END of ICU Orientation

yes get in the next acls class, we try to get all of our newbies in the first class that comes around or even goto another hospital and get it if they are teaching one sooner. if you are going to take care of critical patients you got to have it. in our icu we take all ages of patients from newborns that are on vents for rsv/pneumonia to the elderly so we're required to get pals. i'd reccomend take as many of those courses you can but make acls priority #1 for now.

So I was told I'd get 12 wks orientation, mgmt tried to take me off at 8 wks, I made sure to get 12 (now over.)

I'm wondering what skills I should expect to have down and what I should've been shown during orientation compared with the standard.

1. monitor CVP, A-line B/P, bladder/abdominal pressure

2. set up pressure bags, flush, zero, etc.

3. blood draws through A-lines

4. inserting NG tube (& Dobhoff)

5. IV start/ bld draw

6. i-STAT for ABG, labs, etc

7. Head to toe assessment

8. titrating gtts (which would you expect to be familiar with at this point? eg. Levo, Phenylephrine, Dopamine, insulin, etc.)

9. admits-fresh post-op or ED pts

After reviewing a previous post, I wonder if I should be getting EKG-basic, ACLS, CRRT, etc. before being on my own... How about being familiarized with the pacemaker, defibrillator, etc... I haven't been shown these at all. Anything else?

Thanks!

Did you have a checklist that you were supposed to complete before ending orientation?

Have you been exposed to swans?

You should be familiar with CPR carts, defibrillator, intubation box, emergency trach box, emergency pacemaker box - all emergency equipment on unit.

You should know EKG basics (not necessarily 12-leads). Be able to calculate PR interval, QRS, Qt/Qtc - know basic arrhythmias. Pick up a book (Dubin's is great.)

I received CRRT training, including Ca and citrate in orientation - I don't know if this is the norm. But we have so many of them, so often, you need to be trained.

The only thing that was not included in my orientation was IABP's and VADs - both require at least 1 year on the unit.

I did have a checklist of various skills... some have not even been observed yet.

I've come across several hospitals in which new ICU nurses work for about 6 months or so before getting ACLS. Is this the norm?

I had to have ACLS before leaving orientation. I don't get the rational that you get the experience first before you get the class.

You should get the class and begin to incorporate what you've learned into each code.

You should be able to know what to do if your pt codes BEFORE you are on your own...

I had seven years of previous experience in ICU prior to me taking a five year break. I just returned back to work and have been in the unit orienting for three weeks and they were ready for me to come off next week and I refused. I still feel that I do not know the doctor's, specific protocols, monitors, where everything is, variety of patients and mostly the computer charting (very antiquated system.) We chart EVERYTHING on the computer and it is SO time consuming compared to paper charting. My clinical skills have come back very quickly.

If you come off, request a primary support person to refer to for a couple of days for consistancy. I requested specific things I needed to be exposed to before I am counted as staff and I plan on having a specific person or to go to on those days for consistency.

I have ACLS AND PALS and I feel that as soon as you can ACLS is a must regardless of your time there. Good luck,....

I have been in ICU orientation for approx 5 weeks. My hospital had me start basic EKG prior to transferring b/c ACLS is one of the first classes they wanted me to complete ( you need EKG for the ACLS). Have you learned about ventilators?

What I've learned is basically what I learned during my high acuity clinicals during school, and what I've learned on my own.

Listen,

Make sure or demand that they get you in and ACLS class... At my hospital they insisted that they don't give people ACLS until you are there for 6 months... They had even scheduled me for it and then took me out the class when they realized that I wasn't off orientation yet. Well they did me a great disservice, one day while I was on orientation my patient coded and it was like I was in a tornado motion, everybody was doing everything so fast and I was trying to understand what to do so of course my preceptor tells me to document while she's helping out. Well silly me no one noticed that I was writing everything on a piece of paper and not the code sheet (which of course I would not know where to find it 'cause they didn't even bother to me show the code cart) I was a new grad as well!

Well when everything was done, they locked the code cart and my preceptor turns to me and says you documented everything right? and I show her my paper she was livid!

So we had a good talk and I was scheduled for it a.s.a.p and so was everybody else on orientation. It made a world a difference after I took the class.

We had a good laugh when I got off orientation but imagine if this happened and I wasn't off yet?

So please insist that they give it to you... Sorry for the long post.

Could you tell me a little about what you learned in your ACLS class and how it has now helped you? Thanks. I'm currently reviewing EKG stuff on my own, since my hospital is not covering this area of education.

Could you tell me a little about what you learned in your ACLS class and how it has now helped you? Thanks. I'm currently reviewing EKG stuff on my own, since my hospital is not covering this area of education.

In ACLS you learn what to do exactly in a code situation, you know everybody's roles, who leads the code ect. You know the meds and which meds they give for whatever the patient is going through. That is why you must know the different algorythms and be able to identify them really quick. At my hospital the nurse that is taking care of the patient will usually document while people are doing everything else such as pushing drugs etc.

Hope this helps!

Some ICU's require ACLS before hire. I've been hired in a SICU after working two years on tele/stepdown. I'm taking ACLS in december and I assured them I would have it before I started. After reading through the book (it was given to me three weeks before the class) things that I've seen in codes and medical emergencies make so much more sense now. I don't know why all nurses don't have it, since, at least where I'm working now, the nurse is expected to participate, even though she may not have ACLS, and may be like I was, gripping the clipboard with white knuckles, desperately trying to grasp what's going on and write it in the appropriate spaces on the flow sheet, trying to form sentences when the doctors ask questions about what happened and the pt's history while trying not to look wide-eyed and petrified. Not to scare anyone though. While in orientation we did a couple of mock codes, medications and protocols where thrown at us in such a manner that we all partially grasped it. So in short, definitely take ACLS. Or at least try to get a hold of the protocols and understand them.

Poppy,

Your career is young! 25 out of the last 26 years I've spent in critical care. Do you know what? It's rare that I don't learn something new each day! Keep an open mind, and always ask questions. It's the fool that doesn't! julieg:monkeydance: