Tips for New ICU nurses/New Grads in ICU

I wrote this in reply to another thread so I just decided to start a new one. maybe other CC nurses can help provide more tips than this or elaborate on what I have said. Heck, I haven't had even nearly the amount of experience that some of you out there have, but I feel i have some insight to share

I was exactly in your shoes three years ago. Here are some advice and tips I have that may or may not work for you....
1) try to get your practicum or leadership course with an ICU nurse. Exposure i think is key.
2) don't ever throw your critical care courses notes away. You never know what kind of training you are going to get from a facility so keep them. You don't always get the same kind of patients and generally icu beds are non-discriminatory esp. if it the last icu bed avail.
3) of course not only know all your drips (make cheat sheets in a note book, and I made one to go on my badge as a quick reference of the dose ranges for the drugs and how they are given:
ie. mcg/min, mcg/kg/min, mg/min, units/min, units/hour... etc.
Ask the nurses where you work what are the typical drugs used. The fist ICU i worked in was CICU, then I oriented and picked up in CVICU. The drugs here are pretty similar. THen i moved, and now I work in a Trauma surgical ICU-where the meds, situation are completely different for every patient because every scenario is different.
4)Get your ACLS.
5) If you are having a code situation. Watch. Be the recorder. Do not be the person to push or pass drugs. ONce you get acclamated to the crash cart its contents and what the drugs do.
6) Try to find a hospital that offers critical care classes to nurses transfering to ICU or new nurses. My first job, on top of my orientation I had ICU classes. We did cardio for several weeks, resp., GI/GU, Neuro, then we did a miscellaneous equipment class that went over different things like setting up pressure lines, the swan set up in our facility. We were a very large hospital and we had a very sophisticated manequin that they could make do just about anything from increasing his icps and that to him going into vtach it was an awesome thing... (too bad I moved).
7)Don't think you know everything ever! (This is a dangerous attitude) Noone ever does. I learn things new everyday. If you don't get the extremely difficult patients at first don't worry. Get your things caught up and ask the nurses to do to show you something you may or may not have seen or what they need help with.
8) always keep up with your charting. although difficult at first, but i see nurses out there that chart everything at 5 am/pm and rush around at the end of the shift. what if something actually did happen and you had nothing charted. If nothing else, keep a dry erase marker. most icus have glass windows to write on. if you can't leave the room mark events and meds on the glass so you will remember to chart it later when you have a minute.
9) you can do this. many people criticize that all new nurses should do med surg or tele first to get time management skills. my mom has been a critical care nurse for over 30 years. she said the biggest waste for her was going to an intermediate care first. it's a completely different set of time management skills than in icu as well as a completely different set of technical skills. my answer to this is become a nurses aid or tech while you are still in school or waiting to take your boards. this is where you will get good at basic patient care that can take up a lot of a nurse's time if you don't have a lot of experience doing it.
10) always prioritize! almost always one of your patients are generally sicker and more unstable than the other. take care of the immediates right now tasks with the sicker patient ie bp, resp, etc. get your more stable patient assessed and situated, meds given so you can devote more of your time to the needier, sicker patient.
11) always remember as a nurse, it is a continum of care for the patient. if the nurse before you didn't get to it ie. bath, other trivial aspects of care that are not in need of immediate attention. don't gripe just get it done. the icu is 24 hr care and you never know what happened the night before (really sick patients, code, admissions) be nice! pick up where they left off. it's ok to bathe and brush teeth and change the sheets at different hours than a set time. a dirty sheet isn't going to hurt them.... get my drift. THis however does not always apply becuase some people are inherently lazy and leave their rooms in shambles and patients filty. just rise up and do nursing care how it should be done and your care will shine through as a nurse.
12) ASSESSMENTS are the most important part of your career. a thorough knowledgeable assessment is key. if you worry about technical skills rather than a good assessment you are not going to be a good nurse.

If you have any other questions feel free to PM me.

Hope this helps.

Jamie

:yeahthat:

Well written. I'll offer two more recommendations that apply in all nursing units but particularly critical care.

1. Remember that you are part of a team; don't hesitate to ask for help because your patient can sink in seconds. Also, don't hesitate to offer help.

2. Remember that while your patient is central to your focus, he's not alone (hopefully). Include his loved ones in your care because they need your attention, too.

Good luck,

R