ICU/ER Nurses, Help?

Esme12, ASN, BSN, RN · May 4, 2013

I will be back....I am glad you are going into this rotation...I think you are going to love it.....but I am running out the door....I'll be back...:)

They are a funny lot of people......these patients are fragile....:)

Lovelymo79 · May 4, 2013

I am a Cardiothoracic ICU nurse and I am VERY protective of my patients. Our patients in the ICU are the sickest of the sickest. So, I have every right to be protective. HOWEVER, you are there to learn and I love showing and teaching students! As long as you show you are willing to learn, I'm all for being there for you. Don't try to be pushy (ICU nurses are a crazy bunch...lol) but definitely let them know what you want to learn how to do, what you have yet to see, what you're allowed to so and that you want to learn. Good luck!

Esme12, ASN, BSN, RN · May 5, 2013

This is a very fragile population.....in the ICU. Small tiny stressors can elicit a negative response form these patients.

Nurses of this patient population tend to be very OCD in regards to their patients care and who is involved in this patients care. I would prepare yourself in advance to not expect a lot of hands on tasks. These patients are not stable enough for trial and error...they require efficiency and accuracy.

Nurses in the ED and ICU are very opinionated, strong willed, intelligent individuals that are very set in their ways. In repetition, adherence to routine, there is safety.

If I were you I would be respectful at all times.....not that you wouldn't be, but I mean keep your head down...don't be a 'know it all" and go in tell her/him what your expectations are...for this nurse it is all about her patient....period. When you go to the unit ask how the nurse wants to handle your questions. Tell them that you want to learn as much as you can and that you are very interested in Critical care or ED medicine...which ever unit you are in. Let them know you are willing to do anything and are ready to learn. Be professional at all times and be eager to help out. Don't count the mins until break and unless it is required by the instructor think about staying and helping out with baths, rounds, make yourself available.

In the ED...this is a tough group....another critical area where things happen fast. You might not get much hands on here wither due to the pace that they must keep...there really isn't time for a student to try to insert the foley....gotta get them in and out or to the floor more are coming.

These nurses are set in their ways as well....routine in chaos keeps errors from occurring. They are very accustom to functioning on their own. They are tough and abrupt....but softies beneath the tough exterior. Let them know you want to learn...ask the nurse how they want to handle your questions ask what you can and can't do....offer to take patient to the bathroom or put them in the bedpan...they will view you as taking initiative and not put out of by the lowly tasks and will engage you for the big stuff later. Here there is potential to do alot of procedures.

Have a skills list prepared in advance on the skills you have practiced on a real patient and those you want to practice/observe and give it to your nurse/charge nurse for both areas.....not as a check list but more as a resume for them to know where you are in your training.

If you observe these nurses you will still learn a lot....but let them know you are interested but allow them to make the first move. Stay engaged and attentive.

Good luck!

NYCRN16 · May 5, 2013

Having done both ER and ICU, (new to ICU but nearly 10 years in ER), I think the best nursing students are those that are eager to learn, want to be hands on with the patient, and ask questions.

Yes, many ICU nurses are very protective of their patients, but some of us are not ridiculous about it. I have seen ICU nurses make a big deal about things such as a spot of iodine on the sheet and other non-important things that they need to get over. Coming from an ER background if its not going to harm you, its not that big a deal. IMO its easier to go from ER to ICU than vice versa because of this. In the ER we don't sweat the small stuff and have a rapid turnover of patients where the ICU nurses only have 1 or 2 and putting them into the (different) chaotic environment usually doesn't turn out as well.

We do occasionally have students with us, and I let them do as much as they are allowed to do without putting any time of risk on the patient. Typically the things I have them do are setting up tube feedings, IV fluids and piggy backs, foley's, blood draws all under direct supervision. I show them how to set up the pumps but I am standing there watching and I hook up the tubing to the patient's line. I have a friend who has been working in CTICU for years and her students pull swans and do all sorts of things, and no patient has been harmed at all. Another friend of mine who was doing her senior externship at a peds hospital wasn't even allowed to take a rectal temp without the nurse there because the nurse was so paranoid. Ridiculous. She was 3 months away from graduating.

Both are good experiences, just see which one you like better.

Laurie52 · May 5, 2013

The students that have stood put for me are ones that show enthusiasm and an interest in really learning about the patient and the disease process. Know what you know, and, more importantly, know what you don't know. No matter how busy I am, I would rather my student asked rather than guessing theft were right. I will let my student, especially the ones who are there for a period of time, do almost anything if they are prepared to do it. For example, if you want to do swan readings, know what the normal values are and be willing to discuss what those values mean to that patient.

The ICU is, in my opinion, the greatest place to practice nursing. Enjoy this time of learning, there are wonderful things in store for you!

Laurie52 · May 5, 2013

OK, now to correct my typos.

1. Students that stood out for me

2. Rather than guessing

Lovelymo79 · May 5, 2013

Another friend of mine who was doing her senior externship at a peds hospital wasn't even allowed to take a rectal temp without the nurse there because the nurse was so paranoid. Ridiculous. She was 3 months away from graduating.
Both are good experiences, just see which one you like better.

Very ridiculous. I let a nursing student pull mediastinal tubes recently. But, I talked him through it before and during the procedure. I also was right there with him. The family was at the bedside so I explained that I was letting the student do it under my direct supervision (we are a teaching hospital). They were a little wary (I could see it on their face) but since I was rift there, they were eased. Good experience for him and I got satisfaction in teaching.

Stephalump · May 5, 2013

I'm obviously not an ICU/ER nurse, but I've done rotations there and I just wanted to mention that I've gotten more skills done in the ER than anywhere else! I'm sure it's due, in part, to the amazing nurses we've had (they turned it into a competition - who could get their students the most skills), but it's also because that's the front line for so many patients. On the floor, most patients come up with ng tubes and things like that already done. The ER is also where I've learned the most from physicians next to the OR. There's a collaborative spirit there that I love.

ICU does seem like more of a "watch and learn" type of place. But the reality is, we can learn the skills fairly quickly out of school. What we really need to learn is the thoughts behind the care - when we do something and why. So still an amazing experience.

Good luck!

Annaiya, NP · May 6, 2013

I'm a PICU nurse and definitely not one of the outwardly over protective nurses. When I was a student in the PICU, my nurse told me before we went out to see our first patient that if I touched anything or did anything without her saying it was ok first that she was going to call security and have me escorted out. She ended up being a great preceptor, but I thought that was a bad way to make a first impression!

The first thing I ask my students is if they are interested in ICU nursing. If they say no, I pretty much don't let them do anything, because if they aren't interested, they are less likely to be safe in the critical care environment. So, make sure your preceptor knows you're interested in the ICU and that you want to learn as much as possible. Most ICU nurses like to teach, so if you're interested and receptive, they will work harder to teach you things.

Have some specific goals, so they know what to focus on with you. There is so much going on in an ICU, that there is no way to teach a student even half of what the nurse is thinking about. So, I think it is helpful to just focus on a few basic things while you're there. I usually ask my students to set goals for each day, and then I try to help them focus on whatever they want to learn. Things that I think students should know by the end of their ICU rotation (assuming there's time):

1. Blood gas analysis. Every nurse should have this skill down, so practice while you're there.

2. Ventilator modes and what all of the different settings mean.

3. Understanding inotropes, how they work, things to think about when your patient is on them, etc.

4. 5 rights for medication administration, you can't practice this enough.

5. VS normals and changes. Look at your patient's VS every hour and think, "Am I concerned about any of these numbers?"

Students tend to focus on procedures, but that will come so quickly when you're working that they just aren't a big deal. Understanding the critical thinking necessary to monitor and care for these sick patients is the best thing to focus on, imo.

If your nurse trusts you, she will let you do more. Ways to gain her trust: Ask questions if you don't know something. I expect my students to know nothing at all and am pleasantly surprised anytime they can answer one of my questions. Don't worry about sounding stupid, just ask! Any time you're doing something, verbalize out loud to your nurse what you are doing. If you're checking a med, say out loud each thing you're checking. If you're starting an IV, walk though the steps and what you're doing. This way your nurse will feel comfortable that you aren't going to do something really crazy:)

If you are meant to be an ICU nurse, you will know it when you get there. My first night in the PICU as a student was about as crazy of a night as you can get, and I knew right away that I was meant to be a PICU nurse. Good luck with your rotation!