Cross Training to ICU

[gemmi999]

Hi, all!

I recently got offered a new grad job at a small, rural hospital ER. The Manger of the ER is also the manager of the ICU and said that I'd have the option of cross training in ICU because of how often ICU patients end up in ER. He feels it is good for all ER nurses to have experience with drips, vents, etc. I am not questioning this, it seems like a good idea.

My question is this--I have never felt comfortable in the ICU setting. I work as a NA and frequently get floated to either MICU or SICU at the various hospitals in my hospital system. I also did my critical care rotation at a major hospital system and got about 10 shifts in an ICU setting. What can I do to get more comfortable in the ICU setting, especially if I am going to be cross-training and seeing ICU patients frequently in the ER?

What materials should I review? What drugs should I make sure I know inside and out? Specific disease pathophys? Since it is a small, rural hospital that does not take trauma patients, I expect I would see more common conditions versus more unique/rare conditions that would go to a larger, more specialized hospital.

Any help would be appreciated!

[calivianya, BSN, RN]

You will see a lot of GI bleeds, DKA, COPD exacerbations, sepsis, and miscellaneous other causes of respiratory failure. I would go ahead and pull your facility's P&P on how they run insulin drips and at which point you switch from one IVF to another and memorize that because that's something that's very simple once you've done it a couple of times, but is a little confusing the first time you see it in action.

Be very familiar with your vasopressors - how each of them work, which ones of them are going to jack up the heart rate, which ones increase contractility. If you are going to be in a rural hospital I suspect you may have to watch out for overzealous hospitalists ordering dopamine for someone with a heart rate already over 110, as an example, and gently guide them to something that's not going to make the heart rate 150 instead.

Icufaqs.org is a great resource to bookmark, and if you're not proficient in reading strips already, practice with SkillStat ECG Simulator until you're feeling more confident. That's what I used to learn to read tele strips.

Good luck!

[armyicurn]

Those sites above are good resources. I give it to every new RN that shadows me. For the record, I have no financial connection to that site. Some of the books that I keep on my home library are:

Critical Care Nursing Secretes by Schell & Puntillo

Quick Reference to Critical Care by Diepenbrock

As you read them, quiz yourself to ensure you understand what you are reading. Critical thinking and working yourself through "what if" situations will keep you on your toes for when your pt might surprise you (i.e. crashing!!!)

Good luck.

[WorldDay]

I think being comfy in ICU will come to you after 12 months of waking up/driving home thinking, "Oh God, I forgot that," "Oh God, I forgot to tell them that." What pathology and what you need to know will come naturally because you get same types of patients over and over including dying one after an arrest and dealing with family and departing loved ones. Cut yourself a lot of slack and if you are not in supportive environment, you should switch hospital because some ICU is very toxic.

[joyful_wanderer]

I started out in an ER in a very rural hospital. There was no ICU and if we had ICU status pts we kept them in the ER till we could medevac them out which at minimum would be 3 hours up to several days (rural Alaska). Knowing your resources (books, site links, people) ahead of time will make it easier to look things up in a crunch. Next is time and experience. The only way you will become more comfortable is to do it. It can and will get scary but you will make it to the end of the shift and everything you went through will give you experience for the next time.

Congrats on the job!