Information Pearls: How to be a good ICU RN

carolina4 · May 26, 2009

yes that would be awesome! I am a new grad starting in the surgical trauma burn ICU and would LOVE any advice!

ImMrBill3, RN · May 26, 2009

I'm in the same boat as the rest of you! I hope (starting in Sept in MICU). My Critical Care instructor has a ton of stuff on the class website. One of the best things I found is ICUFAQS.org. Very cool, informative, amusing and reassuring. I start my senior clinicals in the unit this week.

chani · Jun 7, 2009

Early in my ICU career I learnt to plan so I knew when items such as meds and obs needed to be done, so that then I could slot in bigger items such as dressings and line changes.

One of the biggest lessons I have learnt over my 20+ years is to complete all routine tasks like dressings or line changes over early in your shift. You never know when the s**t will hit the fan and you run out of time to get straight forward tasks done

JJRBuckeyeRN · Jun 7, 2009

I agree with the previous posts. Try to get "tasks" done early in your shift. But, at the same time...do not focus on "tasks" if there are more pressing issues (such as your pt having hypotension or desaturating).

The ICUFAQs website is a great website.

I have only been a nurse for 2 years. I have worked both of those years in a tertiary care, university medical center MICU. In my 2 years I have earned the respect of my co-workers and charge nurses and often times get the most sick pts on the unit.

I ALWAYS ask questions. Also, if I have a patient that has a condition that I am unfamiliar with I look it up and read about it. Uptodate.com is a great website with up to date information on all conditions, illnesses, treatments,etc.

I also tend to get to work about 30 mins early. Some of my co-workers give me a hard time about it (all in good fun of course). However, in that time, I do my tele strips. Read the H & P and the progress notes for the day for the patients that I am going to be taking care of. That way if I get a less than great report from the previous nurse I will still feel like I know what is going on with my patients.

I hope this helps. Good luck in your careers.

vastudent09 · Jun 8, 2009

thanks so much for that post! I am definitly going in early from now on, at least while on orientaiton, b/c i got a really bad report the other day- had 3 replacemnt bags of KCL, and 2 of Ca gluc. to hang ( b/c night rn didnt get around to starting to hang replacements), plus a hypotensive pt who just had a chest tube placed. Needless to say, I was behind from the start, wasn't as prepared as i would like to be for 9am rounds, and jsut felt behind all morning. ( not somehting i liked AT ALL!)

SO thanks agian!!:bowingpur hope to have a better day tomm. :yeah:

Pediatric Critical Care Columnist · Jun 8, 2009

As a senior ICU nurse and one who mentors new grads in my ICU, I'd like to offer the following:

* Be on time. You don't necessarily have to arrive early, but don't be tardy. Be ready to go for your breaks at the agreed-upon time and be sure you're back when you're supposed to be. Poor time management's a sure way to make your own life miserable.

* Ask questions. Don't pretend you understand something if you really don't.

* Ask for help. If something happens and you aren't sure what, why or how, don't wait until things get REALLY bad before you ask someone to backstop you.

* Be organized. Keep your charting up-to-date and know what you need to do for your patients at the top of each hour. Plan for med administration so that you don't get too far behind. Some ICU patients will have half a dozen IV meds due at the same time but only two lines that you can use. Figure out early on how you're going to time them so that they're given as close to on time as you can make them.

* Make notes. I keep a piece of paper handy to jot down things like urine output, PRN meds given (eg "0940 hrs morphine 2 mg IV pain, effective"), titration of infusions with corresponding vitals parameters (eg "1035 hrs decreased epi to 0.04 mcg/kg/min SBP 130"), discussions with other staff members, changes in vitals (eg "sats 84% FiO2 up to 45%) and so on. When your patient starts having respiratory distress, somebody is going to ask about your fluid balance. You should be able to tell them within a reasonable amount.

* Look for opportunities to learn new skills. If your workload is light and somkeone else's patient needs a 12 lead, ask if you can watch so next time you could do it for them. Offer to do the foleys and NGs for others, practice your IV skills, anything that is skill-based can be practiced until it's second nature.

* Don't take yourself too seriously. Life is hard enough without forgetting to have fun.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Jun 8, 2009

1. Ask questions, even when you get off orientation- still ask questions

2. Keep your rooms clean. There is nothing worse than coming into a shift and your patients room looks like a bomb went off.

3. Keep it simple. That goes for report, tasks and interactions with MD's.

4. All the other good advice that was already given.

C-DIFF PHIL RN · Jun 9, 2009

concentrate on mastering the basics of pt assessment and frequent, frequent reassessments. fine tune the basic icu skills of peripheral iv sticks, ngt placement, nasal tracheal sxn, trach care, alot of the regular nurse skills you learned in school. also it very important to become familiar with the equipment of your unit, the bedside cardiac monitors, crash cart and know how to work the lifepack. also become aware where equipment is stored and supplies are in the unit and who to call to get more in a hurry. i'll tell you like it was explained to me, "every nurse comes to the unit with the goal of becoming a icu nurse, but first they must become just a nurse first". i've only been an icu rn for just a few yrs, but i really love a new rn in the unit that has really good basics and is swift with a iv stick and getting some equipment for me in a quickie. master the basics first then you'll be finding pacemaker thresh holds and troubleshooting hemmodynamics and running codes.