ICU Nursing Learning Goals

[Nessie Mano]

Hi, 

 

I'm new to ICU from medicine unit, I have 10 orientations shifts and have to set goals. Does anyone know what's reasonable goals fresh on ICU unit? For instance how much of ventilator monitor should I know or should I stick to particular skills? 

[chemshark, BSN, LVN, RN]

Hi welcome to the ICU! Here are some things I wish I had known right away:

- Understand what makes the ventilator alarm and what steps I should do to 1. Prevent it, 2. Do immediately before calling the doctor or RT, 3. Set the RT up for success, 4. What to know to say before calling the doctor and what I recommend he or she does (especially if you’re in the COVID unit during night shift and doctors can’t come down to assess your alarming patient right away. 

- How to chart fast and accurately 

- Which drips and drip combos are preferred in your unit for different types of shock, paralytics, pain, and sedation (and how/when to wean them off)

- How to prevent self-extubation and/or falls

- What steps, equipment, and personnel  are needed for rapid intubation or if a patient self-extubates

 

 

LATER ON when you get experience :

- what are acceptable methods of titrating drips in an emergency (I.e., not necessarily based on the order directions) and how to justify that in the charting after the mess is over (retro-charting) 

- how to catch shock/sepsis if the ED misses it and get fluids then pressors/antibiotics on board

- how to balance sedation and pressors just enough that you don’t snow the patient (and when you have no choice but to keep the pt snowed but just enough not to piss off the intensivists) 

- catching DVTs (in ANY limb)

- basically understanding everything in the AACN Critical Care Essentials book, and the Marino ICU Book

- how to time your drips so that you know your units acceptable way to replace them so they never dry. Ever. (And not waste a single drop of you can help it). 

- how to fend off burnout and the constant creeping sense of mortality that hovers over you in this unit and how not to take that home (or how to deal with it if it does)

- dealing with usual nurse drama and ICU ego

 

 

THATS IT FOR NOW...I’m sure more seasoned nurses can chime in better tips but this is what I wished I knew starting off! Good luck, fellow nurse!

 

-ChemShark

(Qualifications: ICU 3 years. I have a BSN, CCRN and biochemistry degree)