Words of wisdom for a new grad starting in the ICU? - page 2

Hello! I'm a new grad (Aug '13) and have just passed boards at the beginning of the month. I've accepted a position in an ICU internship beginning in October in a 70-bed ICU at a L1 trauma center and am curious if any of you... Read More

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    I'm not an experienced nurse. I'm a new grad and I've only been in ICU for 4 weeks now, but here are the things I've learned:

    1) Assess your patient right away. It doesn't have to be a complete assessment. Check the IV lines to make sure they look good. Double check what's running through the lines. And check your alarms!! I learned that the hard way. My patient started to desat and the night nurse had turned all the alarms off!

    2) Don't be afraid to tell people that you're new. Sometimes doctors will start asking me a whole bunch of questions, and sometimes you just won't know the answer. Go get your preceptor, and then remember what the doctor wanted to know, so you can look it up next time!

    3) Make a list of the doctors and their specialty. The first couple of weeks, I spent so much time being confused over who was the kidney doctor, and the pulmonologist, and the cardiologist, etc.

    4) Know your labs. We all know whether a lab value is abnormal or not, but piecing it together with the patient's condition is harder.

    5) Most importantly, always ask yourself, "why?" Why are you doing what you're doing? Why are you giving a certain med. Why is radiology coming up to take a chest x-ray? This seems like common sense, but there have been times when I've had to give a report and the nurse has asked me why I did a certain thing, and I didn't know what to say!

    For example, I had a patient yesterday whose entire lower left leg was necrotic. It was awful. It smelled like death. The family decided to switch him to hospice, so we were going to transfer him to med-surg, and I was giving report to the nurse, and the nurse asked me why we weren't just amputating the leg. Well, it was obvious to me just from looking at the patient that he was dying, and that he probably couldn't survive a surgery like that, but why?​ I felt like an idiot.
    bmendi and jalyc RN like this.

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    Congratulations on the start of an amazing career.

    Johnwaynehair has some wonderful suggestions, especially numbers 3 and 6.

    1. Learn all that you can.
    Read up on each condition that your patient has and correlate what you learn to that person. Easier to remember 'Mr. Smith's problems' that just text. Lab results mean more when you understand the bruising from DIC. Xrays are easier to read when you see the hairline fracture because you looked harder due to the swelling at that site.

    2. Volunteer for any and every opportunity to participate in something new.
    You can learn a lot from side comments during tests, ect. and ask more about reading Xrays, interpreting labs, observing symptoms while they are happening. Techs can be a wealth of knowledge to new nurses.

    3. Take that extra minute to breathe, to think, to calm down, so you can respond appropriately.
    Don't be like me replying to bystanders that my friend who was passed out on the median after an auto accident "... is fine because she is a nurse." She WAS fine, but us being nurses had nothing do with that. lol (Immediately after that comment, I checked her pulse, etc. duh!)

    4. NEVER be afraid to ask questions or to admit you don't know something.
    Everyone has to learn things. As a new LPN in CCU 40 years ago I once asked one of the founding doctors of our hospital why we would do q4h V/S on a fresh cardiac through the night if they needed so much rest. The head nurse and all others were freaking out behind his back. "NO!!!! He is DR. D!!! You don't ask him questions like that!!!!!" He took off his glasses, looked at me for a minute or two, then started explaining how the heart works and how low B/P affects the kidneys,in turn how kidney function affects the B/P, etc. etc. etc. Thirty minutes later I had an encyclopedia of knowledge that I did not have before.

    5. Don't let negative people or experiences get you down.
    Move on and above them. As a new grad, I worked the county hospital in L&D and we did our own C-sections. The first one I did the doctor exploded to my head nurse after to NEVER put me in with him again. I worked hard to learn the instruments, how to assist, what to do and QUICKLY. A month later we had an abruption come in. Baby was out in 10 minutes from getting to the ER and she was closed in 30. The same doctor, when now praising my work to the head nurse was told, "But you said you never wanted to work with her again." in front of everyone. Things do get better with time and experience. You WILL get there.

    Best wishes for your future.
    bmendi likes this.
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    You are all awesome! Thanks so much for taking the time to respond

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