How to be a successful New Grad in ICU

[greyL]

Hello everyone. I was recently offered an ICU position (hopefully it works out. I've been verbally hired before and then later been called back and told that they wanted someone with experience so I don't trust that I have a job anymore until I'm actually working!) and I'm so nervous. I've been out of school for over a year and I'd like advice on how to be successful.

For any ICU nurses that have helped trained new grads or new grads currently in ICU:

What separated successful new grads from the ones that were unsuccessful?

What reference books would be best for me to buy since I've been out of school for so long?

Any other advice or tips are appreciated. Thank you!

[ktliz]

I am coming up on one year as a new grad in the ICU. Here is what helped me-

In the beginning, I kept a journal, and would write an entry after each shift. It included things like 1) what I learned that day 2) things I wanted to look up to learn more about 3) what went well 4) what I could have done differently 5) goals for my next shift, etc. I did this for a few months before it fell by the wayside.

My greatest resources were icufaqs.org and The ICU Book. I read both of these basically beginning to end. The ICU Book is geared toward med students/residents, so there are some things that are not relevant to nursing that I skimmed over (physics equations? No thanks!) Other than that, it's a pretty easy read.

Our unit uses a Kardex aka "brain sheet" for each patient. The previous shift RN updates the kardex then makes a copy for the oncoming RN that you can then write on during report. I would highly recommend coming up with a sheet like this if your unit doesn't already use one. Once I went to nights, I also came up with my own "night shift brain." It is half a sheet of paper that i tape in front of my computer at the beginning of the shift. It is basically just a checklist of everything I need to do during the shift for each patient, so I don't forget things like daily weights, updating care plans, entering I&O, etc. It also has a space to jot down notes for each patient as i think of things through the night (ex. "Needs bowl regimen," "cath lab at 0800"). Oh, and it has each hour listed and i just circle the times when meds are due. The kardex stays folded in my pocket as a resource, but I run my shift off of that paper taped on my desk!

[gypsyd8]

take a critical care course. fast facts is a useful book. white coat clipboards have pertinent info printed for easy reference. join the AACN.

[ronsrn]

i also like the icu book but the washington icu book is the best read. You didnt say how old you were or your preferred learning? are they providing good orientation?? I was 42 and hired as a new grad ICU RN i had 6 months or "grad" trainng then an additional 6 months of ICU training, i had excellent co workers [some icu RN's are hard to work with] I actually attended the course by Laura ???? she wrote the ICU CCRN review book and is excent to listen to [very funny and informative] ask around someone may have her CD's. Also go to as many CEU courses as you can, to be a good ICU RN you have to submerge yourself in the culture, ask lots of questions then after a while things will come natural, dont be afraid to ask when you arent sure.

[RileyRN2013]

I love Fast Facts by Kathy White. I also agree with joining the AACN and reading critical care journal articles.

[ronsrn]

good point riley

[jtruland]

The ccrn review ronsrn is referring to is by Laura Gasparis Vonfrolio. Here's a short clip of her speaking (, to give you an idea I'd what to expect.

[SENSUALBLISSINFL, BSN, RN]

Grey congratulations, that is a job I would want as a new graduate. The journal one is excellent for any unit too.

Much success.

[greyL]

Hi everyone! So, I got the job! I'm actually going to be trained in their stepdown unit first, then crosstrained to ICU. I start my first shift tomorrow. I'm super excited and super nervous. My hair has been falling out! o.O

I feel like I don't know anything. I just have this huge fear that I'm going to be an incompetent nurse that doesn't know anything and I'll screw up so bad. Do other new grad nurses feel like this? =/

[dcw132003]

where is the job?

[mizznurse]

I have precepted a number of new grads in our unit. Successful new grads are the ones that are receptive and eager to learn.

Also, read/learn about basic ICU topics: vents, abgs, hemodynamic monitoring etc. on your free time.

visit icufaqs.org

i downloaded fast facts by kathy white on my phone for easy access for a lab value/term i do not know.

Always remember that if you are unsure about something or you don't know something- ASK ASK ASK.

it is still hard for a new grad to look at the big picture because you will be working on your time management skills.. but remember that knowledge comes with experience as well. so keep on learning along the way. Goodluck!