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

[francoml]

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 position and I was one of the lucky 20 who where hired. I know there are a million and a half things I need to learn but from an experienced ICU nurse, what are 3 or 4 things I should know going into this position? What are your opinions of new grads working trauma??

Oh and as a side note, to all the students out there... Don't let anyone tell you that your cannot do something! Everyone told me there is no way you will get to work T/SICU as a new grad! Dream big and fallow your heart!!!

[nurseprnRN, BSN, RN]

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.

[andrew.youv]

This will be helpful: index

[francoml, ASN, RN]

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!

[francoml, ASN, RN]

Its good to know that even experienced nurses still have some fear about patients. Thank you for sharing this with me!