Changing the culture in the ICU

[SuperNurse225]

I know I am not the first one to write about this and I wont be the last. I have worked on the same unit (MICU) for about 3 years. Before that I worked tele. When I was new to ICU, there was clearly a lot to learn and I was open to feedback. I was given a lot of constructive criticism by experienced nurses, those I worked with and those that I gave hand-off too. It may not have been in the nicest way but they addressed the things that I was lacking and I was able to take that and grow from it. Now that I am an experienced nurse, I am noticing that the newer nurses simply don't care. They tend to do the bare minimum and forget the basic things (like labeling lines, clean rooms, neat looking patients if you know what I mean). Some days I will walk in to my patients room at the beginning of my shift and it is pretty clear that oral care hasn't been done once during their shift. I am not one of those nurses that will pick you apart on every little thing but quiet frankly, I am tired of cleaning up their mess before I can even start my shift. So my question is, how can I change the culture on my unit? All the experienced nurses that whipped me into shape have left, I am one of the few experienced nurses left and I don't know how to change the culture on my unit. These new nurses seem cocky, they act like they know it all and do no wrong so giving them constructive criticism has been ineffective. Management is of no help because we are in between managers and the director has no ICU experience. I in no way want to micro manage or bully the new nurses, but how do you change that kind of attitude of entitlement and not caring. I just want to provide our patients with consistent and safe patient care and be a part of a strong ICU team.

[MYSTICOOKIEBEAR]

Help build the team that you want to see. Be a good, helpful nurse and lead by example. One thing that I make a point of doing is doing rounds on the nurses on the unit 3-4x/ shift, beginning, twice in the middle, and near the end. Unless I have an absolute train wreck of a patient, which happens quite often as of late, I always do this. I also ask them if they have any questions or concerns about their patient or if they do not understand the rationale behind the decisions that were made for their patient by the team.

I make sure they know that I am there for them and that they can always ask me questions. I regularly get questions from the newer nurses that they are too embarrassed to ask the other nurses for fear of ridicule or judgment. I'm not going to lie, there are some questions that I am mortified that they do not know because they have been on the unit for so long, but I keep a poker face and teach them the right answer or the right way to do things.

There is no easy way to change the culture of an already established unit. But there is a way to change the culture for the newer people on the unit if you get to them early enough. If you do this, you will slowly start to see that there are more nurses who belong to the new culture than the old one, which makes for a better unit.