If you were my preceptor......what should I know?!

  1. I am a new RN who is starting a critical care nurse internship in a month. I will have months of orientation, which is a true blessing! I want to try to prepare myself for this experience so that I can get the very most out of my orientation. I have been out of school for 8 months now and feel like I will have to catch up on a lot of things that have slipped over those months as I planned a wedding, got married, moved 700miles away and passed boards! I know that I can't be expected to know everything as I spend my first days/months in ICU, but I want to try to know as much as I can!

    My question for all of you is.....if you were the preceptor for a new RN in the ICU (MICU, SICU, Neuro ICU) what would you want her/him to know starting out? Is there a medication that you would be shocked they didn't know about? A task that you would think they would be comfortable with already? Pretty much.....what would you want in your preceptee/orientee? And what would drive you crazy?! (definitely don't want to make my preceptor's life harder when I am there!)

    Thanks in advance! I look forward to hearing your thoughts! This message board is such an awesome support system!
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    About FLancaster11

    Joined: Jan '11; Posts: 7; Likes: 1


  3. by   Biffbradford
    Basics: EKG, normal ranges for blood pressure, pulse ox, HCT, K+, BUN/Creatinine. Do a couple head to toe assessments on someone before starting: eyes PERLA?, heart/lung sounds?, stomach sounds? pulses? (radial, pedal), capillary refill? ABG's would be nice, but those are tricky. Good hand washing!
  4. by   FLancaster11
    Awesome! Thanks for your input!! I think I can manage those!!
  5. by   godfatherRN
    I've been a nurse now for almost 2 years, like you I started out as a new grad in the highest risk cardiovascular intensive care unit in the state (What was I thinking!?!?

    I did have a summer internship at Mayo Clinic the previous summer in an ICU so I did have a little experience, but it was pretty overwhelming starting out as a new grad.

    A great resource I used when I was starting out was a textbook called "critical care nursing a holistic approach" I used this book in my ICU nursing class and really liked it. It explains things really well, has great pictures and is pretty all-encompasing. It will be a great resource for you to learn more about topics that you first learn at work.

    Ok so I'll put some basics down also.
    normal/abnormal vital signs
    Labs: Na, K, Glucose, Mg, Ca, ionize Ca, CK-MB, Myoglobin, Troponin-I, PT/INR, PTT, H/H, WBC, Platelet count, Fibrinogen, ABGs (also agree with above, this takes time)
    Note Labs: These are a lot, but in my opinion you learn so many in nrsg school and these are the ones I see all the time in my every day practice.

    Those are the basics, things to start really getting down once you start and get experience would be for sure hemodynamics, vents, ABG analysis, common invasive gtts (vasodilators, vasopressors, inotropes) and antiarrhythmics. Please know this stuff will come with TIME and EXPERIENCE

    You will face frustrating days ahead, learning how to be a nurse and then an ICU nurse at that is very tough. However you seem like someone who has a drive to learn. Just be patient with yourself and know that it takes TIME to get good at this stuff. I can say from experience both for myself and many on my unit who started as new grads that you can totally do it, and not only do it but be very successful at it. Just take one day at a time!

    Good luck!!
  6. by   traumaRNmelissa
    I have precepted a few new grads and the MOST important thing for them to know is when to ask for help, or admit they dont know something. That is very hard to do as a new grad as you dont want to appear "dumb". A good preceptor will never harass you for not knowing something, just know how to find the answer.
    Also important: If you make a mistake (and you will, we are all human), own up to it as soon as possible. It is probably not as bad as you think and your preceptor cant fix it if they dont know something is wrong.
    Good luck!
  7. by   FLancaster11
    Wow....thanks for that advice! I am starting right now and feel so overwhelmed and dumb! I know that I will need to admit I don't know things that are simple and just don't want my preceptor to think she got the stupidest new nurse on the planet. thank you for giving me this encouragement to bite the bullet and ask for help. I pray I have an understanding preceptor such as yourself!
  8. by   burn out
    If you really wanted to impress me, know what is normal i.e.lab values, vital signs, sinus rhythm,hourly urine output. because everything we deal with will be abnormal.
  9. by   RN1980
    the only thing i expect the preceptee to know is what they were taught in school. i honestly cant expect them to really feel confident in anything other than what they were exposed to in their program.
  10. by   nurse.sandi
    Congratulations on all your accomplishments.
    Here is a good story. One of my ICU preceptors was amazed at how I got the ivpb med into the line. She showed me an easier way. I thought she would make fun of me to the others but she did not. I was a LPN before RN so I had a lot of different experience, but nothing like what I learned in the ICU/IICU (stepdown unit) which was a lot. I would expect you to be a new grad who is eager to learn. A big challenge for me was calculating for heparin and body weights, because that is a very important med. I learned how to caliberate IV meds. Another important thing is to make sure you know what is compatible with different iv fluids. My rule of thumb for me was if I had extra lines or ports, I hung meds separately than running them together. It might seem like a little extra work but it made me feel better about iv meds.
    A manager taught me not to say "I don't know", she taught me to say "I will find out for you". It was great advice. Good luck.
    Last edit by nurse.sandi on Apr 28, '11 : Reason: addedum
  11. by   stewiegriffin
    Most of this sounds exactly like what I do on my general Med/Surg floor.
    What differences in nursing can I expect to see in ICU?
  12. by   LUNETUNES
    ]firstly, congratulations on entering critical care!!! and secondly, for caring enough to ask for the thoughts of seasoned rns!
    one of the most important suggestions was mentioned above....ask questions, admit what you don't know, admit if you make errors.
    preceptors are there to teach and answer questions!
    admitting what you don't know, and not misleading us that you do know, prevents errors to start with.
    admitting errors asap, allows quicker correction of the error, alleviating injury to the patient, or you, or the hospital.

    next, remember, every nurse, like every person, has their own way of accomplishing a task. three excellent nurses, may do the same task through a different method, and as long as all three achieve the same result, in the safest way to the patient, without compromise to your license, the hospital or doctor, it is the right way. you find the method that feels the most comfortable for you! do not let anyone tell you it is the only way, unless it is the only way, such as with some equipment, etc.

    always remember the key to being a great nurse, is always keeping safety as a primary responsibility.
    safety to the patient, your license, the hospital and the doctor.
    keep little notes for yourself of tricks, codes, and math equations.
    have simple things in reach always, sharpie, scissors, hemostats, and a smile!
    good luck!!!!
  13. by   stepdown_niteRN
    The basics apply first in any area of nursing practice: Physical Assessment Skills, Basic electolytes norms and treatments, basic hemodynamics and interventions, work up to Acid-Base balance and the physiology behind it, and then 12-lead. Always ask questions, depend on your experienced workers who have the heart of a teacher.