IMCU New Grad Books/podcasts

[jj16, BSN]

I am a career changer who just finished orientation at a busy city hospital on an IMCU that was the primary COVID step down and I am struggling with feeling like COVID patients are the only patients I know how to care for.  I don’t want to keep asking other nurses a million questions and wonder if there are any good books or podcasts for new grads. I feel like I spend so much of my day just getting tasks completed that I’m not seeing the big picture until I get home and process the day or sometimes not at all.  I’m on a medical floor and our patients have so many comorbidities. It’s like I don’t get a great handle on the big picture in the morning and struggle to hone in on the the relevant labs off the bat and then my whole day I’m playing catch up. For a COVID pt I know to check their WBC, D Dimer, Lactate, ABG, their CXR, their Fio2 and O2 requirements. And I do this quickly and can respond to things quickly. I want to be able to do this with other patients - at least the quick and dirty - what should I know for each “type” of patient. I also still have many skills that I’ve never had the chance to do. Any books, podcasts, Youtube’s, words of wisdom for new grads who constantly feel incompetent?  

[criticallycaring, BSN]

I don't know of any specific books, but Youtube is the place to go. There are hundreds of nurses (and physicians) who post videos on nearly everything. I look up Youtube videos at work frequently. You can also join AACN and get their journal/magazines which are always interesting. 

In my experience the best way to learn is time. It took me a solid two years to feel comfortable in the ICU and even 7 years later I still get patients that baffle me. Critically ill patients are complex, and the fact that you realize you are struggling with "the big picture" is a good thing. This is pretty normal for a new nurse, especially a new nurse who just experienced COVID as their introduction to critical care. Nurses who do not recognize they have some learning to do are the dangerous ones.

Approach every patient the same way and have a system, that way it won't matter if they are a COVID patient or a GI bleed. Start your day the same way every shift. 

I always start by going through the chart. Read the physicians last note! This is extremely beneficial as you usually can see their plan for the patient, pertinent medical history, important events during their stay, etc. You also begin to understand their thought processes. I next scan through the labs and note the abnormals. Look up labs in your spare time and see if you can figure out why they may be off. Pay specific attention to electrolytes, they commonly will need replaced. Write down the medications you need to pull for the first 4-6 hours of your shift. After this, I go assess my patients and see if I need to pull any drips with my morning meds. Then I give medications and chart. Obviously this routine can change based on patient acuity but generally works for me. You will find your own routine as time goes on.

Good luck!