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

  1. 0
    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 wonderful nurses have pearls of wisdom-- not necessarily what to expect etc as programs vary, more so things you know now that you'd wish you'd known as a new grad? Any advice for a newby is welcome. Thanks!

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  2. 12 Comments...

  3. 3
    Quote from bmendi
    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 wonderful nurses have pearls of wisdom-- not necessarily what to expect etc as programs vary, more so things you know now that you'd wish you'd known as a new grad? Any advice for a newby is welcome. Thanks!
    Be a sponge and don't be in a hurry. It seems to me that the newbies who couldn't get into CVVH and IABP fast enough, were the first one's to burn out. Sounds like a huge unit and probably has plenty of patients who are 'sicker than snot'. Just pace yourself. Good luck!
  4. 1
    Quote from Biffbradford
    Be a sponge and don't be in a hurry. It seems to me that the newbies who couldn't get into CVVH and IABP fast enough, were the first one's to burn out. Sounds like a huge unit and probably has plenty of patients who are 'sicker than snot'. Just pace yourself. Good luck!
    I can't like this enough. I agree wholeheartedly. I feel my edges getting a little burned out from taking the 1:1 sickies. I love to take care of them, but I see the nurses who were raised this way and see how much they dislike their job. I've gotten a break lately, and feel slightly more energized.
    bmendi likes this.
  5. 3
    Some tips: don't hurry ANYTHING. Even the scariest moments, you can take a second to breathe, and check what you are doing.

    A nice quote:
    "Listen or your tongue will make you deaf."
    jalyc RN, antania31, and bmendi like this.
  6. 2
    Be positive.
    Pace yourself
    Ask Questions, be teachable.
    If your asked a question and don't know it, admit it, ask them to teach you, tell them you will find the answer, then ask them if there is anything you missed.
    Read up on the patients you are seeing.
    Try to work harder than anyone else there,impressions matter.
    Its a competition.
    Be Positive.
    Be on time.
    jalyc RN and bmendi like this.
  7. 2
    ALWAYS put your KVO pump (for antibiotics and other IVPB drugs) on one side of the bed, and put all other IV drips (vasoactive drugs, insulin, sedation, anticoagulation, etc) on the other side of the bed, or at least somehow separate the KVO pump from all your other pumps.
    One time I took over care of a patient that had the KVO pump and a Bivalirudin pump on the same IV pole (these weren't smart pumps, they were the kind where you have a plus/minus below each digit on the screen and you adjust/bolus the drips that way). Vancomycin was due, so I hung it piggyback on the KVO pump and set it to infuse 200mL over an hour. I came back an hour later and noticed that the vancomycin bag was still full and the Bivalirudin bag was almost completely empty. My heart sank into my stomach when I realized I had just made my first med error, and it was a huge one. Instead of programming the KVO pump, I accidentally programmed the Bivalirudin pump to bolus 200mL in an hour when the normal rate was like 3mL/hr. I thought the pt was going to die.....long story short, I was the happiest RN on the unit the day I saw that pt discharged well & alive.
    Advice: separate the KVO from other infusions, slow down, take your time when giving meds and double-check your work.
    jalyc RN and bmendi like this.
  8. 0
    Thank you all so much! It means the world and I hope to put your advice to good use soon
  9. 2
    Take time to organize your patient and room at the start of every shift after report.

    LABEL YOUR LINES!

    Check everything for yourself:
    - pump settings and what they are infusing.
    - drains/wounds
    -alarm settings
    -etc

    NEVER ASSUME ANYTHING (a general nursing rule) just because the nurse who handed over to you has 20years+ experience doesn't mean she didn't accidentally set the PCA up with the wrong opioid.


    Tidy your room.

    Check your labs.

    Check vent settings.

    Realize your an advocate and that this might make you unpopular on a Drs list from time to time- they'll get over it.

    Realize it's about the whole patient, not the tasks you need to complete.

    Build your assessment skills and trust them.

    Ask questions and write answers down.

    Know when to call for help and don't feel bad about doing it.

    Realize your not going to be fast super nurse from day one- pace yourself, no one expects you to "get it" straight away. Don't compare yourself to other nurses.

    You'll never get out right on 7 o'clock.

    That's all I can think of right now! Good luck.
    bmendi and jalyc RN like this.
  10. 1
    Cannot stress enough about being OCD with your lines. Label, label, label.

    And check everything that goes in or comes out of your patient any time other people have been in there without your supervision. (Which should be almost never.)
    bmendi likes this.
  11. 3
    1) Eat when you can, pee when you can, sleep when you can.
    2) Keep your eyes and ears open, and take whatever lessons you can where you find them.
    3) Don't let a senior nurse bully you into doing something you are unqualified to do (I cardioverted a patient with a doctor on the phone, but not in the hospital once in my first year because an older nurse said "we do this all the time"; luckily it turned out OK).
    4) Forgive yourself for the mistakes you will make, and resolve never to make them again.
    5) Check and re-check.
    6) Realize that patients will die on you no matter if you do everything right.

    Good Luck in your practice, and Welcome to Critical Care.
    bmendi, jalyc RN, and goodgrief like this.


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