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eCCU, APRN, NP 5,183 Views

Joined Aug 31, '10. Posts: 222 (36% Liked) Likes: 169

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  • Sep 22

    I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so.
    Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics.
    Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing!
    Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research.
    Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis.
    Cardiologist...cause they do crazy stuff that works that's not in any textbook and I have yet to meet one that freaks out.
    Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night!
    Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome
    Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity.
    Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one.
    Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings.
    Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc.
    Keep learning ask your intensivist for feedback consistently and ask for areas of improvement.
    The rest enjoy it it's actually fun
    Hope that helps

  • Sep 20

    I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so.
    Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics.
    Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing!
    Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research.
    Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis.
    Cardiologist...cause they do crazy stuff that works that's not in any textbook and I have yet to meet one that freaks out.
    Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night!
    Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome
    Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity.
    Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one.
    Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings.
    Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc.
    Keep learning ask your intensivist for feedback consistently and ask for areas of improvement.
    The rest enjoy it it's actually fun
    Hope that helps

  • Jul 19

    Nurses and their titles kill me! . How about we focus on making our NPs ready when they graduate? I once knew a really smart friend who had 4 PhDs never once heard him introduce himself as a doctor. I introduce myself as a "Nurse Practitioner." No need to confuse the little old ladies in the ICU use that time on important patient clinical issues.

  • Jul 18

    Nurses and their titles kill me! . How about we focus on making our NPs ready when they graduate? I once knew a really smart friend who had 4 PhDs never once heard him introduce himself as a doctor. I introduce myself as a "Nurse Practitioner." No need to confuse the little old ladies in the ICU use that time on important patient clinical issues.

  • Mar 27

    Get into an internship program. ACLS? My hospital doesn't let new icu grads take ACLS until they are 6 months in the icu setting. I have to wonder whether you are ready for that type of critical thinking to take ACLS. Am sure you will pass it but reality putting together the whole picture is another story....remember the more you show management you have the credentials for all this the more your legal responsibilities increase as a new nurse. Take it easy learn first. ACLS will be there. Don't corner yourself. Sorry if i sound harsh, it is not meant to be. I just don't like seeing new grads panic in the middle of a serious case administer wrong med and boom your career is over before it began.

  • Jan 5

    Most of the advice is on par like highlight your resume and leave out things that are may look a little over the top. For example an ER Nurse manager would be a little wary of a medic who lists things like suturing patients, intubating patients and all types of invasive procedures that require a physician. Remember they do not just go to school for 14yrs for nothing there is a lot of critical thinking that goes with the procedure. List things that are within the NPA that you have been exposed to this gives them more confidence that you will not be suturing patients when the MD is running a little late :-)
    Also remember if you are applying to a level 1 trauma you will not directly go to the trauma rooms. Like the previous RN stated there is more than running codes that goes with it for example head injury motor vehicle accident who has dka...how do you control the dka without increasing ICP and decreasing K+levels and bicarb levels or cardiac arrest MI whats is the treatment for inferior wall infarct vs Anterior....my advise to highlight things that are used in todays ER and possibly list the specialities you have been exposed to. Finally do not forget most hospitals like to train their graduate nurses through an internship program despite the medic status, when it comes to specialty departments. Otherwise best of luck and hope you get a position very soon.



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