Critical Care Clinicals!

LoriRNCM, ADN, ASN, RN · Jan 31, 2015

I've been in SICU and MICU so far this semester (my last semester), and neuro last semester. It is soooo much more fun/interesting than medsurg. The good thing is you have one or two patients, and your nurse has two patients. So that means she is in your patient's room very often, giving you lots of chances for observing and participating. She's not running between 5 or 6 patients. The units are intimidating, lots of patients on vents, lots of co-morbidities and multiple diagnoses, but I find it very interesting.

Bedside_Life RN · Jan 31, 2015

This is the time ask the questions you still have from working with "floor" nurses. They most likely didn't have time to rationalize implementations and provide a thorough answer. In this setting, you will be dealing with a one to one or one to two ratio (according to facility and unit). Remember, the idea that these nurses have it "easy" is false. The nurses working in these units are deceivingly laid back in comparisson to those on most med/surg tele unit. This is because of the maticulous monitoring and intuition, gained from experience, that they "should" withhold. So don't let the atmosphere fool you. Most of these units run their own codes, the nurses push paralytics, manage Art. lines, titrate some of the most critical medications to the most unstable patients, provide complete pt. care (b/c CNAs are not often seen in this setting), and practice very independently.

Prepare to stay at the bedside a lot. This is because the frequency of diagnostics and monitoring (in almost every aspect) is ordered, as per protocol, at intervals from q5min to q4h.

Familiarize yourself with thorough assessment, compensatory mechanisms, expected findings/results of critically ill patients, such as acid base balance, CVP, positioning, coagulation, mechanical ventilation, Procedure related risks (such as bleeding, damage to surrounding tissues, and stimulation/manipulation of tissues, glands, and nerves, or infection), Drains (output), Lines(input/output/overload), Airway, Suctioning (output/electrolytes/placement), CAUTI, CLABSI, VAP (some post-op patients will have a goal for extubation within 6 hours). If post op CT patients are in your unit familiarize yourself with pacer wires and rhythm strip interpretation.

I could go on and on, and I am sure that a CCRN response could really help you with your questions. But all-in-all, capitalize on this opportunity, it is the best of the best environments to learn from. Enjoy it. Good luck!