What You Wish You Knew From The Beginning...

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Hello Everyone,

I am a new graduate nurse, still waiting to take my NCLEX but I have accepted a position at a hospital in the ICU floor. The orientation is 12 weeks, with 3 of those weeks in the classroom and the rest with preceptors and rotating night and days. Once orientation is done, I'll be doing night shifts.

As a new nurse, I am scared of ICU but excited. I love to learn and ICU is where I always wanted to be (I'm so thankful that I got my dream job). I was just wondering, what do you guys wish you knew really well before you started your ICU rotation? What are some things that as a new nurse in the ICU you can learn to make transition easier once you start. Also, what things should you always have with you that will be accessed often.

Any advice would help!!!

Thank You

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Understand that you will need to study at home in your time off. That often makes the difference between an orientee who succeeds and one who never makes it off orientaton.

New grads who are well liked will be forgiven more numerous and more serious mistakes than new grads who are not well liked. It's all about being fake. (There are numerous threads about that.) You won't like everyone you work with, but all of your colleagues should BELIEVE that you like them. Be friendly, even to shy colleagues. Ask them about their children, their pets, their hobbies. Don't be too rigid about your beliefs. (A new orientee once sat down next to me on her very first day and announced that "The men who work here are all immoral." She graduated from a Christain Bible college; her idea of morality was quite rigid. What did she expect from me -- she knew I'd been working with these folks for years!)

And know how to type. Online charting is the norm these days. Figure it out and make it work for you.

I have lots more, but DH is urging me to come have lunch now.

Smile, introduce yourself, get to know everyone you can, be friendly, ask questions....in other words COMMUNICATE! If people like you, they'll be more willing to help you & teach you & forgive your mistakes!

BRAIN: for report, for organization, for tasks, for your wish list, for everything. Find something that works for you because starting out you won't be that nurse who doesn't have to write it down. You will forget due to information overload and will make unnecessary mistakes or calls. So be prepared!

FLEXIBLE: learn to go with the flow! Yes follow policy & procedures! Realize that your patient is rarely textbook. They have co-morbities that affect other things so what worked with your last patient won't always work with this one. Breaks & lunches...mmm...yeah sure...try to remember to eat & use bathroom sometime your shift. Also hydrate!

THINK: please look up anything you don't know, ask appropriate questions after you looked it up & use your common sense. It will help you to avoid the question "what the heck were you thinking?"

ASK FOR HELP: because you can't reposition a 600 lb patient by yourself. Also learn to recognize that you are drowning because your preceptor sure will. This usually affects patient safety and/or quality of care. You are not your own island & you can't do it all yourself; so delegate.

FORGIVE: you will make mistakes so learn from them & don't beat yourself up for them; forgive yourself.

CONSCIENTIOUS: make your best effort; give 150% to the learning process.

DETAIL ORIENTED: the little things affect the big picture. Something changes in patient status is subtle so pay attention!

There's a whole lot more, but that's what I expect new grads to bring with them during orientation.

Good Luck!

I started in an ICU as a new grad, and I'm almost at two years of experience now. I truly think attitude and personality are going to make a bigger difference for you than you might realize. Initially, I think you should just be humble and try to take in any and every experienced nurses' advice. You eventually will develop your own routines and critical thinking strategies. However, if you really are looking for something you could study up on that would be helpful... I'd say go back over the pathophys of the major chronic illnesses that you are going to see all the time. You can never know enough about COPD, CHF, DM, , Kidney Failure, HTN, A-FIB, DVT, PE. If you truly know how these disease processes work, what abnormal labs are associated with them, and the physical and pharmacological treatments for them, you will be a leg up on even some experienced nurses. You really don't know what you don't know until its front and center with a patient that is decompensating from one or more of these illnesses and the better you know the theory, the more confident you'll be when you are intervening, because you'll know what's going on and why you are doing what you are doing. I know it sounds like common sense, but you'd be surprised how many nurses you are going to run into that have misunderstanding/misconceptions about interventions they are performing every day.

Good Luck.. You'll be great. Just be prepared for you first year or so to be nerve-wracking.

Better to call the doc with something that turns out to be unimportant than worry about bothering them and miss something big.

Ask the nurse you are taking report from, as well as the docs when they round, what you should be watching for in the patient, what parameters you need to keep the patient in-between, and what the goals are for the patient on your shift.

Don't be afraid to ask questions of your nurse buddies.

Take your time when calculating meds and drips, and make it a true independent nurse check.

Keep up with I&O and Vitals. If you are pressed for time, the assessment charting can wait.

Activate your computer system so new orders pop up immediately and you don't miss them.

Make friends with the pharmacists. Ask them lots of questions. Same with RT's.

Make sure to look your patients in the eyes, not just at the tubes and wires on their bodies. Make sure to call the patient by name frequently, even if they are unconscious. Call family members by name, also, when you talk to them.

Take time to trace your lines to make sure they are labeled properly and connected to what they should be connected to.

Make sure to feel the patient with your hands for cold hands/feet, as well as look at them and listen to them.

At the end of the day, make notes on what you learned. Then clock out and leave it at work. Learn to disconnect from work at the end of the work day.

Make a point to smile and be friendly to you patients and their families, no matter how busy and stressed you are. I'm not saying this from a customer service perspective...it's because I've found that when I am super friendly, people are much less likely to get rude when something isn't going their way. Some people are just looking for reasons to feel attacked.

When you call a doctor, know what you want him/her to do. Don't just call with a problem and sit there and wait for them to solve it for it. They seem to appreciate it, and are much more likely to trust your judgement in the future. At first you will have to ask your coworkers for a lot of help in this department, but you'll get better.

Also, if a doctor does something you don't understand, find a tactful way to ask them to explain their decision to you. You will learn so much this way.

Carry a little notebook and write things down. People know you have a lot to learn, and nobody expects you to be perfect. But I've seen nurses get pretty impatient with new grads who keep asking the same question. And on a similar note figure out how to access your facility's policies and procedures. That way you'll be able to figure out some of these things on your own.

And lastly, you are NEVER too busy to pee. It may feel that way sometimes, but there are very few things that can't wait two minutes.

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Make friends with the pharmacists. Ask them lots of questions. Same with RT's.

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A great bit of advice (as well as the other stuff). knowing who the pharmacists are (Ask if you can go to your pharmacy and meet them it they don't make rounds) makes a huge difference.

My ICU has a pharmacist assigned to it on weekdays M-F. She is a huge asset to me and the unit. I know I can call her anytime and ask any medication question (either a dosing, interaction, administration, ordering or just general med question). Also the pharmacists in the pharmacy know me by voice (I guess I call too much LOL) and are always willing to help me with any questions.

With my on unit pharmacist I have actually started teaching her EKG interpretation every time I call her. She will be an expert at reading them in a few weeks at the rate I call.

RT's are also a great friend to have. Having them willing to do things that are within their scope of practice but maybe not "their job" can make life much easier. Trach care, oral care, suctioning, ET suctioning, VAP care etc are all nursing tasks assigned to the nurse, but in my facility RT can do and chart them, if your nice.

Specializes in ER, ICU, MED/SURG.

Better to call the doc with something that turns out to be unimportant than worry about bothering them and miss something big.

Ask the nurse you are taking report from, as well as the docs when they round, what you should be watching for in the patient, what parameters you need to keep the patient in-between, and what the goals are for the patient on your shift.

Don't be afraid to ask questions of your nurse buddies.

Take your time when calculating meds and drips, and make it a true independent nurse check.

Keep up with I&O and Vitals. If you are pressed for time, the assessment charting can wait.

Activate your computer system so new orders pop up immediately and you don't miss them.

Make friends with the pharmacists. Ask them lots of questions. Same with RT's.

Make sure to look your patients in the eyes, not just at the tubes and wires on their bodies. Make sure to call the patient by name frequently, even if they are unconscious. Call family members by name, also, when you talk to them.

Take time to trace your lines to make sure they are labeled properly and connected to what they should be connected to.

Make sure to feel the patient with your hands for cold hands/feet, as well as look at them and listen to them.

At the end of the day, make notes on what you learned. Then clock out and leave it at work. Learn to disconnect from work at the end of the work day.

THANK YOU everyone for your responses. I will definitely follow up on all of them to make the transition easier. I am scared but excited and I just want to be ready for what comes with this job. I have been to this hospital to shadow and the teamwork is exceptional, so I know I'll be in good hands. The classes for orientation also sound really tough so I'm hoping that they prepare me a little better for ICU. Thank you all again, great insight!!!!!

PS: Any advice on how to get ready for night shift???? I think this is also making me anxious. Thanks

I'm a newer ICU nurse and I have the best quote from a doctor. It was one of my first days off of orientation and I lacked lacked the experience and knowledge to realize exactly what was going on with the patient, but I felt like the doctor needed to actually lay eyes them. I was very shy and very apologetic about calling him into the room. But Ill never forget what he said to me. and this was an a-hole doctor too. But he looked at me and said "What makes an ICU "intensive" isn't because the care from the doctors is more intense, but because the care from the nurses is more intense." Never jeopardize the safety of your patient for fear of the doctors response. Better to get yelled at (that happens even when you are doing nothing wrong) and have a patient who is alive and be that annoying g nurse than to be that nurse whose patient died because she didn't speak up. Looking back now...I think I called him in over something silly too. Like their urine was green Bc I didn't know propofol did that

As far as night shift is concerned... I don't think anything can really prepare you for it other than the experience of doing it. At my job, I swing 4-6 weeks on nights, then 4-6 weeks on days, and I can tell you I much prefer the day shift, its much busier with all the MD's and ancillary staff making rounds, plus you do more "road trips" d/t more testing/imaging being done during the day, also there are more transfers and discharges during the day. This is not to say that none of this stuff happens on nights, because it does occasionally, just much much less so than days.

Some nurses love the relative quietness of nights, but for me it just makes it harder to stay alert and motivated to work. Now, codes can happen anytime day or night, its hit or miss if you are on the code team.

But to answer your question... I think the best way to prepare for nights is to have a sleeping strategy and stick with it to help you make the transition. Few nurses stay on the nights schedule on their days off, so you'll be cycling back and forth to "day" mode versus "night" mode. For me, I try to stay up a little later the night before and sleep in for as long as possible the day of going back onto night shift. Then, hopefully you'll have consecutive nights where you can be a vampire and get all of your sleep during the days... Then when you transition back to day schedule, you might want to wake up extra early from your daytime sleep for that last shift, then re-sleep that same night in order to be ready to be on a day schedule the next day. At least that's what I do. You'll still probably feel like crap that first day or so, depending on how many days off you have, then you start it all back over again the next time you work.

Contrary from the first post, DO NOT under any circumstance, be fake. It is absolutely NOT about that. Be genuine and be yourself. Realize that you know nothing and be eager to learn. Offer to help out.... A LOT....doing whatever needs to be done. If someone offers you an experience, take it. Even if you think you've already mastered something, you can always learn something new. Never turn down an opportunity, EVER. You will learn. You got the position because you are meant to be there. You can do this...we've all been there. Be kind and do what it takes to advocate for your patient. Best of luck to you!!! :)

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