(AGAIN)new grad to ICU

[TypicalFish]

I know this has been covered, but I am asking now instead of reading. I have about 15 years experience working as a OR tech-primarily in OB/GYN; I have also worked as a ICU/CCU monitor tech, Unit secretary, done staffing for hosps, gotten my CST, and generally floated. ALso worked briefly (VERY) as a NA and home health aide. I am 43, and just graduated in May/NClex'd in 75 in May as well. I turned down a position in an Oncology unit due to commuting issues, but now i am wondering if i did the right thing. I have started in an M/C ICU, and I did pt care last week with preceptor. I am a pretty quick learner, handle stress well-my OR experience-and know enough to know that I know very, very little about real nursing. I turned down a position at this same hosp in the IMCU. Everyone in the ICU is really great, the nurses seem to really help each other out, brainstorm, etc; the unit has in-house intensivists, also. But I am worried that I don't know enough to be able to "read" when things are going wrong-in that subtle way that happens before a bad occurence. I have no problem asking questions, but if I don't KNOW there's a question to be asked-what happens then? My internship is about 6-8 weeks, but some of that time is spent at CC classes, and so forth. Then they will try to "buddy" us with our preceptor(s) when we work our own shift. I think I can do it-I don't expect for it to be easy at all, but I also wonder about going to IMCU for a year-just to get going......so, what say you?

[sway]

It sounds to me like you're good to go. It sounds like you work in a supportive environment, and have a good amount of quality preceptor time, and then are paired with a partner when your preceptor time is done.

As far as not knowing enough to 'sense' when things are going wrong, I wouldn't worry about that either. I've seen some pretty experienced nurses miss some big things, but the bottom line is that we all just do the best we can. The thing for you to do is to take nothing for granted. Double check everything...all meds, your drip concentrations and pump settings when you first come on, etc. When someone's BP drops 20mm but is still WNL, many nurses don't really pay much attention but the best ones are at least mentally thinking of why. Just try to be really observant and ask LOTS of questions.

Have fun!!!!

[RosesrReder, BSN, MSN, RN]

You seem to be all squared away and know what you want. good luck to you. :)

[flaced]

I've started in ICU about 8 weeks ago as a new grad with no more than nursing clinicals hospital experience. First 4 weeks I had only classes and a couple of hours in the afternoon on the floor. After the classes were over I moved to nights following my preceptor schedule. The preceptor started teaching me as if I do not know anything and I just loved it. Even I knew some of the things I was very glad to let him explain and review things with me. The night shift is somehow slower paced than the day shift, but the residents still do procedures. For whatever reason our patients were usually the sicker from the whole unit, and if they were not, they would definetely turn into one by the morning.

Last week they gave me two patients (the full load for our ICU) with little help from the preceptor. No, he didn't plan to leave me alone, just thought that i am ready. I still have lots of questions, but also plenty of help from all the other nurses. Sometimes I literally feel my heard is tachycardic (maybe SVT's :) ).

I am taking one shift at the time, but I do trust the support I have at work. I do not feel ready to end the orientation and be on my own, even if this is going to happen soon, but I know that starting directly in ICU wasn't a bad choice after all. I imagine that IMCU experience is different, so why not start with something you want to do from the beggining, and you will do fine.

[papawjohn]

Hey Y'all

Darn, sounds like you're really well grounded.

A few pointers maybe. Put you hands on your Pt. Learn what they can teach you. An experienced Nurse can tell within a few tenths what their Pt's temp is through touch. Find a pedal pulse. If your Pt has a palpable PedDorsalis I guarantee their MeanArterialPressure is 60 or better.

Look for trends, not absolute numbers. If the HR was 60's at 2000, 70's at 2100, and its 2200 and the HR is 80--don't wait for the magical "greater than 100" to send you trouble shooting.

Think behind the data. If the foley bag is suddenly FULL, don't think "good urine output tonite". Think, WHY? Recall the meds, obviously. Diabetic? (High glucose = diuresis. Accucheck!) Post-Op? Check the CVP; probably mobilizing all the IVFluids the anesthesia people gave 'em. Etc etc.

Don't get hyponotized by the monitors. Keep your attention on the Pt.

And relax. Lots dumber people than you have found they can be great ICU Nurses.

Yer Papaw John

[Zoomer]

I agree with everyone else. I think that the judgement you are looking for comes with time. Pay attention to the patient. The way he looks when he is in pain or when he is overloaded. Listen to the patients lungs and heart sounds. You will get the knack, just trust your instincts which are basically a sum of your experiences. I don't know how many times I have gone in to assess my patient and just known from his "look" that it would be a rough night. As Pawpaw said don't get hypnotised by the monitors.

Best of luck.

[TypicalFish]

Thanks for all of the great advice, and even more so for the kind moral support. I had my own pt lastweek-and felt like I did okay; my preceptor was always around to help; She had two pts-she requested them the day before, so that we'd be nextdoor to eachother and she'd only have one, and time to precept me. One thing I am trying to do is be as helpful as possible with all of the nurses, moving, lifting, cleaning, and it is pretty cool b/c they think of me now if they have something like an IV to start or an NG/OG tube placement, or even just something good to watch. Thanks again, Fishy Oh, and any good tips on NG tube placement?