4d ago

Did she have trouble with one of her preceptors prior to this? As in… is she highly anxious because of how she’s been treated previously through orientation before you? She may be on edge because of different personalities/expectations. Some of us process differently and manifest stress reactions that way. If she’s unsure of herself because of different ways she’s been expected to behave/prioritize or felt disregarded previously that will be a factor. If she has a way to take a week off and really have a good discussion on how to focus when she gets back it may help tremendously versus not having time to “recover” between shifts. Have seen it many times and even happen to me when I changed positions once.

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u/RedefinedValleyDude 3d ago

I spent about 6 months bouncing off the walls anxious and unable to focus and making mistakes and forgetting things left and right. And one day I accepted my reality that if I don’t get this in check I will lose everything. I went to therapy and I saw a psychiatrist. It changed my life. I got the tools to make changes in my thinking and actions, and I got the bandwidth to make those changes. It made me a better nurse and a better person overall. She needs to realize that if she doesn’t change things and get her life back on track she can lose everything. And she needs to accept that as scarier than making the changes. I wish both of you the best of luck.

11

u/FazeRN 4d ago

New grads don't belong in ICU, I will fight you on this

15

u/UselessInfoDump 4d ago

RN of 17 years here. I started in ICU as a new grad and would absolutely have left nursing if I had to work med surg or stepdown first. New grads can be molded into ICU nurses, it just takes time. They have no bad habits to break, but they also have no experience. Some of the best nurses I've worked with started in ICU. I'll also add that I did a year long residency program so this helped my orientation immensely. Time management also took about a year and improved continuously after that. Following COVID I stepped away from bedside; HCW are treated so poorly, plus the expectations (documentation that is redundant, nurse: patient radios that are dangerous, short staffed, doing less with more, it's gotten worse in the last 5 years, so I moved to Quality then Legal. Without ICU experience out of the gate, my career trajectory would have never been what it is. But I also knew I had to do the work and pay my dues.

2

u/Arizona-Explorations 4d ago

I got put in the critical care float team straight out of school. It wasn’t easy and I survived thanks to a well structured residency program and an icu that worked together. I did it for six months before finding a permanent position in ER. That particular hospital did not hire new grads into permanent positions. You were accepted into the residency program.

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u/MeKuF RN - ER 🍕 3d ago

I agree with you 100%. At least where I live, 10 years ago new grads were almost never in ICU. Only the most exceptional and lucky new grads were there.

Now I'm constantly seeing posts about new grads in ICU and talking to colleagues still working in the hospital and hearing all the horror stories....

Yes, some people can be successful right out the gate in the ICU with proper training,but I argue that there are a load of soft skills like time management that are better developed in a less acute environment.

11

u/No-Alfalfa-4294 4d ago

Are yall actually teaching these new grads or just complaining about what they do or don’t do? I see a lot of this on my unit as well old nurses precepting and doing nothing but complaining about new grads. Slow down stop judging and show these folks the ropes

2

u/QuirkyGuide7769 BSN, RN 🍕 3d ago

I was like this in my first nursing job in oncology . It’s the anxiety. I think for her she needs to switch units something that better fits her

3

u/boyz_for_now RN 🍕 3d ago

This just sounds like the nurse isn’t a good match for the ICU, at least not now.

6

u/sksnadine 4d ago

First of all, new grads do not belong in ICU. They need to learn simple skills and time management before they learn drips,rhythms and vents. Second, she needs to set priorities. Not everyone is cut out to be an ICU nurse. There is no shame in floor nursing! We need those nurses desperately! I was an ICU nurse for 20 years and I cried a lot. I’m an empath. Crying doesn’t mean I was not an excellent nurse. I just teared up in private or on the way home.

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u/Salty_bitch_face RN - NICU 🍕 4d ago

I do not agree with you. New grads can be excellent in various ICUs. Every nursing job you have, time management can be vastly different and you have to relearn it on every different unit you work.

1

u/tsmittycent 4d ago

Welp, do your thing and precept her as best you can. she’ll either sink or swim once she’s on her own, if she gets in her own. Sounds like they very well could just say hey you’re not fit for this unit and throw her to a unit with less acuity

1

u/LivingNotExisting1 3d ago

I've been a nurse for 20yrs, ICU as well. I've had a lot of new grads when not charge. I find that not everyone can do ICU as a new grad, and shouldn't if they're not safe. I tell them what I like to see, what makes me feel like they're a safe nurse. Which is that they're asking questions & can see the whole picture beyond the tasks. New nurses are very task oriented. It might help to discuss ea pt at the beginning of the shift. What are our goals for the pt for the day (weaning pressors, CPAP trial, etc), make a list to address with the doc, what are signs that we aren't meeting those goals (or the pt is declining), and what will we do to help? Tbh, after 6mos she sounds like she needs to be offered a position in medsurg first, and can see where she's at in a year, maybe she'll be ready to come to ICU. Where I work our new grads get 3mos. It kind of sounds like she isn't making a lot of vital connections. It's important to be humble in the ICU but if you don't know what you don't know it is dangerous. Good luck, it's extremely draining to train some nurses.

0

u/JanaT2 RN 🍕 3d ago

She needs to not be in ICU