Advice for "seasoned" nurse moving to ICU

Specialties CCU

Published

Specializes in floor to ICU.

Making the transition...finally! I have Med/Surg floor experience and am leaving a Tele charge nurse/unit educator position for an ICU staff nurse position. We do open hearts and eventually I would like to be skilled enough to care for them. Scheduled to be precepted by two great nurses. I have been at my hospital for 10 years and I know a lot of the staff and doctors.

I am nervous but extremely excited about all the new things I will be learning. Any advice?

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Specializes in ICU.

Congrats! I think it is brave of you to leave a position you know and comfortable in for a new, unknown adventure. Just remember to stay humble and learn~ even though you might know nursing care the equipment and some hemodynamic concepts might be new to you. For me it was comforting have Sr nurses I trusted to go to when something just didn't "feel" right and the resident didn't see eye to eye with me!

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Specializes in floor to ICU.

Yes, staying humble will be important. I hope I can transition smoothly. I am bored with the chaos surrounding charge nurse and ready to deal with a different kind of chaos!

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Your medsurg/tele background will be helpful but you will be learning a 95% different way of taking care of patients. Your assessment skills will change. You will become extremely detailed and focused with charting, numbers, positioning, serial labs, and managing multiple drips.

You will learn more about respiratory and cardiac physiology than you ever imagined you would need to know. Advanced ventilation modalities and oxygen delivery systems. IABP, CRRT, PA Catheters, Rotaprone and Rotarest, Heliox, Nitric Oxide, etc.

Meds you'll use frequently: Diltiazem gtt, amiodarone gtt, Lidocaine gtt, Heparin gtt, Dopamine, Norepinephrine, Epinephrine, NeoSynephrine, Dobutamine, Xigris, Argatroban, Albumin, Fentanyl, midazolam, lorazepam, propofol, and precedex.

You will hopefully become well versed on the mechanism of actions of those gtts and not just that "it's a beta blocker, or a calcium channel blocker."

Most of all....keep an open mind and always ask for help!

Enjoy the ICU!

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Specializes in floor to ICU.

Thank you so much for the responses! My 3rd day was today and I was baptized by fire! Overdose 30 yo pt on a vent w/ Levophed, Propofol, Bicarb, NS boluses, con't Protonix, K runs, multiple antibiotics, Albumin. Troponins elevated- cocaine induced MI? Thinking sepsis now though w/ rhabodo... no urine output X 8 hrs, sky hi WBCs. Doc put in a central line, Quinton and started CVP monitoring.

Didnt get to wolf down lunch until 3pm. OMG, I was so busy w/ my wonderful preceptor and charge nurse but I was still smiling because I am so happy I am learning new things (even though am out of my comfort zone).

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Specializes in Critical Care Nursing AKA ICU.
Thank you so much for the responses! My 3rd day was today and I was baptized by fire! Overdose 30 yo pt on a vent w/ Levophed, Propofol, Bicarb, NS boluses, con't Protonix, K runs, multiple antibiotics, Albumin. Troponins elevated- cocaine induced MI? Thinking sepsis now though w/ rhabodo... no urine output X 8 hrs, sky hi WBCs. Doc put in a central line, Quinton and started CVP monitoring.

Didnt get to wolf down lunch until 3pm. OMG, I was so busy w/ my wonderful preceptor and charge nurse but I was still smiling because I am so happy I am learning new things (even though am out of my comfort zone).

Welcome to a Real ICU...

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WOW, sounds like a busy day. My advice: Make friends! So that when you have another day like that (you will!) you have some people to recruit in for help!

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Specializes in floor to ICU.

Thats one thing I hear from everyone in my unit, that you are never alone. There is great teamwork there and I am thankful.

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So how's the ICU going?

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Specializes in floor to ICU.
So how's the ICU going?

Thanks for asking! I am still enjoying it. Getting more comfortable with the 8 page trifold (no computer charting) and not having flip it over 20 times to find my spot-lol. I have been with a few other preceptors. I had personal plans and couldn't follow my original preceptors schedule. This has been good because it is great to see how others work and do things.

It is weird to see the docs taking your clipboard and actually reading your nurses notes. I am from a Tele unit where this never happened. Since I have been at my facility for >10 yrs, I know most of the docs except for the cardiothoracic surgeons. I have not had much interaction with them. I am looking forward to developing a relationship with them and knowing their individual preferences.

I have been taking both patients and doing as much as I can for them in order to get ready to fly on my own. My coworkers and preceptor say I am right on track with my orientation and feel I will do well. I will probably go off official orientation in 2 weeks since I will never really be alone and have so much support from those around me. I still need practice titrating pressors.

It has been an adjustment for me though. I mean, I went from being a very confident competent charge nurse who was a great resource person for the unit to being the new kid on the block with knots in her stomach! Don't get me wrong, I love it in ICU, but being out of your comfort zone isn't always pleasant. One of the other posters told me that I need to learn to "give myself a break". Before I started in ICU, I didn't really understand what they meant. Now I totally understand. I cannot learn all that I need to know on orientation. It is going to be a process.

So my goal for the remaining two weeks of my orientation is to take care of as many sick unstable patients that I can get my hands on.

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Specializes in multispecialty ICU, SICU including CV.

You sound like you are doing well. Good for you!

The best advice I can think of to give you is know who your resources are. Know which staff have been there and are willing to help. Off the unit, know who to call for problems you can't troubleshoot. It is rare that I get through an entire shift without calling at least one of respiratory therapy, anesthesia, the Aquadex people, the pacemaker nurse, the dialysis department, sterile supplies, the other ICU, the OR, the pharmacy (I love my pharmacists!!!) -- on and on and on.

To take care of a critically ill patient, it truly does take a team. Likely you have figured this out already though.

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Specializes in floor to ICU.

Oh my. ICU is so exciting. I am learning so much.

Had a patient on 7 IVs yesterday. Rocuronium, ativan, fentanyl, NS x 2, Vasopressin, Levophed. She also had an art line, was vented (of course) and had chest tubes, feeding tube, tesseo for HD.... We started the Rocuronium gtt on my shift so I got to practice the Train of Four with the (what I call) the tazer. I switched out the flush bag for the art line. We changed all the tubings and hooked up a manifold for the infusions. This poor patient had the most subcutaneous emphysema I have ever seen. It seemed to grow as I watched. Her neck and face were huge. Issues w/ her trach and air escape plus chest tubes leaking. Got to practice lots of blood draws from her art line. Lots of practice titrating the pressors because her bp dropped a lot during HD. Lots of tips from RT about vent setting changes related to current ABGs. So sad because she is so very sick. I feel guilty because I was excited to get so much experience from one patient.

Sorry to keep babbling on about my transfer to the unit. It is just so fascinating that I find myself unable to NOT talk about it.

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