Cultivating Confidence as a New ICU Nurse
I remember starting in the ICU and questioning my decision. I wondered if I would ever “get it.” I’d compare myself to more experienced nurses and be amazed at their ability to almost glide through the steps of setting up for intubation. They moved effortlessly in the most chaotic situations.
Meanwhile, my hands would shake drawing up etomidate and rocuronium, and I am pretty sure I went into SVT when my patients did.
My confidence was at an all-time low, which was a really weird feeling considering I had always been a confident overachiever.
Sound familiar? You are not alone! Being comfortable and confident (because they are not the same) takes about 1-2 years for new ICU nurses.
During that period, you have stepped onto the most unique rollercoaster ride you will ever experience. Highs, lows, fear, excitement, I am going to throw up, get me off of this, I love this, and let’s do it again!
I was so frustrated by my lack of confidence. I kept asking: how can I fix this, and when will I finally feel like the badass nurse I strive to be?
Little did I know that spending all that time worrying about my confidence was stealing my limited energy from the real solution that helped me feel more confident.
The myth: You cannot control your confidence. There will be moments in your career when your confidence is at a critical low needing to be resuscitated. Nor can you control how quickly you start to feel more confident when presented with a new skill, concept, or clinical scenario.
The secret: Even experienced nurses have moments when they feel uncomfortable or lack confidence, but you would never know that because they always seem to do things *effortlessly*.
With over 15 years of Critical Care experience, I can tell you that I have had moments where I stepped right back on that rollercoaster ride. Like the first time I cared for a patient with an EVD, when I pulled my first set of chest tubes from a post-op CABG patient, or when I taught hundreds of nurses at NTI about the Diamond of Death.
You don’t need a bolus of confidence to be a badass ICU nurse. You need sustainable actions that support you in moments when your confidence is critical, such as the following:
Master the ICU Foundations:
You cannot build from an unstable foundation. It will not make sense why certain vasoactive medications are used with specific clinical situations if you don’t understand the foundational concepts of pharmacology.
Additionally, your foundation must be solid to withstand moments when things are shaky or chaotic. Working in Critical Care is like standing outside during a hurricane. Unstable foundations will crumble, while solid foundations can withstand the high winds.
Experienced nurses constantly rely on their base to guide them when unsure or presented with new situations. They don’t know it all; they just developed their practice from the ground up.
Learning on the job isn’t enough. You’ll need to take time outside of work to deepen your understanding of critical care concepts such as hemodynamics, common continuous medications, ABG interpretation, and ventilator basics. From there, focus on standard procedures that cross all ICU settings and any unit-specific disease processes.
Shift-tip: Check out my resources or consider joining The Critical Care Masterclass to strengthen your own foundation.
Use Exposure Therapy:
You become more comfortable through repetitive exposure to similar situations, skills, and clinical scenarios. This is how you go from “I have no idea what I’m doing” to “I’ve been here before.” This means you’re being proactive and seeking out opportunities to learn. Experienced nurses are not more intelligent than you; they just have more exposure. Intentional effort turned into effortless.
Shift-tip: Be curious in the unit. Does someone else have something you haven’t seen or a situation you’re uncomfortable with? Ask to participate, watch unfamiliar procedures, ask the “
stupid” questions, etc. Nosey nurses WIN!
Reframe Confidence:
Instead of thinking, “I am not confident,” think, “I’m being challenged to grow in my practice.” Doesn’t that FEEL better?
You don’t need more confidence; you need courage to take <safe> steps when feeling challenged. I promise that whoever you look up to professionally or personally has lacked confidence numerous times, but they were brave enough to step forward. The only way you become more confident talking to physicians and using your voice is by talking to physicians and using your voice (even if it is a little shaky).
Shift-tip: Lack of confidence, which often manifests as anxiety, insecurity, or fear, will always be present when you are asked to operate from a higher level. Knowing this allows you to recognize it, celebrate it, and level up rather than shrink.
The bolus dose:
Your time and energy are short-staffed, so use them wisely. Focus on things that you can control. Establish a solid foundation to fall back on, expose yourself to new situations to keep growing, and take safe steps even if you are scared.
You got this!
More details about me…
- Founder of The Critical Care Masterclass
- Published writer
- Keynote speaker on various Critical Care topics
- Critical Care Consultant
- Trained and mentored hundreds of New Grad Nurses and countless experienced ICU nurses.
- Assisted with opening up a NSICU in 2021
- Developed a structured program for new CVICU RNs
- Lead in developing a Nurse Residency program for Critical Care
- Professionally Trained Coach
- Playing Big Facilitator Alum Coach
- CCRN & TCAR Certified