New to ICU? What have you learn so far?

Specialties MICU

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I am new to the ICU. I thought we could start with experiences to help us use our critical thinking skills. Any one?

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Specializes in critical care, PACU.

if a patient has NPH scheduled, and you were told they were on D5NS while NPO, check to see if the D5NS is actually hanging, not just NS so that you dont bottom out the patient's bsg

when another patient is tanking on the unit, even if you are busy, try to go and watch and help so you will know what to do if it happens to you.

ask for help from the charge nurse or another nurse whenever you make a big autonomous decision, even if you already know what you want to do.

you really can get all that busy work charting done in an hour, so just push through when you are really slammed and do the tasks you have to do for your patients when the going gets rough, and know that you can chart it all later.

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Always give and get the best report possible! Oh, that pt went asystole 2 days ago? That would have been nice to get passed on. (Some things do get lost in report though.)

Always check alarms, zero invasive lines at start of shift. Print off labs. Know code status ALWAYS.

When a doctor asks what "inotropes" a pt is on, he means vasopressors. That caught me off guard at first.

Better to look stupid and have a live pt, than to try and look smart and have a dead one. :)

I'll try to think of more

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Specializes in lots of different areas.

I'm starting ICU next week also :) I'm not exactly a new grad RN, but my RN experience has been in med/surg and LTC. So nervous and majorly excited!

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Specializes in MICU/SICU.

Better to look stupid and have a live pt, than to try and look smart and have a dead one. :)

AWESOME!

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Specializes in CVICU.

Learn to trust yourself and like fiveofpeep said, when making decisions that push the envelope (ordering tests etc) check with someone else first.

When in a crisis, try your best to jot down simple notes on a piece of paper that you can save for later to document the sequence of events. If it takes 3 hours to stabilize a patient, you're going to have the biggest headache of your life trying to document it without a reference.

If sufficient backup is available (ie - free charge RN or supervisor) take the sickest patient on the unit and just have them stop in once and awhile to check things over and make sure your bases are fully covered.

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Specializes in critical care, PACU.

here's some more

if UO is low and you work the night shift, try checking for bladder volume with the bladder ultra sound before calling to wake the md up

check with the charge nurse before calling any mds and always make sure to ask your fellow nurses if theyd like to talk to the doc you are calling

I agree about keeping notes on when you call and what is happening when you have a patient crumping

be very vigilant about restraints, and dont ever trust a patient who appears cognizant. he could rip out all his lines right after you leave the room

always chart in the room of your most delirious patient so you can keep an eye on them (can you tell I work mostly neuro patients?)

dont forget to check your chest tube water level to make sure it's actually at however many cmH20 is prescribed

when people want to educate you, even if you have an excuse or already know, just go with it and be appreciative

lets keep this going, I love all the posts so far :)

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Specializes in Surgical Trauma Burn ICU, Oncology.

Tooootally agree w/ the chest tube comment... and make sure when you admit a new trauma that the chest tube ISN'T CLAMPED! May sound crazy, but yesterday my new trauma came up from the bay with both chest tubes clamped..

If your pt goes to the OR or anywhere else where you hand off to anesthesia and they're on an importany gtt (i.e. esmolol for transsected aorta) have another bag sent up from pharmacy to have on hand for when they arrive back to the unit incase the one they went down w/ is BONE DRY.

Bring a BP cuff & cord on road trips incase your pt rips out his art line

I have many more, just gotta think...

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Specializes in Primary Care and ICU.

Im starting MICU soon too, so this is helpful . Not a new nurse, but will be new to the unit. (Tele charge nurse is my background) Thanks ! :)

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Specializes in Trauma ICU, MICU,Tele. PCU, IMC.

My biggest issue is delegation. It's okay to ask for help from other nurses, they aren't going to think that you are a slacker...

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Specializes in NICU.

Be thankful and appreciative of your coworkers! When you have a slow day, help others! Because one day you will need the favor returned!!

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Specializes in Critical Care.

Make sure you always check and recheck your IV access. I got report on a post op from a nurse who complained that the patient liked her pains meds because she kept calling her about pain. This patient had an ON Q pain pump and a dilaudid PCA, plus Toradol for break through pain. I asked this nurse why she was still in so much pain with all these pain options? She replied that the patient was a pain in the you know what. So, I go to assess her and guess what, the freaking IV was blown!!! I restarted the IV, she took one press of her pump, and that was all she needed my whole shift! I did have a little talk with that nurse the next time I saw her. I mean, where was critical thinking here? :mad:

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