ICU Orientation Almost Done and Freaking Out...

[cardiacRNatheart24]

Just for a little background story, I have 4 years of experience working on a cardiovascular step-down unit with the patient population of post heart-paths, stents, s/p ablations, cardioversions, carotid endarterectomies, work-up open heart surgery/TAVR patients, etc. I started orientation in a CVSICU unit which takes fresh open heart patients, lung surgery patients, and primarily thoracic surgeries in general terms. My orientation is ending after this week and I can honestly say I have had panic attacks with the thought of being on my own and not being able to keep up with the pace...I have a wonderful preceptor who has been there for many years and has taught me so much. My biggest issue according to my preceptor is time management. He knows I can grasp the concepts but need to speed up more with my tasks. I understand I'm falling behind since I've only been there for a few months, but it's becoming more discouraging that I'm not able to meet his expectations when it comes to completing all tasks for the shift by his terms. I'm also nervous about missing a crucial piece of information whenever I give report and causing issues...

For all my critical care nurses, will this get better with time? I'm worried I will always be behind... I don't know if I should just go back to the step-down where I feel more comfortable or just continue moving forward in critical care and gradually get my own routine in things. Did you guys go through the same issues? Just needing a few words of encouragement.?

[Morelaur288, BSN, RN]

I’m sorry I have no advice to give because I’m not an ICU nurse (yet)... I’m still in school. But I am also freaking out just about starting my career in the ICU. I wish you the very best of luck! I think you will pick up the pace with time. I’m sure you were slow when you started in Step Down too. It’s just one of those things where you have to practice and develop that motor memory. I’m sure you are going to do great and your background in step down will help you a lot.

Good luck!! You got this.

[cardiacRNatheart24]

Thanks for the positive input ♥️

["nursy", RN]

It does get better over time. The one thing that helped me most is to develop what I called my "brain". This is a written form that I developed over time that was like a cheat sheet/schedule that I kept in my pocket. Each form had a space for pertinent medical info like dx, procedures, labs, then on the side I had the hours listed and I would fill in at appropriate times the meds, glucose checks, lab draws, dressing changes, etc. I would cross off what I did as I went along. You can find templates online but I created my own, and it was a lifesaver. Even though you only have 2 patients in ICU, it can be really easy to forget the Vanco trough, or the glucose testing before lunch etc.

[Pheebz777, BSN, RN]

Regarding giving report, always develop a routine/system and get used to it so you minimize forgetting something when giving report. As what was said above, use a workflow sheet or "brain" as we call it.

I usually start with: Name, age, male/female, full code/DNR status, allergies. Then..

1. Presentation to ER (ex. Chest pain w/ SOB, etc. )

2. Diagnosis - ex. NSTEMI - include pertinent supporting data ex. negative EKG, elevated troponin+, etc.

3. History - ex. CAD,CABG,HTN,

4. Consults. Reason for consult and plan of care for each consult.

Then I go head to toe:

1. Head - ex. pt is alert, awake, confused, etc.

2. Lungs - ex. pt on 2L/min NC, BiPAP, Vent, Breathing even and non labored, wheezing, chest tube, etc.

3. GI - Cardiac diet, PEG tube w/ Glucerna at cc/hr, takes pills whole/crushed, NPO, puree, etc.

4. GU- PT is on HD MWF, foley, urinal, ambulates to Bathroom, etc.

5. Legs (LOL!) - PT ambulates, uses walker, prosthesis, bedrest, etc.

6. Skin - intact, wound care, etc

Then:

1. IVF - fluids, TPN, etc.

2. Pending: Labs, procedures, etc.

Then all the other little chit chat.

Rude family, patient requests, etc. Even without a "brain" or workflow sheet, you can give and receive a solid report once you integrate some kind of personal workflow so as to avoid jumping from one topic to another and then forgetting to report or forget to ask questions about the patient when getting report.

For me it also works when getting report when floated to other floors.