How not to puke on your shoes during your first real ICU shift?!?!

[dogmombyday, RN]

I'm finishing a new grad fellowship this week and will be heading to a permanent position in ICU after that. I'm very, very excited (I may or may not have squealed like a small child when the ICU manager pulled me aside to offer me the spot) but also nervous. I've scoured the forums for posts of nurses in my position and read a lot of helpful advice. I'm just wondering if anyone else who's recently been in my position has some great how-not-to-vomit-on-myself advice or any anecdotes from their first few months in critical care?

[Pghfoxfan1]

Remember a few things. You are there to do your best to help the patient...but, don't blame yourself, sometimes people die.

Sometimes families can be a pain in the butt but, think of what they are feeling and going through with their loved one in an ICU. They are not at their best during this stressful time.

Offer help to others and they will offer help to you. Even though you have your patients, it doesn't mean a group of you can't function a bit like a team. Tag teaming helps with bathing and turning for example SAVE YOUR BACK NOW so you are not a cripple later.

If you have time, make rounds with the doctors, including looking at X-rays. You can learn so much, even when it's not your patient. I love to listen in when doctors were teaching residents and fellows.

[elkpark]

I'm guessing you'll be too busy to have time to vomit on your shoes. :) (But, seriously, keeping busy and paying attention to what you're doing and learning, rather than focusing on how you're feeling about and reacting to what you're seeing is a good distraction technique.)

[Ruby Vee, BSN]

I'm finishing a new grad fellowship this week and will be heading to a permanent position in ICU after that. I'm very, very excited (I may or may not have squealed like a small child when the ICU manager pulled me aside to offer me the spot) but also nervous. I've scoured the forums for posts of nurses in my position and read a lot of helpful advice. I'm just wondering if anyone else who's recently been in my position has some great how-not-to-vomit-on-myself advice or any anecdotes from their first few months in critical care?*

It's been a few decades since I was a brand new ICU nurse. I still remember my first ICU code and the first time I wanted to vomit on my shoes. (Not the same patient, by the way.) "Slow, deep breaths" is cliched advice, but it works. That and concentrating on the patient (and/or family of the patient) in front of you. That gross, ugly wound "that I could put my head inside," to quote a former student of mine, is more than just a gross, ugly wound. You're taking care of an actual person here, one with feelings and emotions. I remember desperately wanting to not make the patient feel worse than he already did.

Keep the patient in mind, and take slow, deep breaths when you need to. If you absolutely have to vomit (and I did -- once) do it outside of the patient's sight and hearing and please try to miss your shoes.

[purplegal]

I'd do anything to be in your position. I would love to be vomiting on my shoes.

[dogmombyday, RN]

Thank you for the advice! I know that as a new nurse it's easy to get caught up in task completion vs patient centered care so I've been trying to focus on the patient not the work list! It helped today :)

[dogmombyday, RN]

That's how today was! Too busy to be scared! But thank goodness it went well. I appreciate your comment!

[Wuzzie]

Don't lock your knees. I'm not kidding about this.

[bgxyrnf, MSN, RN]

Try to set some learning goals for each new shift.

Keep a log of "pearls" that you pick up.

Study, study, study.

While you're at home and relaxed, visualize a chaotic code... and picture yourself calmly making a contribution.

During the real thing, look for what's not being done... clearing space, getting another line, raising/lowering the bed, getting a stool for compressors, getting a board, spiking a bag of NS on a pressure bag, engaging the family, getting suction hooked up, bagging, putting in an OPA, getting flushes, setting up ETCO2

Pick your moments and pick your people but learn to chat up the docs... most young docs love to teach enthusiastic learners.

And remember, always go back to ABCDE and DOPE

And above all, never forget: Treat the patient, NOT the MONITOR... a patient can have decent vitals but look crappy as heck and be ready to crump... alternatively, the monitors may be screaming at you but the patient is still mentating and ventilating and perfusing.

[dogmombyday, RN]

Thank you! I love the idea of visualizing a code, as I haven't been involved in one yet. Thanks for the advice, I truly appreciate it!

[HannahMarine30]

So true. In the Marine Corps when we'd be standing in formation for hours, it never failed that someone would pass out because they locked their knees.

[PixieRN1]

Get a Nissan fundoplication and you'll be good to go for life! :-) ::wink wink::