Tips for a struggling new grad

Hello everyone. I’m a new grad ICU nurse. I’m 8 weeks into my orientation and I’m really struggling. I started out with two preceptors but my main preceptor was pulled to orient another new grad. My main preceptor now is a little rough around the edges. She leaves me to take on the assignment and pops in with little remarks or questions. I don’t mind being given the space to do things on my own but there have been a few times where I felt like I needed a guidance and she’s just not there. I feel like I have to remind her how new I am and just how much I haven’t seen before.

Last week we were trying to extubate our patient with no success. I had only ever extubated one other patient and it was smooth as butter, which I kept telling her. She did help me out a bit because he was really fighting and trying to pull the tube out. But she wasn’t really telling me ways I could manage him to make him a little more comfortable during the process.

And then another situation. We did extubate a patient, she was really anxious the entire time. From taking her off sedation, to extubating her, to placing her on bipap. The entire time she was anxious, restless, and tachycardic. I was able to reorient her and calm her down when she started crying but she wasn’t tolerating the bipap at all. RT switched her to NC after a couple hours on Bipap and she was doing ok. Still tachycardic and anxious but she was alert and oriented, she was maybe a little confused about what happened and why she was in the hospital. But she was talking to her family, thanking the doctor and god for saving her. She started having complaints of discomfort and I’d reposition her ask her a bunch of questions and she’d say her feet hurt, or she was hot/cold. She said something was on her butt, which she did have a BM. I wasn’t thinking too much of it. My preceptor went to lunch around the time the patient was switched to NC. When she came back I talked to her about how our patient was restless and uncomfortable and I didn’t know what to do. Vitals were stable except for being tachycardic which she had been since we took her off sedation. She told me to go talk to the doctor. So I talked to the doctor and he said I could start her on precedex and in the like 5-10 minutes that took she got extremely agitated and was ripping off the blankets, her face got really red, and then she was unresponsive. She ended up being hypercapnic and we put her back on bipap which pretty much fixed the problem right away. Within 10 minutes she was responsive again.

I felt pretty awful for not doing something about it sooner. Thankfully my patient was ok but I just felt so unprepared for that situation. And I do wish my preceptor had been checking in to make sure everything was ok. Even after a few hours on bipap she was still tachycardic and anxious with complaints of discomfort. I kept bringing it up to my preceptor but she said it was fine. I’m just so confused.