So just got transferred into my hospital's ICU after 5 years on the med surg floor. It's been 2 years since my hospital offered a critical care course. I am so glad I got accepted out of about 20 other applicants, but I can't believe how nerve wracking it is for me right now!
I've never been the type to dread coming to work or cry or anything like that, even when I was a new grad, but this is my first week of ICU orientation and I can't sleep! I feel like I have a knot in my stomach all the time. Every night I just lay awake and worry about all the things I have to learn. It doesn't help that I've worked nights for years and now I'm orienting on days, but I know I can handle it at least until I get off orientation and go back to nights.
The good news is that it seems to be a very supportive environment, which I knew already from past experience whenever I've had to transfer a patient to ICU or call rapid response. The orientation is 3 months long and I think that's a good length of time. My first day on the unit was last Tuesday and I really like my preceptor. She's got 30 years experience and is very calm and knowledgeable. We get along great, we've both got a sense of humor and we laughed a lot. A lot of my fears were relieved just being on the unit and seeing what the routine is like. It was familiar in a lot of ways. Assessments, meds, calling docs, documentation, turning, cleaning, more documentation, etc. I already know the computer system and the charting is pretty much the same. I'm also trying to seek out all the learning opportunities that I can. I went with the RR team on a call to the med surg floor, observed a therapeutic hypothermia code, and asked the RT to help me understand a little bit about vent settings. It was a good day, but I'm still really nervous. I'm so glad I've got the experience I do, I can't even imagine trying to do this as a new grad.
Any advice for me? Will I ever stop feeling like a big ball of nerves? Please tell me about your experiences and what it was like for you just starting in ICU!
I've been an ICU nurse for 14 years, and the biggest advice I can give both you KayteRN and Sweet~Revenge, is to relax and breathe. All of the feelings you both are expressing are 100% normal.
@ Kayte...if your having time management problems, make lists. Cross off your list when that task is done. Add to the list as problems/issues develope during your shift. It will help you organize your thoughts, and be able to prioritize by being able to see it with your eyes. I prioritize by most dangerous/detremental to least. If the pt's levophed has 30min left before it runs out, that takes higher priority than trying to unclog one of the ports in the PICC line. Another thing, be flexible. That list changes constantly in my head throughout the day as issues surface. If your having trouble sticking to your routine, write it down. I work with several girls who actually write down their whole day in 1hr increments on a piece of tape and attach it to their desk, and write in the 9am spot for meds, 10am bath, 11am chart etc etc. If your forgetting to grab flushes and alcohol for med time, keep a stash in the room or in your pocket so you'll always have them, and not wasting time running back to the med room. If you don't know where to start as far as routine, ask the people you work with or your preceptor what times they do things, and write it down and adopt it as your own. Over time, you'll be able to modify this to match your own work style, and before you know it, you'll be what I call "On It".
When calling the doctor, 1st, remember that 90% of them are very nice human beings, and appreciate being called when there are issues developing with their patient. It is ultimately their responsibilty to care for the patient, and part of their job to get paged at all hours of the day and night. They know this, so don't be intimidated to call when your pt needs something. A couple of things I suggest you have in front of you before you call, is the pt's most current labs and med list, as well as the chart. You'll earn the doctor's respect when you are prepared and not wasting their time on the phone because you have to log into the computer system to look up that mornings calcium level.
I also suggest getting a book "Fast Facts for Critical Care". I love my little navy book, as it's packed full of useful information on critical care drug drip calculations, how to set up a CVP, how to shoot Cardiac Outputs, ACLS algorythms, just anything you could ever need to look up while at work. And it's all there at the tip of your fingers.
I hope this helps ease some of your fears/anxieties. I wasn't a confident "on it" ICU nurse when I started, it takes time. Learn from your mistakes, but don't loose sleep over them. At the end of the day, the pt is fine and so are you.
Last edit by Zenrn73 on Jun 24, '12