Starting my first RN job.

anon456, BSN, RN · Jan 21, 2014

Are they training you well? With some classes and then some orientation. Just make sure you know the emergency stuff-- how to replace a trach, where the spares are in each room, different suctioning techniques, how to bag someone with and without a trach (in case the trach can't go back in).

Ask about ventilator associated pneumonia prevention policies on the unit.

Know how to operate all types of home ventilators. I know of two brands and each is very different from the other. Know how to troubleshoot alarms and respond appropriately.

Good luck! :-)

TraumaSurfer · Jan 21, 2014

Make sure you are truly competent when the competencies are signed off by your preceptor. Do not be afraid to ask for a review before signing if you are in any way unsure of something.

Know the alarm settings well for the ventilators. Do not get lax on making them too loose nor too tight where they are a nuisance. Investigate before practicing knobology. Never assume the ventilator should still be on the settings you last saw or what the chart says. Always physically run through all settings and alarms. Make sure the external alarm is connected and the ventilator is in the "red" or emergency electrical outlet. Make sure ventilator circuits do not put pressure on the trach and stoma to cause decannulation or pressure sores.

Know the early signs of infection.

Encourage open communication with the CNAs. They will get to know these patients very well and can be a big help in long term health and skin integrity. Some of these ventilator patients will have tissue paper skin. Maintain a good team attitude. This will also include PT, OT and SLP.

If it is your responsibility to change or replace trachs, make sure you get plenty of training with a qualified preceptor. Make sure you follow the policy for a trach change to the letter including all the equipment ready. If it says 2 licensed providers present for the change than there should be two licensed providers. Do not take this skill lightly. Cocky people kill patients or at least put them through some serious suffering.

Assessment skills are a must. You will be doing what most ICU nurses do but without the benefit of continuous monitoring and the good drugs. You will have patients experiencing ventilator dys or asynchrony from pain or inability to adjust well from an ICU ventilator but without all the med drips to make them comfortable. You may be limited to what can go into a g-tube so it will take some creative fixes and a strong knowledge of medications to help these patients. Of course you will also have to do this while caring for 6 - 10 ventilator patients while an ICU RN has 1 - 2.

But, on the up side, you will gain valuable assessment experience and some skills which will make some ICU RNs envious. You will develop time management abilities second only to SNF/NH RNs with 30 patients. You will be a first responder who will have a cool head to handle emergencies or prevent them from becoming a serious situation.

BBRANRN2013, ASN, RN · Jan 25, 2014

Thanks for the great advice. I'm done orientation and out to the floor on Monday!