New Nurse at Burn Unit

  1. I will be working soon in the Burn unit (Medical Surgical), I am quite nervous since this is a very big shift in my career. I used to work in the dialysis area and now I will be in the Burn unit. Can anyone give me advice on what to do to prepare for it? Can you recommend me any books to read? or what to expect in my work? I would really really appreciate your response. Thank you
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  2. 3 Comments

  3. by   Pixie.RN
    Congrats on the new position! How long is your orientation? Make heavy use of your clinical education staff — they typically love to teach! I think reviewing critical care concepts will be helpful, because we all know they leave the burn ICU and step-down areas sooner than they used to. Coming from dialysis, you know all about fluids and electrolytes, which is huge in this population (along with nutrition for healing). Your unit policies and protocols will also help guide you. Best of luck.
  4. by   iamchloe23
    thank you for the advise! I have 3 days for orientation I am really really afraid of what to do during my first day. I really do not know what to expect since they said that the burned unit is something different
  5. by   marienm, RN, CCRN
    Are you moving from ambulatory/outpatient dialysis to an inpatient burn unit? If so, 3 days does not sound like enough time unless you've previously worked on a med-surg inpatient floor before. If this is your first time on ANY inpatient floor, I would think several weeks of orientation would be in order. (Maybe I'm unrealistic? I started on my Burn ICU as a new graduate nurse and had 20 weeks!)

    Anyway, stuff that I think might be unique to a burn unit-

    We give a lot of pain medicine. Lots. Learn your narcotics policies and procedures regarding signing them out/wasting and also how to give them (can you give them by IV push? how fast? etc...). We use ketamine gtts sometimes (mostly for vented patients, but not always). We're not allowed to push ketamine but we can run/titrate the drip (just as an example). MDs can push it for a procedure at my hospital.

    Dressing changes are time consuming and hard for the patient. Find out when your patients will get dressing changes and who needs to be there- does the surgeon need to see it today? If you do moderate sedation, does a respiratory therapist need to be there? Does PT or OT need to work with the patient while the dressing is off? Advocate for your pt- if the surgeon says "I'm going to see this pt at 1100" and you know the dressing will take 2 hours and the pt will be in too much pain to eat lunch afterwards, get them an early tray, or move their dressing change until later...

    Ask a lot of questions about wound care- what medications are being put on the wound? Why? How can you tell this wound needs Santyl and not just Bacitracin? What dressing products are being used? Why? How are they applied and held in place to allow for range-of-motion?

    I don't know how your hospital works- will you receive fresh burns or just pts who have come off of ICU/Stepdown? If you get fresh burns, Lactated Ringers solution is the most common maintenance IV fluid. Not NS, not D5.45NS, and definitely not anything with potassium added to it unless the pt is known to be hypokalemic. Look up the Parkland Formula and the Consensus Formula (though it's possible your hospital will use neither of them!)

    I hope your orientation goes well! I wish my hospital had a med-surg floor devoted to burns!

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