What areas should I prepare for?

marienm, RN, CCRN · Mar 24, 2016

Congratulations! I work in a small BICU at a level 1 trauma center/teaching hospital. We take off-service patients when we aren't full of burns. Mostly trauma/surgical patients, but sometimes MICU; CCU and Neuro are less common. Our hospital also doesn't really have step-down units, so step-down patients stay in ICUs until they can move to the floor or go home. So, on my unit I take care of everyone from vented patients on multiple drips to walkie-talkie patients. We really try not to move burn patients off of our unit, even when they're technically ready to go to the floor, so we really get a broad spectrum!

1) Burn stuff- try to read up on some common topical meds (bacitracin, sulfamylon, santyl, silvadene, bactroban) to understand the different uses. Review the Parkland Formula for fluid resuscitation, but also realize that this formula may result in over-resuscitation OR may not be sufficient to produce adequate urine output and fluids need to be titrated to patient response. Dressings- the unit probably has their own ways of doing burn dressings, and hopefully you'll love doing them if you want to work on that unit! (They take practice, though; don't be discouraged if it takes time to get the hang of it!) Precautions- follow what the staff tells you! On my unit we keeps burn pts in private rooms, especially if they've been grafted. We wear yellow gowns (despite little evidence that truly supports this...a story for another day) and make visitors wear them too. We don't allow flowers. There's no better way to annoy the staff than to ignore precautions, so make sure you understand what they are and follow them!

2) Critical care stuff- if you've had no previous exposure to critical care (I hadn't!), then try to read up on your vasoactive and sedating meds. Ideally, burn pt don't get vasoactives because peripheral circulation is *especially* important for burn healing, but when someone's SBP is in the 70's you gotta do something! Review EKG interpretation and normal lab values.

I don't know how much prior health care experience you've had, so maybe walking into a room and finding a vented patient who has an A-line and a CVC and a foley and a flexiseal and a chest tube is no big deal, or maybe you've never seen it before. If you've never seen it, get ready to learn a lot about safely positioning patients, how to do a full linen change every 2 hours because big burns weep a LOT, and time management so you can get all your hourly (or q15 minute) vitals and checks recorded.

Also, remember that every patient has a history-- we get burn patients who have relatively straightforward *burns,* but have uncontrolled A-fib and CKD and HTN and we wind up spending most of our time treating their medical issues while the burns just get wound care and grafting and heal!

Also also, since you want to work for this hospital, start to get to know their system. Find out how to look up a policy or procedure instead of just asking your preceptor. If they're putting your patient on an insulin drip or a heparin drip, look it up and find out how to titrate it.

lkrob · Apr 5, 2016

Thank you so much for this great info!! Sorry I couldn't thank you faster my sign in wouldn't let me log in!

This is is great and an amazing place to start preparing! Your unit sounds awesome as well!! Can't wait to put all of this together and start this week!! Thank you again!

1056chris · Apr 9, 2016

I wasn't a BICU nurse but at one of the hospitals I have worked at I worked perdiem and would often get pulled there especially on nights. The first thing is they have great snacks for the patients ( drum stick ice cream, crackers and peanut butter, donuts , cokes) they need their nutrition. Also a lot of pain meds, almost around the clock. A lot of drainage and dressings. These girls taught me to make clothes out of a fishnet that would hold dressings in place better. Read up on fluid and electrolyte balance, the different types of skin grafts, infection, pain control, patients dealing with disfigurement. It was truly a great experience to work there. I didn't like daylight as much because they had to be bathed and I remember having like 3 vials of morphine in my pocket. Their CNA's were excellent where I worked and was so greatful for their help. Good Luck! I also remember on that unit we wore regular clothes in and changed into OR scrubs because of all the dressings and drainage. It may not be the same now. You will enjoy it , but it can also be very sad especially when children are involved. Thses units are usually very devoted to their patients and staff.