A Day in the life of an ICU nurse?

SICU_Murse · Jun 24, 2012

Type A personality, you'll sink without one.

I am not sure about others but most of the ICU's that I have worked in the aides do MINIMAL work. I work night-shift and the aide leaves at 9pm (their shift is 9am-9pm, who made that I have no clue). After 9pm there is no aide, so if you have a pooper your gonna be the one cleaning it! I would have to say though, if your already worried about cleaning poo, ICU probably isnt for you...

FCMike11, BSN · Jun 24, 2012

I work nights, 7 on 7 off.

My schedule: roll in at 1830, finish report by 1900 at latest, do my assessments, and check charts/orders and attend to anything that needs immediate attention.

At that point (2000-2100) I like to have this hour aside, last visiting hour of the night, just to be able to attend to families/ask questions.

After they leave give my 2200 meds etc.

After that if we have a vent patient or such we typically do those baths on nights. An my rotation was a tech for 4-6/7 of our days, so its not so bad. Since vitals are recorded on the computer they do temperatures, blood sugars and its a team effort of bathing/cleaning up patients.

As listed is my schedule, have to include codes, sick patients that need attention, admissions so on and so forth. Chart checks, restraint Q2hr documentation, neuro checks (could be Q1 hr/Q4 etc.)

Just depending on the patient (open heart is 1on1 Qhr everything) how your night can go.

Hope this helps.

I like my job, if its a good night I will have plenty of downtime to study.

An to add for the aproximate time breakdown, right after I make sure my patients are breathing ill open up my labs and look over them, and if anything needs to brought to the attention to the physician I will, (doesn't usually take longer than 3-5 minutes to look over labs).

Other things I make it a point to read operative reports, it is relevant to me to know specific wound closures and aproximate anatomy (makes it easier to answer families questions).

As far as personality traits you need to be confident (make more independent decisions than typically a floor nusre), need to know when to ask for help/ask questions.

mal09 · Jun 28, 2012

It's hard to give a routine in the ICU. If you have two stable pts you may have a routine for that shift,

but if you have a very unstable pt, you'll be running around like crazy trying to get orders, titrate pressors, calling MDs, aiding in procedures... in any free time you'll be playing catch up with your other pt.

Then some nights you may have two pts with transfer orders and spent a great deal of time twiddling your thumbs.. it just depends.

We usually have a tech, but with only one on the entire unit, you can't count on them since they are busy usually. If I have a GI bleeder or C Diff pt, I will be spending a good deal of time cleaning poo. But, usually they are other nurses around to help you who have a lighter load that shift.

NewbieNurse78 · Jul 4, 2012

It's hard to give an idea as to a routine on the ICU because it depends on the state of your patient and how stable/unstable they are. You an have a night where you sit most of the night or a night where you are running non-stop.

The poop issue. Yes you get a fair bit because in the ICU most patients are so ill that they don't control themselves well...or they are comatose.

The aide issue. Many ICU's the aide help is nearly non-existent, mine has no aide we do all the care ourselves, but we do help each other.

The personality thing. You need to be pretty calm and level headed, you can't fall to pieces when your patient starts crashing. I agree that you need to be confident and be able to work independently because the doc's expect ICU nurses to be capable of doing more without them. For example HR goes up and BP goes down, they expect you to know enough to start a bolus of fluids, not call them for permission first. Also, you need to be strong enough to stand up for your patient when the Doc is doing something you feel is wrong. I mean you always need to do that but in the ICU you have less room for error, so if you feel in your gut something is wrong you need to pipe up and not back down.

If it has been awhile since you worked on the floor in acute care I strongly suggest you brush up and perhaps take a refresher course for critical care as they will expect you to be up on drip titration and other things. But again if poop is a big issue for you, I'd think twice it's a pretty big part of the ICU.

Kitty

RN: Real Newbie, a nurse's blog

mizznurse · Jul 9, 2012

I agree with the above posters, if you have stable patients then you'd have a an idea of your routine for your shift. I work noc shifts and if i have unstable patients, then my routine will flow out of the window. You have to always expect the unexpected.

As for typical duties. In our unit, we have no CNA/aide so we do our baths ourselves w/ the help of fellow RNs. We draw our AM labs. We turn our patients Q2hrs and do oral care Q4hrs especially on orally intubated patients. We do vitals every hour, pass meds, and sometimes neuro check q2hrs when patient is unstable. It is a looot of work. It's Total Patient Care. And this is what i love about working in the ICU, i know my patients intimately.. what's happening to them.. their medical history.. their families. I clean poop every night. (it's not the only thing you're going to be cleaning if you work in ICU)

I think to become a great ICU nurse, you have to have a good attention to details. Know when something is different w/ your patient. You have to be OCD of some sort.. (just in my opinion only), I can not stand tubings that are everywhere.. I have to label everything. You have to be outspoken. Know how and when to advocate for your patients that are unable to talk. You have to be a team player. ICU is a tough place to work. You need team work in order to better care for your patients especially when they are crashing down. You have to be willing to learn every day even if you have been working for years.. You have to be assertive w/ patient care.. You have to have good nursing judgment.

Good Luck!

Good Morning, Gil · Jul 18, 2012

Personality traits: like others have mentioned, detail oriented, patient, empathetic, high emotional intelligence (since you will be dealing with poor outcomes, death, fast-paced, stressful situations in which you are working on the patient, doing everything for them, only for them to die a few days later), good team work since ICU nurses rely on each other.

Typical night: 2 patients (I work MSICU, large teaching hospital). Just depends on what kind of patients you have: could be 2 stable patients, 1 empty bed (which means you're next up for whatever walks into the ER or rapid from floor), 1 ETOH withdrawal, which means you're in/out of that room frequently all night, and they poop sometimes, esp if ammonia levels are high from encephalopathy, so lactulose. Sometimes 1 critical, unstable patient (and they try to give you a stable patient with a patient like that). Critical, unstable patients in our unit are typically septic shock, sometimes acute GI bleed, varices.

Lots of poop. Even if you're patients don't poop that night, you'll be helping other nurses clean their patient's poop. It's not uncommon that I'm cleaning poop on my patient 3x a night (from the tube feeds). Patients are totally dependent, so no self turns (rarely a self-turn, which means you help each other). No CNA's on our floor; we do everything. You start out your shift with report, chart checks, I give a quick look at my labs, so I know my patients' baseline, then my assessment/meds, charting, reassessments, charting, charting lol, baths, labs (we draw our own labs). That's a typical night; however, I have walked in where I get report and am immediately in my patients' room b/c my patient warrants that (either they're very sick, and I need to check them immediately and do immediate labs, whatnot, or they're trying to crawl out of bed lol).

Best of luck to you! Some people stay in one area their whole career. While I really like the ICU, and will stay for a good while, I'm sure I will try another nursing area down the road, as well, just like you. Probably oncology. I've found that I enjoy caring for these patients on my unit.

MomRN0913 · Jul 18, 2012

Ahhhhh, you're all making miss the ICU. Really.

There is a really good book written from the point of an ICU nurse. " A Nurse's Story" by Tilda Sharof. Great book, about her experiences as an ICU nurse, starting from newbie in Canada. I downloaded it to my Kindle.

DutchRN09 · Jul 29, 2012

I just started in the SICU. It was complete shock the first day, its better now. I have 2 patients, all with chest tubes, foleys, vents, vs q1, oral care q1, I/O q1, assess q4, careplan daily, families that are stressed, residents, nursing students, no techs, baths daily, and all the other regular patient care, mixed in with lab draws, art lines, CVP lines and titration. I am learning a lot and love it.

Ruby Vee, BSN · Jul 29, 2012

i'm curious -- what makes you want to jump from psych into something so completely opposite like icu?

Teleflurry, DNP · Jul 30, 2012

I can tell you work psych because you seem more interested in the psychological aspects of icu nursing rather than the actual application (which is cool.) ICU nursing requires a high level of independent thought, especially in specialty icus like neuro or open heart. You rely on your judgement and skills ALOT. We happen to have techs at my hospital to help, but it depends on where you work and what hospital system policies are adopted there - as with any job...do your research first on those types of things. There is NO routine when you have unstable crashing patients. There no feasible way. Your moving fast to save these peoples lives - routine doesnt exist unless you have two stable patients...even then your still going to be helping your collegues. I LOVE critical care - but to work with here you really need to be type A.