New to ICU. What do you hate to see a new ICU nurse do?

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Little over a year experience floating between PCU, med-surg, joint/spine/general surgery post op floors and ICU. I am transferring to full time ICU soon and am wanting tips! I would like to hear from you what the things you absolutely HAAAATE to see a new ICU nurse do because of lack of experience. Clinical tips only please. Things such as "never piggyback potassium riders, or always make sure to hang around for first 15 of new blood transfusion if possible, etc." Would love to hear from my RRTs as well!

Love this reply Julius Seizure! And that's what I do with the rates if I am short on pumps and have to run it as a secondary. I like that it flushes the rest in there. I just personally do it as a "second primary". It's fine either way I guess that was a bad example on my part. I am very good about asking questions, so I'm sure I'll do good there! Thank you guys so much for these replies !

I don't like to see ICU nurses (old, new, or otherwise) who don't pay attention to their patient's monitor. I've gone in a patient's room because their sat was in the 70's for a minute only to find the nurse in there scanning meds, completely oblivious. An alarm might be insignificant, but always glance at it to be sure, even if it's not your patient.

Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.

The following are things that I think most ICU nurses APPRECIATE:

Think about the Why's of what you are doing when giving your care, not just about the tasks or not just the machines. Study, read, ask questions. Think things through, and if something doesn't make sense, ASK before doing it.

Help your coworkers, ask for their help. You are all responsible for the patients, rather different than in other acute care areas.

Remember there's a human being attached to the machines. Never ever forget their humanity. Talk to your patient, even if they are comatose or you don't think they understand. As much as possible, have a gentle, caring touch. There are times that people recover from a difficult ICY stay, and they remember what was said.

If you think something doesn't look right with your patient, but can't put your finger on it, ask for advice. Trust your instincts.

Lastly, and most importantly, take care of yourself. Sleep, eat, exercise, go to your healthcare provider on a regular basis.

Love this! Thank you! There is great teamwork in our ICU. So excited.

Specializes in LTACH/Stepdown ICU.

*Taking notes as well.

Specializes in Pediatric Critical Care.

Investigate if something is alarming and you dont know why.

Examples:

If your IV pump keeps alarming occlusion, dont just keep restarting it. Something is either wrong with your pump, tubing, or your patients IV. It could be that your IV is no longer patent and it needs to be changed before the infusion causes tissue damage. If it is the equipment, those need to be changed out so that you can reliably delivery medication at the correct rate.

If your monitor keeps alarming, either fix your patient, or if they are okay, then adjust the alarms so that they are appropriate for the patient's condition.

If your vent keeps alarming and you can't figure out why, CALL THE RT. Don't just silence the alarm because the patient looks okay and you don't see an issue. I once saw a nurse do this because the vent kept alarming high pressure despite suctioning, and she didn't investigate further. Within 30 minutes we were coding that patient, due to pulmonary edema, and they nearly died. That nurse no longer worked there after that night.

Specializes in Burn, ICU.

I hate finding IV tubing connected to the patient with the channel turned off and who knows when the line was flushed! I also hate finding the CVP connected to any-old-port, through a clave. Check your patient over when the come from the PACU...I swear I find most of these from the PACU at our hospital.

I also hate when someone takes the last of something and doesn't re-order it. (I work nights, and we have no tech/clerk/secretary. If you use all the 1000mL NS, call for more! I guess that's actually just general politeness, but sometimes the need for an item is a little more urgent in the ICU!).

I hate when people don't make sure to order refills of gtts and PCA cassettes (which, depending on the med, are not automatically stocked by our pharmacy). It can take between 1-4 hours to get refills, so think ahead!

Speaking of thinking ahead...you can't predict every little thing that might happen, but try. If they're going to intubate your patient, make sure your suction is set up and working...on both sides of the bed. Have your ETT holder ready, but maybe have some tape ready too, just in case you can't get the holder on fast enough and the pt is either fighting or coding.

I'm sure I have many more, but I definitely hate when people talk like they've never made a mistake or had a rough shift in their lives! (Usually when talking about someone else's mistake...)

Like plenty of other nurses have commented.. Alarms, alarms, alarms. Many ICU nurses experience alarm fatigue, but you ALWAYS have to check. Also, keep an eye on the monitors with every patient's vitals. For example, say a patient is typically sinus tach in the 100s, but over the past fifteen minutes has a decreased HR to the 60s. The alarm may not necessarily go off (depending on the parameters), but it could save someone's life if they become symptomatic from the sudden change in vitals.

Also, remember your role in a patient's death. The nurse is at the bedside when the patient is terminally extubated and taking their final breaths. The nurse is the one giving hugs to the tearful family members after CPR and all measures have been exhausted to try to save their spouse, parent, sibling, friend. Something that breaks my heart with every single death is the family's last walk through the ICU after a loved one has died. It's not necessarily clinical, but it is a vital part of your role as an ICU nurse. Sometimes, it is natural to put up a guard to protect your emotional well-being because you have to carry-on with your nursing care of the critically ill patient your other room. And it's easy to become "hardened" by seeing death and it becomes somewhat "normal," so just be aware.

A last tip is to ask your neighbors how they're doing. If you have a free moment, check in on your co-workers and help with a boost, check a blood sugar, or hang a med in the next room. The following day, it could be you wishing someone would lend five minutes of their time.

Good luck and I hope you enjoy your new adventure as a critical care nurse!

Don't be careless with sterile technique! A central line bloodstream infection can absolutely kill a patient. It might be difficult to trace it to a particular nurse because it takes time to develop, but we are absolutely responsible as nurses. When accessing a port, always keep track of where your fingers are, where the port is, and where the sterile tip of your syringe or IV tubing is. We should view it the same as handling a loaded firearm. The slightest slip up - a momentary brushing of a gloved finger against the port or syringe tip - is all it takes. If your flush slips off the port and touches your glove or bed sheet, throw it away and use a fresh one. If the dressing is peeling off and there's already an air tunnel to the insertion site, don't "reinforce" it by slapping another Tegaderm over the top. Do a full dressing change and swab with chlorhexidine. When a doc is inserting an IJ line on a man with a beard, insist on trimming back the beard with clippers so the dressing doesn't peel halfway off and become contaminated 5 minutes later. Insist on it even if the doc is in a hurry. And probably most importantly, always be thinking ahead to get invasive lines out as soon as possible to minimize infection risk. Don't just leave a central line or Foley because it's more convenient for nursing. If your patient's arms are edematous and it's Friday morning and your IV access team (i.e., PICC nurse) doesn't work weekends, call them and see if they can start a couple ultrasound-guided peripheral IVs so the central line can be discontinued later that day or on the weekend instead of having to leave it in due to lack of planning. Be proactive in asking the docs if you can pull central lines and Foleys - even if it means you will have to work harder to get lab draws and help your patient with toileting. Do what's best for your patient. Nursing schools are sadly deficient in providing adequate practice with these very important clinical skills. It's not your fault, but it does mean you will have to develop the skills on your own.

Specializes in MICU - CCRN, IR, Vascular Surgery.

Label all of your lines at any place where something could be attached at a Y site! I absolutely can't stand to see a bunch of cord spaghetti with no labels anywhere, it's so unsafe and disorganized. Always check IV compatibilities, and with your first assessment, always find out where you will push meds in the event of a code. And staying in the room during the first 15 minutes of blood administration is not optional, it should be mandatory.

Specializes in ICU.
Always check IV compatibilities...

Yes PLEASE!

I always check if I don't know right away. I came in one day this week to a hot mess - patient only had a triple lumen PICC (don't even get me started on how useless only having three lumens is), running TPN in one lumen, an antibiotic line (patient was on four different abx) in another, and then propofol, fentanyl, and amidarone together in the third one. Guess what? Amiodarone is listed as variable compatibility with fentanyl and is not tested with propofol.

I get REALLY irritated coming in behind someone who just doesn't give a crap and runs things together whether they're compatible or not.

Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.

Yikes, sounds like that patient needs an additional site big time.

Which brings up another point: Don't be hesitant to ask docs about putting these in, or about anything involving the welfare of your patient. This should be standard, but its very important in the ICU.

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