Capstone practicum in the MICU

CrufflerJJ, BSN, RN, EMT-P · Apr 12, 2012

Here's a few ideas:

- learn to assist with insertion of central venous & arterial lines

- achieve greater familiarity with cardiac rhythms, and for abnormal rhythms learn typical causes & interventions

- become familiar with invasive monitoring (art lines, CVP, Swan, Vigileo/FloTrac)

- learn about meds typically used in the ICU setting (sedative drips, pressors,...)

Most of all - have fun, ask questions, and learn.

Good luck!

nurseosoks · Apr 12, 2012

@ CrufflerJJ. Thank you so much of the info

CrufflerJJ, BSN, RN, EMT-P · Apr 13, 2012

@ CrufflerJJ. Thank you so much of the info

Sorry....I forgot to welcome you to Allnurses. Hi!!!

A few more things that you may get to experience....

- withdrawal of care/making pt comfort care - how it's implemented by the staff & what's done to ensure the utmost in pt & family comfort during the process

- how staff communicates/interacts with pts and their families in stressful situations (i.e., having "the talk" with pt & family members re: DNR status, exactly what CPR entails, and do they really want ribs broken/shocks delivered...), and the ever-popular interpretation of medical-techno-mumble-jumble into ordinary language for the non-medical

- gain a better hands-on understanding of sepsis - diagnosis, causes, signs/symptoms, initial & later interventions

- you might get to see ARDS, DIC and HIT. If you don't know these abbreviations, look them up

- see/obtain basic knowledge of dialysis (CRRT/CVVHD/whatever)

- see/obtain basic knowledge of balloon pumps (may not be seen in your ICU), and why they're used

- obtain basic knowledge of ventilators

- obtain basic to moderate knowledge of CBC, CMP, Mg, Phos, PT/APTT/INR - what they tell you, what they don't tell you

- gain basic to moderate knowledge of arterial blood gases - what they tell you, what they don't tell you, when they're ordered

I'd encourage you to note how teamwork is implemented by the staff (NOT just the nurses) - is it functional, or dysfunctional? Note the differences in "intensity" of workload/pace between day shift & night shift, if it exists at your site. Is there greater teamwork at night....if so, why?

See how your preceptor handles time management - how they manage their day. With only 1-2 patients, time management should be pretty easy in the ICU. Right? RIGHT??? OK, it's not that easy. This was probably the hardest thing for me.

Note the types of critical thinking skills needed in the ICU environment. What info does your preceptor gather at the start of their shift? When/why do they think that things are going wrong, and the pt is about to crash? What interventions do they perform to avoid the crash (& associated stress/paperwork)? When don't they blindly follow physician orders, and why not (one example: if your pt's blood glucose is 90, and they're NPO, it might not be a good thing to give that 1473 units of Lantus)?

What procedures are performed at bedside in the ICU?

What sort of training is offered to nurses entering the ICU? Is there a structured Critical Care Fellowship training program, or is it just a "sink or swim" approach?

Please don't forget to write a note to the nurse manager prior to the end of your time on the unit. Express gratitude for the opportunity to work with your preceptor, gush about the preceptor and how good they were (hopefully this part will be true!), remind the unit manager of your strong desire to work in the ICU.

If you want to work in that ICU, I'd encourage you to see your capstone time in the unit as a sort of extended interview. The workers there (not just your preceptor) will be evaluating you, your attitude, and how well you might fit in. They will give feedback to your preceptor, the unit educator, and management.

When in the unit, PLEASE don't just find a comfy chair & start surfing the web on the nearest computer or iPhone. See if anybody needs help with a bath, a dressing change, cleaning up poo, or anything at all. Hopefully your preceptor will be "on the lookout" for neat stuff for you to see in the unit. In any case, keep your eyes open. If something interesting should pop up, ASK your preceptor first before dumping them & going onto the neato-keen procedure or seriously messed up patient. Common courtesy, don'cha know.

Get your preceptor a gift card at the end of your time there. Nothing too extravagant - $20 would be great. They probably receive ZERO extra pay for precepting nursing students, and a token "THANKS" would be highly appreciated.

Get to know the Clinical Educator (the person who typically runs the Fellowship training program). Be bright eyed, enthusiastic, and willing to learn. You want to be remembered.....in a good way.

The worst thing you could do would be a "know it all." You don't. Please don't try to BS your way through questions. Expect to have questions thrown your way for which you likely do not know the answer (such as "why is the pt's K so high?"). If you don't know the answer, admit it and ask for guidance/hints. Plan on working outside the unit to gain a solid understanding of the questions asked you during your capstone. Follow up the next day with your preceptor to show that you've worked on your own to learn the answer.

Don't ask the same question over & over & over & over & over.

Don't ask lots of questions during a high stress situation (code or pre-code).

That being said, be willing to ask questions (at the right time) to both gain knowledge and show that your are interested in learning.

The ICU is an amazing (and horrifying at times) environment. It offers a tremendous opportunity to learn, along with the opportunity to see how caregivers either function or fail to function in potentially high stress situations.

It's pretty darn neat.

Enjoy!!

2ndTime · Apr 13, 2012

Wow that was a really thorough rundown. You hit the nail on the head. I just finished my capstone or my school calls it "immersion" in the CVICU. It was amazing. Just another thing. Don't be afraid to jump in situations such as skills or patient teaching. It shows initiative and I think as a student you have some immunity for making mistakes. Also, They make for great answers for those dreaded interview questions, "tell me a time when...." If it didn't go well, then you can always say how you learned from it and so on.

nurseosoks · Apr 13, 2012

@ CrufflerJJ. Thank you once again for the words of wisdom. You are such a wealth of experience!. Will follow your advice.@ 2nd time,thanks for the encouraging words. I love allnurses.com!!!!!!!!!

CrufflerJJ, BSN, RN, EMT-P · Apr 13, 2012

Don't be afraid to jump in situations such as skills or patient teaching. It shows initiative and I think as a student you have some immunity for making mistakes. Also, They make for great answers for those dreaded interview questions, "tell me a time when...." If it didn't go well, then you can always say how you learned from it and so on.

Agreed about don't be reluctant to jump in and help with new things. That being said, if you're not sure how to do something, ASK. You will not be fondly remembered if you contaminate the doctor's Swan catheter prior to insertion.

One interview question I remember from my interview was "tell me about the sickest patient you've taken care of." Being able to talk about pts you've taken care of in the ICU will be a good thing.