New Grad starting off in ICU

Congratulations to all you new grads who dive right in to the ICU. Yes, you must be competent in terms of normal values, dosages, procedures, etc. etc. and all the technical textbook stuff.
But here's some advice (you cant learn from a book)when you guys are on your own as primary nurse.....

1. Dont just take any assignment handed to you. If one of your pt is a 1:1 then they should NOT be paired up with another pt. You must be familiar with your hospital's and/or unit's policies if the pt is categorized as such. Check with the charge RN and/or RN youre getting report from. Examples of 1:1's

a post Code Blue pt,

a surgical pt who bypassed recovery room and came straight to you with A-line, CVP, Swan-Ganz, multiple drains, multiple gtts, blood products.....!!!!!!

Q15min BP on one or more vasoactive gtts

a confused, combative, restless pt complete with Posey vest, wrist restraints, pulling all his lines and tubes out trying to get out of bed (Arrrrggggghhhhhhh!!!!!!!!!) while pooping 5X in your shift

Our license and the Pt's well being are all on the line.......you must have some type of malpractice insurance.....




2. The essence of being an ICU nurse is to anticipate what might happen...to catch something before a sentinel/horrific event occurs...
Kind of like playing Chess-"you must think first before you move" (Whats gonna happen if I do this, What will happen if I dont?) Heres where your BEST attribute comes in to play.....critical thinking. Throw in common sense and your gut intuition and you and your Pt will make it through.....
However, there are some things we are unable to fix/help.....sometimes its just their time to go......



Hope this helps.....I can throw some more of my 2 cents later

Thanks for the advice Snakes&Wings! Please share more when you have time.

Thanks for the advice! You are so right!!

I just have to say at my facility, though, yeah right!!!! I have had 2-patient assignments with one or two of these types of patients already in orientation. I know that patients like these should probably be 1:1, but it doesn't seem like my facility follows that logic. Just this past week I had TWO patients on q15 minute vasoactive drips (3 drips in all betwee the two patients throughout the day). I know it is risky, but what do you do if that is your assignment????! Oh, and restless, combative, in restraints and pooping 5x day...?!? I have that patient every shift in one form or another. I hope it will get better as I become more experienced, but I can't help but wonder if it is the norm or just the downfall of the facility I chose to work at. Two year contract looking long now....

wish me luck!!

traumas usually go to the SICU or TRAUMA ICU..not that often the MICU

nurse2be09,

Thanks for the update! Glad to read the ER rotation went well. Wishing you the best with the ICU experience.

I'm coming off classroom orientation mid-next week. Then I'll be on the unit full-time, orienting for the next 15 weeks. So far, things are going well.

I just got hired for the ICU at one of the best trauma hospitals in the area. Even though I have one year psych LPN experience I'm a new RN grad. Its all new to me and I'm very nervous. Thankfully I have a six months critical care program and I've been very blessed with this job.

My question is. Any tips on how to make the best impression for the first few months?