Advice and tips on how to become an ICU/ER nurse.

Nurses General Nursing

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Hey everyone! Right now im going into my last semester of nursing school and was looking for advice/tips on how to become an ICU/ER nurse and with skills sets that are particular to them. Every rotation ive done in the ER/ICU has been so terrifying and stressful but i want to be able to do it! What tips or advice could help me in that process? Thanks!! :D

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Specializes in Critical Care and ED.

Try to aim at getting an acute inpatient position your first job. Meaning, don't apply to an outpatient clinic or a long term care facility and then turn around and try to get in to an ICU. If your first job was a high-acuity surgical unit you'd be lined up to be a shoe-in for ICU, especially if the unit utilized telemetry. My ER hires new grads quite a lot as it's chronically short staffed. Our ICU hires new grads into a new grad residency but only take a handful each year. Getting your BLS and ACLS wouldn't hurt either.

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@Rocknurse

Thanks for the reply! That info is very helpful to know. Would you have anymore advice with things that those two type of nurses focus on a lot. For EXAMPLE: Lab values, medication, skills. (I know these are all important no matter where you go but just wondering if certain areas focus on certain things more.) My last ICU rotation the nurse i was with advised the same thing about telemetry, that learning that and pretty much everything about it best prepared him for the ICU over things. Thanks again for the replies! Cheers!

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Specializes in Critical Care and ED.

I would definitely do some basic rhythm recognition tutorials...there are some great resources on YouTube for that and you can find free rhythm quizzes on the internet. You would also be required to have your BLS and ACLS in the ICU, either before you started and at the least most definitely after you started, so it would be prudent to get and maintain those certifications. Your local hospital most likely offers those classes and most are open to anyone although you'd have to pay. Learning basic lab values is very helpful, including ABGs (arterial blood gases and acid base). Again the best resource is YouTube as there are some really great lectures on there that help you grasp the basics. Learn the basic components and values of a BMP, CBC and coags.

I also recommend getting and practicing the BKAT 9r. It's an assessment tool that is used in the ICU to test your knowledge, usually for new hires. The lady who runs it is kind of tough and everything is done by mail but this is the gold standard test and is worth having. All the knowledge in it is invaluable in the ICU. BKAT 9r You probably don't need to know this yet, but having the ability to read and interpret EKGs will always stand you in good stead, although no one would expect you to be able to do this as a new grad it would certainly impress. Here's a link to a free pdf of a great book: http://www.medarcade.com/uploads/4/5/5/4/45547265/ekg_dale_dubin.pdf

And if you really want to go crazy, invest in The ICU Book by Marino. It's a bit heavy duty and more of a graduate level but it's a great book and I use it in my NP class.

Oh...and nearly forgot, learning about vasopressors would be a good idea. If you search pharmacology tutorials on YouTube there are some really great lectures on there. I have a few to recommend but I have to go find them so I'll make a separate post. You should learn about epinephrine, norepinephrine, vasopression, dobutamine and dopamine. You want to learn their mechanism, what conditions they're used for and what receptors they act on as well as dosing. At this point, just being familiar with them and what they do is a good start. No one will expect you to remember dosing and half lives at this point.

Hope that helps!

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Specializes in Critical Care and ED.

Here are a few resources from YouTube that you might find useful. As you start scrolling around you'll see tons more links just like them:

ABG

https://youtu.be/1yHDtWK9zSo

EKG

https://youtu.be/URBREKIUALk

Vasopressors

https://youtu.be/-nq9mvNb-b0

ACLS drugs

https://youtu.be/KxTHhsO55n8

Critical Care Guide - Vasopressors in the ICU

https://youtu.be/nw_WIl89LWo

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Specializes in Critical care.

Don't be upset if you don't find yourself in your dream unit right out of school. My first job was on a very high acuity tele unit. I became very good with my rhythms and was exposed to a lot of stuff. After working there for 1.5 years I landed an ICU job at another facility with no issues. I didn't have ACLS with my first job, but I paid for a class myself when I started looking for a new job to show I was serious and invested.

Edit: once I took the ACLS class I found myself wishing I had done it sooner- I found it helped other things click more and was well worth the money.

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