New Grad working in a level one Trauma Center...Few questions - page 2

by francoml

3,594 Views | 15 Comments

I just got accepted into an internship in Trauma/Surgical ICU!!! It is at a level one trauma center in Texas. I am excited but nervous to start because this is a regional trauma center, 200+ new graduates applied for this... Read More


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    Quote from francoml
    Thank you for the advice!!! I will definitely be getting that TNCC book. I have a 13 week internship that will be a mix of 1:1 patient care with a preceptor and critical care classes 1-2 x's a week. I know 13 weeks is not enough to learn everything but I hope it is enough to give me a base to work from. Also I LOVE the team atmosphere of trauma and I plan to ask about 10,000 questions. One more question, How long did it take you to feel comfortable on your own??

    Some of you have heard me tell this story before. I was several years out of school and had been staff in this fabulous ICU for three, and I was actually pretty good at it. One day I was in the break room with Sarah, a nurse of more than a decade's experience in the unit, one who could take every kind of patient that rolled up the hall, who was never flustered, always expert, always willing to teach and explain. I asked her when I would stop feeling scared when I sat in report. She smiled and said that every day before report started she felt a pang of anxiety, but that it passed when she started working. She said that when that little stab of fear went away she would have to go somewhere else, because it's what keeps us awake and sharp. I never, ever forgot that (and here I am telling that story again, smumble-mumble years later), and I am happy to pass it along to you.

    Congratulations! This will be a great experience and you sound like you have a good attitude going in.
    jrose17, francoml, Sun0408, and 1 other like this.
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    Quote from francoml
    Thank you for the advice!!! I will definitely be getting that TNCC book. I have a 13 week internship that will be a mix of 1:1 patient care with a preceptor and critical care classes 1-2 x's a week. I know 13 weeks is not enough to learn everything but I hope it is enough to give me a base to work from. Also I LOVE the team atmosphere of trauma and I plan to ask about 10,000 questions. One more question, How long did it take you to feel comfortable on your own??
    Will they be offering you a position after the internship? Some do not....and they can decide at any time during this process you "aren't a good fit".

    GrnTea is right......even after 34 , soon to be 35, years in critical care, Emergency medicine, trauma flight....I can start an IV upside down in a car at 2am in a blizzard while maintaining C-spine and intubating......I still get that "Oh, Crap I hope I'm good enough" feeling in the pit of my stomach. I think fear of making a mistake, maybe not being good enough....gives you that edge to make you better.

    I have never stopped reading, learning researching....trying to make myself better because for me..... anything less in unacceptable. I think TNCC is a BIG plus for trauma nursing and understanding how to care for a trauma patient. This is a multi-system injured patient that will encase all body systems at one time....heart, lungs, kidney, bone, head.....this is a specialized population that are critically injured and critically ill.

    13 weeks is a good start....but there is much more to learn. Your first year after graduation is overwhelming in the best circumstances and as a new grad will be overwhelming at times. You will be a new grad and a new ICU nurse at the same time....while it is possible it is a daunting task you have ahead of you.

    HouTx is right.....be humble and be willing to be corrected.
    Most important - drop your defenses & receive all critical feedback as it is intended - to help you develop your own skills and expertise. Be open to criticism & modify your behavior accordingly. Take up the slack by moving in to assist others when you're caught up. Be respectful. NEVER say anything negative about any of your co-workers. Sure, Suzy may be putting Joe down, but if you join in she's may be the first one to relay your comments to Joe.
    I have given you some references to study in the meantime about critical care in general. It will be a ton of hard work. You will need to be highly organized and focused. ICU nurses are very OCD and anal retentive to detail.....that is where they find safety. Here are some brain sheets that you might use at first to organize your thoughts.....or to take report on to get your thinking focused.

    Critical Care Medicine Tutorials
    index
    http://drkamaldeep.files.wordpress.com/2011/11/iv.pdf

    But still...have fun! Don't forget to breathe! Good Luck.....we are here for you!!!
    Sun0408 likes this.
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    Yep, my first jobs were in critical care units, too (I'm just a wee bit older than Esme). I loved knowing how and why things worked, and that's a great habit to get into when you are in a highly knowledge/skills/judgment-intensive area.

    When I wondered howcum we gave open heart patients nitroprusside to drop their BPs and dopamine to increase them at the same time, I learned that increasing inotropy with dopamine (contractility) in a sick heart wasn't a good idea unless you decrease afterload (with the nipride) at the same time, to decrease the heart's workload at the same time you're increasing its oxygen consumption with the increased contractility. Cool, I said, and it opened up a lot of avenues for understanding.

    When I wondered what the peak pressure on the vent was supposed to mean to me, I learned about pulmonary compliance (stretchiness) and how it goes away with interstitial fluid, inflammation, fibrosis, and other things, and how, if I looked at the ABGs on the same flow sheet, I would see those change together over time. I also learned how to recognize a pneumo and to watch for it if peak pressures were creeping up and up and up and up.

    When I wondered why setting up the transducers had to be done just so, I learned about intracardiac pressures, and preload ... and that made me remember inotropy and afterload and contractility, and I put together why the Frank-Starling Law of the heart was something to think about every day.

    I learned why to laugh at the joke that says "Dobutamine is just half-strength Isuprel." I learned not to ignore that teeny, itty-bitty bit of new red blood in the NG drainage; I learned how sepsis worked. I learned how to jury-rig things so the patient benefited without compromising safety or accuracy. I learned new things all the time. I loved that stuff.

    You can have a lot of fun in a good ICU.
    Mully, ataymil8, and Sun0408 like this.
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    This will be helpful: index
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    Thank you for your input. To answer your question, yes they will for sure hire me after the internship (assuming I don't do something really stupid). They call it an "internship" but I think it is just because there is a lot class time involved. I signed a year contract with them already and they are giving be money to relocate (I live in a different state). My school does our clinical there once a year for 4 days and I have to say they are some of the most amazing people to work with!!!! From the techs to nurses to the directors they are all so humble and I feel like they just want to teach you more and more!
    Last edit by sirI on May 7, '14 : Reason: edit per OP request
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    Its good to know that even experienced nurses still have some fear about patients. Thank you for sharing this with me!


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