New nurse in ICU (floating to all)
- 0Jul 2, '12 by khatfieldI am a recent nursing grad with no previous experience with critical. I now have a job in which I float between four ICU's.
How can I quickly gain confidence and make the most of what will be constant learning? I want to know everything possible so I can provide outstanding care to my patients. I don't want to keep questioning if I'm even cut out for this.
I guess what I want is tips, tricks, and resources that helped others.
- 0Jul 5, '12 by Bec7074What kinds of ICUs are you floating too? Is each one a different specialty? Give more specifics about what types of ICUs you are going to and how often you will be rotating around and maybe that will give us some insight to help you. Do you have any prior work experience? Did you do an ICU clinical or preceptorship in ICU?
- 0Jul 6, '12 by khatfieldMy hospital has neuroscience, SICU, MICU, CCU, and burn ICUs. I am in the ICU float pool so I am fair game to float to wherever needs help. I could spend 8 hours in SI, followed by four in MI. The next day I may be in burn.
My only nursing experience, besides clinicals in school, comes from 7 months in an outpatient surgery floor. I'd admit patients, care for them post op, and discharge them home. It wasn't a ton of experience that I can translate to critical care.
My concerns are learning all the new information and being comfortable with things. Vent settings are difficult at times. I feel like it's little things that I should already know: abg's, drips, all diseases... I just got of orientation but feel dumb for not knowing everything already. Everyone says it's better to be nervous and ask questions than pretending you know everything, but I want so much to be a great nurse.
- 0Jul 6, '12 by umcRNI hope you're getting a REALLY good orientation (like 4-6 months). I was a new grad in NICU with 6 mos orientation and then tx to CICU with 4 mos orientation and even with my experience (and previous floating to that unit) I really needed that orientation. As a new grad I think ICU is totally do-able if you're well supported and educated but float pool seems like a whole other ball game.
And never, EVER hesitate to ask questions in the ICU, no matter how dumb it may seem. It could be the difference between life and death. 3 years in ICU and I still ask questions on a daily basis.
- 0Jul 7, '12 by Bec7074I do think float pool is a whole other ball game depending on your facility. I was a new grad just 3 short years ago and now is such a vulnerable period for you. But a lot of times all you need is confidence during this time. As long as the units are good to you and don't give you the really "neuro-ish" (ICP monitors and such) patients and CCU doesn't give you really cardiac-ish patients (fresh open hearts and balloon pumps) you should be fine. My advice would be to not be hesitant about saying if an assignment is too much for you or makes you uncomfortable. At the same time you want to learn stuff, but some units look at float nurses as "they're here to help US." how was your orientation on each unit? Did you do most of the care independently?Have you done admissions alone yet??Hopefully you spent quite a bit of time on each unit to get comfortable with the type of patients and staff. Support is key. I've never worked resource, but I do get the impression they are more independent and don't have the same camaraderie as us. Our ICU resource team has to have 2 years of ICU experience so I am surprised but it doesn't mean you can't be a good nurse. Another suggestion I have is to begin studying for your CCRN certification. You won't be able to take the exam until you've been working for almost a year in ICU, but learning the material will make you a better nurse and will def help a ICU floater! That I promise! It may seem overwhelming, but it doesn't sound like you've had any situations that you couldn't handle right?
- 0Jul 7, '12 by khatfieldWe were only given a month in each unit so that's not the longest orientation. I've never been in a bad situation at this point. The units are all very good and very supportive. I'm always asking questions and someone is always around to help if needed.
Assignments have been pretty standard. Usually not very heavy patients. I get sedated, vented patients, overdose patients and patients that are about ready to leave the unit. I don't often get a lot of drips. When I do it's usually amio, which we don't do anything with, and sometimes levo.
My goal is to be able to take any patient and know what to do with all my drips, which ones to wean first, and basically be able to see problems before they occur. I've tried looking through old nursing books but there isn't a lot of critical care specifics in there. I'm looking for books I can really get something out of.
Another thing that's been suggested is to not only know my drips but to also know why and how they do what they do. I've been told to know the receptor sites (alpha and beta1&2). I've also been told to really know the renin-angiotensin process. If anyone has a very simplified way to explain receptors, RAS, and drips, I'd love to hear it!
Is the CCRN book expensive?
- 0Jul 7, '12 by Bec7074I've been using Pass CCRN. Link on Amazon here:
Amazon.com: Pass CCRN! (9780323025928): Robin Donohoe Dennison DNP RN CCNS CEN CNE: Books
Kinda mad about the price haha. I paid 80 and now they have it for 45 with free shipping. It is not only great for the exam (it comes with a CD with lots of practice questions that are great for the test) but it's a good reference book. It also covers all the critical care pharmacology you could ask for. They have a chart with pressors and what receptors they affect (alpha, beta, dopaminergic). I would say knowing all the different types of shock is a major thing for working in ICU too (hypovolemia, cardiogenic, neurogenic, and distributive (sepsis). Of course, it is all covered in this book. It's great too when you have a patient and go home and read that part of the book. I find that the information really sticks then because I can picture my patient!
I think it sounds like you are doing fine. Nursing is a life long learning process. I've told this to other new nurses on AN, but when I started in ICU, I would take home the report sheets (On my unit we have a little packet that covers basic info on every patient on our team including procedures, drips, etc) and I would highlight and look up drips, procedures, even conditions in their health history I was unfamiliar with so that I would be proficient the next time around. I hated not knowing something, or having a patient where I didn't understand what was happening. It sounds like you are motivated to do well. And because of that, you will!!!