ICU advice needed please!

Published

Hey all!

I just got hired for a Progressive ICU position & I'm not only nervous, but I got hired because I'm a fast learner and adapt well to new environments and I am passionate about any new type of nursing I try to take on. With that being said, I only have 2 years of experience - 1.5 yrs in Psychiatric Emergency Dept & 6 months in a Pulmonary Progressive unit. Needless to say, I'm completely new to the ICU with the exception of 2 shifts where I begged to shadow at my previous facility. I would like some tips from experienced ICU colleagues.

I am a very fast learner and feel like I know how to do many things, but certain things such as pulling sheaths, burns, trauma, etc are things I haven't dealt with before. I know I will be fine and I "know" the material from school and catching up on ICU patients and things, but I don't have the "hands on" experience yet.

Can you give me some tips on maybe the top 5 procedures/treatments you see and deal with often and how you approach it, do it, and any links you can provide me with tutorials and things so I'm not completely blind when I start next week so my preceptor doesn't look at me like "umm, how did she get hired?" Any tips/tricks/help you can give me I'd be forever thankful.

JenHRN

12 Posts

Has 3 years experience.

What sort of ICU will you be working in? That makes a huge difference on what you will be frequently dealing with. I work in a small hospital on weekends only... so the main diagnoses I see are COPD exacerbation, DKA, overdose, sepsis, and various cardiology issues like symptomatic a fib.

Esme12, ASN, BSN, RN

4 Articles; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience.

What do you mean by a progressive ICU unit? Is this a high acuity PCU?

These type of units are fast paced and a higher patient load. usually 4:1. You will need to be familiar with common arrythmias, drips and treatments. Pulling sheaths will go by facility policy and you will be taught to handle these patients.

Hard core PCU units have patients with active chest pain but no EKG changes. You will have patient with multiple gtts. Heparin/Nitro. You will see cardizem gtts and patients with arrythmias requiring intervention. Vents and critical patient will be saved for the ICU. Burns are typically flown to burn centers for specialized care.

Here is a good resource....

[h=3]Icufaqs.org[/h]

ICURN2013

3 Posts

Specializes in Critical care. Has 1 years experience.

I've worked in an 18 bed general ICU for a year now, and we deal with a little bit of everything. Most of the patients assigned to me as a newer nurse in the unit have had diagnoses of sepsis/SIRS/MODS, pneumonia/ARDS/respiratory failure, DKA, acute renal failure, MI (post cath lab overnight observation), or symptomatic EKG abnormalities. I've also had quite a few trauma patients (GSWs, MVAs- lots of chest tubes). Familiarize yourself with ACLS, rhythms and drips (nitro, cardizem, levophed, dopamine, etc.), sepsis protocol, vents, etc. If you have a high population of ARF patients, brush up on CRRT. Also, in the critical care environment, it is so important to be familiar with your state's Nurse Practice Act. Physicians will ask you to do things that are not in your scope of practice in emergencies! Protect your license.

bcburke90

15 Posts

Specializes in MICU. Has 4 years experience.

I started in an MICU as a new grad and was terrified. I had worked as a tech on the SICU the summer before and during my senior year with allowed me to feel somewhat comfortable with handling patients on vents (like if they become disconnected during a turn you just put it back on.... freaked out the first time that happened). My advice to you is to try to absorb AS MUCH AS YOU CAN during your orientation period. Ask for that crashing patient coming from the ED, ask another nurse to show you a procedure they're doing that you're not familiar with, thats what this time is for. Know that your manager and preceptors will not let you be on your own until they know you are competent. and my biggest piece of advice is DONT STOP ASKING QUESTIONS OR BEING CURIOUS ABOUT THINGS AFTER ORIENTATION. If you're not 100% positive about something, ask. If you are 100% positive about something and just want to hear it out loud, ask! I will always say to other nurses" I just need to talk through this for a second." As time goes on you will get more and more comfortable, and now people even ask me things!

Just trust yourself, trust your coworkers, and most of all HAVE FUN. and always try to keep a positive attitude, that always helps too especially in stressful situations!

Specializes in ICU, Psych, ED, Tele, Progressive.

Thanks everyone. Yes, my Progressive ICU has a 2:1 or occasionally 3:1 patient:nurse ratio. It's very high acuity; ventilator dependent patients, sepsis, traumatic brain injury, trauma surgeries, some oncology, some psych, unstable cardiac patients. A little bit if everything. My first week went well, already learning a lot. I'm excited to continue my second week of orientation tomorrow-Saturday.

If anyone has ever made themselves cheat sheets or good study guides for anything pertaining to ICU care, common drugs, common procedures/tasks, I would love if you'd share a copy with me.

thanks everyone for being so sweet!

Ruby Vee, BSN

67 Articles; 14,023 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.
I started in an MICU as a new grad and was terrified. I had worked as a tech on the SICU the summer before and during my senior year with allowed me to feel somewhat comfortable with handling patients on vents (like if they become disconnected during a turn you just put it back on.... freaked out the first time that happened). My advice to you is to try to absorb AS MUCH AS YOU CAN during your orientation period. Ask for that crashing patient coming from the ED, ask another nurse to show you a procedure they're doing that you're not familiar with, thats what this time is for. Know that your manager and preceptors will not let you be on your own until they know you are competent. and my biggest piece of advice is DONT STOP ASKING QUESTIONS OR BEING CURIOUS ABOUT THINGS AFTER ORIENTATION. If you're not 100% positive about something, ask. If you are 100% positive about something and just want to hear it out loud, ask! I will always say to other nurses" I just need to talk through this for a second." As time goes on you will get more and more comfortable, and now people even ask me things!

Just trust yourself, trust your coworkers, and most of all HAVE FUN. and always try to keep a positive attitude, that always helps too especially in stressful situations!

This forum is an anonymous forum. I'm not so foolish as to think there truly is such a thing as internet anonymity, but we try here. Using your own photo as an avatar and your name as a user name, you are far too identifiable. Sooner or later -- and probably sooner -- you're going to post something that you'd rather your boss or coworkers not know you posted, you'll post a little too much information about that patient that has you confounded or you'll complain about your nasty coworker who never bathes. And anyone who has ever met you will know immediately who posted the offending tidbit. Please change your avatar AND your user name before you find yourself in serious trouble!