Advice for Student Nurse in the ICU

[pogi]

Hello everyone,

I am a BSN student 2 months away from graduation. I just began my month-long Preceptorship (final clinical) in an ICU unit. I chose the ICU to challenge myself and become more comfortable with IVs, vents, chest tubes, etc., however I am feeling overwhelmed. The goal of my preceptorship is to transition from student nurse to professional nurse, but I am intimidated by the high acuity of the patients that I have never experienced before. My nurse preceptor is really tough and I am struggling to do my best at learning and becoming more comfortable with new skills. I have only been on the unit for two 12-hour shifts so far, and when I performed skills that were new to me, my preceptor made some comments that I am not performing them fast enough. So of course, this added to my anxiety and fear of failure. This, along with sitting in on difficult family discussions regarding withdrawing care, witnessing codes, and providing emotional support to family members, I go home physically and emotionally exhausted. I know it will get easier with time, but I am hoping that some of you have some advice and words of wisdom to help me get through the next three weeks. After experiencing the ICU, I give you all my respect for doing what you do.

[ghillbert, MSN, NP]

Physical skills which are new to you will not come naturally - you only get faster and better with practise. If it's a skill you can practise, do so. If not, don't worry about the preceptor. It's far better to do something safely and correctly than to do it fast.

I found it helpful to look up unfamiliar terms, equipment, procedure between shifts. Ask lots of questions - critical care nurses know a lot, and are generally happy to teach those who are interested.

[Summitk2]

It makes sense that you're overwhelmed... You are in an environment that challenges even the most seasoned nurses. Even those who have been at this for decades still have things to learn. You're in a new environment with an overwhelming amount to learn. You can't be expected to care for these patients with your training thus far. I believe new grads can eventually thrive in this environment by immersing themselves in it, but it requires patience and perseverance. Continue to hone the skills you have, ask tons of questions, try to identify and understand the key problems with each patient, and don't be afraid to jump in to new territory. Part of a challenge can be the feeling that you might not be able to make it--but keep yourself engaged and over time you will start to see the knowledge you're gaining. On the other hand, if you truly feel this might not be the type of work for you, consider other areas of nursing... there's plenty of options!

[cvicugirl, BSN, RN]

Hang in there. It is very common to go home emotionally and physically exhausted, especially with this stuff being so new. Do you hear bells and alarms when you are in bed trying to go asleep? We've all been there. As long as you know WHY do are doing the things you are doing in the ICU, don't let anyone bully you because you're slow. Your skills will improve with practice.

[GeauxNursing]

keep plugging away, you sound very dedicated to it. I also applaud ICU nurses. They are very smart ppl and I use them as a resource all the time. Some of the smartest nurses I know started out in ICU and moved to dialysis where their critical thinking helps them to excel. I learn lots from these ladies all the time, being a new nurse myself.

[netglow, ASN, RN]

I also did my last many weeks in the ICU. Take a deep breath. These ICU intensives are hard to get into! If it helps at all, this was my plan of action as a student:

1. Get group report, do quick exam while receiving bedside report. Look at everything going in and out now too. That way if you see something like oozing blood, site infiltration, wierd vitals, or lung sounds, etc. You can pin that offgoing nurse down to explain or help if needed ex: repositioning.

2. Look at MAR report - what's been given and what's due.

3. Get those labs! don't think to start any meds without looking at your labs with your initial assessment findings.

4. If you have walked into a hemodynamically unstable situation, grab your intensivist or NP for a look right away, often this will change meds/plans as you often get immediate intervention.

5. Start care and meds and prepare for interdisciplinary report.

6. In report, everybody is there so you can also inquire on interventions then. They'll be trying to assess LOS issues - what's the goal/plan kinda stuff.

7. Chug down a Coke. LOL.

8. Continue/initiate care.

9. Document your every move.

10. Repeat.

At home after clinical look up vents, all cardiac lines, etc. and you'll see how handy your physiology knowledge is to have too as the major swings the body can go thru happen in the ICU. All is done under the supervision of your RN. Never give a thing without one more OK from your RN as things change fast. You are in for one wild ride. Just go with it.