Advice for a New Burn ICU Nurse

Specialties Burn

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Hello all,

I am a fairly new nurse with 1 1/2 years of experience of general pediatrics mixed w/ some trauma-surg overflow at a level 1 Children's hospital. I was just hired into the BICU at Parkland in Dallas and am very excited, but am feeling a little overwhelmed as I do not have either critical care experience or adult/burn experience. I am going to be out of my element for sure other than the fact that they take pediatric patients as well! To any and all, what is your advice for a nurse going into this highly specialized specialty and do you have any clinical text recommendations for me to brush up on before the internship begins? Thank you!

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Specializes in CVICU, MICU, Burn ICU.

Welcome to Burns! Hopefully your burn center will suffocate you with clinical education regarding burns. I know mine did, and it was GREAT. Also are they putting you through some sort of critical care internship? That will be necessary before taking on any CC patients, peds or adults. But your peds experience is going to to go a long way.... it's hard to find clinicians with both peds and adult experience, but many burn centers do both. You can check out the American Burn Association website. There are plenty of articles on there that you can get access to without being a member. The other thing is, every burn center does things a little differently. Some have their own formulas for resuscitation for instance. Wound care looks different at different places.... how often and extensive are the dressing changes? There are differing philosophies about this. You said BICU, so looks like only critical patients? I seriously doubt they will set you on the ground running before getting you ready. What will your orientation look like? I think since you don't have critical care experience, my main advise will be get your hands on some critical care texts. One for peds and one for adults. I say this, because a BICU is not like other ICUs in that (depending upon specific practices at your unit) you will not frequently see a lot of the same kinds of "sick" that you see in say a MICU or CVICU. But golly when your burn patient starts having an MI or renal/liver/heart/whatever failure you better know what to do. MICU and CVICU nurses practice that kind of nursing everyday, but that is not necessarily true for BICU nurses. You might see a swan once a year..... but you need to know what to do with it and have a good understanding of hemodynamics. You need to know blood gasses, and you might not have that competency yet, but you will FOR SURE need it in the BICU. Hemodynamics, lab values, blood gasses, normal hemodynamic ranges for BOTH peds and adults..... these are things they will probably go over but its up to you to get em in your head somehow (and know what resources to use when you don't have them in your head). Drugs. We use a LOT of narcotics. Ask your unit for a copy of the peds and adult fluid resuscitation guidelines just so you can kind of familiarize yourself a little before an admit rolls in. Again, they aren't going to throw you to the wolves. You'll learn what you need to and it will take some time, and hopefully you have a great team to support you -- which every burn nurse needs regardless of experience. A couple of books I personally like for ICU nursing: Note on ICU Nursing (this is free online, but you can buy a hard copy off Amazon and its very informally written and easy to read. And - Care of the Critically Ill Child. There is that big burn text.... Total Burn Care. Nice to have that on hand and your unit might have a copy. Also your ACLS and PALS texts (I especially like the PALS one) are great references. I'm sure others have more helpful stuff to tell you, but maybe this will get you started. :)

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This was so incredibly informative! I am a nursing student interested in working in the BICU at NYP/Weill Cornell. Hoping I can get my Capstone there this fall, and this was such a great post to prepare myself if that happens. I looked up some of the books you recommended and everything lol

@bent1993 Did you start yet? How is it going?

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The burn unit is why I didn't go into Peds. I couldn't deal with kids in such agonizing pain.

Somehow I had gotten the idea that general anesthesia was being used for dressing changes in this modern

era in which we now live, but I think that is not really true. Dressing changes are still savage events,

multiple times, every single day, for months and months.

So try to be prepared for the emotional realities of the Burn Unit.

Best wishes. You will likely handle it better than I did.

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Specializes in CVICU, MICU, Burn ICU.
The burn unit is why I didn't go into Peds. I couldn't deal with kids in such agonizing pain.

Somehow I had gotten the idea that general anesthesia was being used for dressing changes in this modern

era in which we now live, but I think that is not really true. Dressing changes are still savage events,

multiple times, every single day, for months and months.

So try to be prepared for the emotional realities of the Burn Unit.

Best wishes. You will likely handle it better than I did.

I will say, I wouldn't call dressing changes savage events. Many centers are doing them only QD now (as evidence shows cost/benefit of QD is appropriate), and we use pain meds appropriately. Sometimes this means conscious sedation. Burns are painful, yes. And our goal is NOT pain free b/c that is unrealistic and the results of pain-free philosophies have given us the opioid epidemic we have now. But we do the best we can. Dressing changes are hard, but not savage.

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