Advice for clinical rotations on ICU/Trauma/Stepdown ICU floors

[firefly101]

Hello!

I am in a BSN-RN program and will be starting my final semester of clinical rotations at a surgical/trauma ICU at a large hospital. Pts include level 1 traumas and abd surgeries (1-2 pt load). I live up north and due to the weather we have lost clinical days. We will have no computer training/orientation/shadow day and just hit the floor running next week. Later I will transfer to the ICU step-down unit and receive the same pts, just at a less critical state. Description included "heavy care, lots of wounds & drains, variety of pts, 3-4pt load."

I am very nervous for this rotation and even more so now that we won't have orientation. How can I prepare (what material should I review)? Are there special items I should bring? I have only used "brain sheets" on med-surg floors - how will ICU/stepdown ICU sheets differ? Any advice would be much appreciated! Thank you!

[Kitesurfing bum]

You will have a blast, I remember my first clinical in an ICU. A lot of it may be over your head, but that's OK!

It will be hard to prepare beforehand, but keeping a pad of paper and jotting down unfamiliar terms to be reviewed later will keep you plenty busy. Here are some to start your list:

ABG

Ventilator settings (PEEP, FiO2, SIMV, Assist Control, etc.)

Central lines

Vasopressors

You will certainly hear these topics, and you may be familiar already. Have fun.

[ChipNurse]

You will not be expected to be an ICU nurse and have all the answers when you enter this clinical. You will be expected to look up and ask a lot of questions. Things to look up before you start: VAP prevention, CLABSI prevention, CAUTI prevention, ABGs, Vasopressors (Epi, Levo, Vaso, Neo, etc), Sepsis and treatment bundles. Know your cardiac meds: Beta blockers, Nitro, Amio, etc. Look at proton pump inhibitors, Look at heparin, heparin gtts and protocols and insulins. I found that using a sheet of paper with each body system will help with report, as ICU report is more in depth into each body system than med surg.

Mine looks like this:

Dx/Surgery:

Hx:

Neuro:

Resp:

CV:

GI:

GU:

IV:

Gtts:

Skin:

Drains:

Family:

Plans:

Keep organized and you will be fine. Ask a lot of questions. Be prepared for clinical and you will be fine. Good Luck! :)

[katie.f.lowe]

As long as you know what you don't know and ask questions, you will be okay. Along the way you will find people besides your preceptor to ask for help/advice about a situation. Also, really listen to your preceptor, and have no chip on your shoulder...peoples lives are at stake for real! What I mean is, you can't be too sensitive when you receive criticism; it should all be done for the sake of the pt and sometimes instructions can come out harsh and bossy; that's just what CCU nurses are like, they say what has to be said.

[Natural510]

A lot of good suggestions here; I will add to not pretend you are in control of a situation when you aren't (don't let your ego overrule the needs of the patients) and don't try to be bossy or think you know more than your experienced preceptor. The fact you're on here asking questions probably means none of this will be a factor, but I remember in school we'd have those "know it all" students who wouldn't take instruction from seasoned nurses (even in ICU) and surprise! they were the ones who were most likely to fail the NCLEX and struggle to find employment after graduation.

[ICULINDA]

Look up sedation/pain drips( fentanyl,propofol,versed) I'm sure you'll come across them as well. Jump in and ask lots of questions. Ask to place that foley, IV, dobb-hoff, NG/OG, draw from the central line, of course if you've been signed off and your instructor says you can ask to do that stuff. I enjoyed critical care rotations and got my hands on anything patient related. Good luck!

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