Just got hired in ICU....any advice?

oregonchinamom · Sep 22, 2008

If I were you, I would start studying now and get a very good understanding of preload and afterload and what drugs do what to them. Even if you don't work in an ICU that takes cardiac patients, this will help you with any critical patient. Someone gave this advice to me about a year after I started in ICU and soon all the "old hands" were coming to me for advice.

nursekatie22, RN · Sep 23, 2008

thanks a lot....will do! :)

stephlucasrn2008 · Sep 24, 2008

I am just ending my orientation in MICU. It is VERY hard! But I love it! Orientation is somewhat like school and treat it like that. If you aren't familiar with a drug or condition or test, go home and look it up. I knew it was going to be hard, but was totally unaware of how much work and brainpower it would take. BUT I LOVE IT! GOOD LUCK!!!

NurseHirzRN · Sep 25, 2008

I am also just finishing orientation in a MICU. I love my job, and the best advice I can give is if you are unsure of anything ask and if you don't understand the answer you are given keep asking till you understand. Just remember while on orientation you will do better if you follow your preceptors way as most ICU nurses are OCD, but after you get on your own you can find your nich. Hope this helps.

nursekatie22, RN · Sep 28, 2008

thanks for the advice! i do have one thing on my side....i never hesitate to ask questions if i'm not sure of something. i'd rather ask first, and not screw something up! :)

Critical_Care_RN · Oct 1, 2008

Like someone else already said, start studying up and have a good understanding of preload and afterload and what medications effect those and how. Fluid & electrolytes are a basic concern on any floor but they're an even bigger concern in ICU so review those too. Ask lots of questions. Take every opportunity you get to learn everything you can. And every time you see something you've never seen before whether it be a medication, procedure, or a certain condition or disease process, learn as much as you can from your preceptor, the docs, etc. and then, when you get home look it up and read up on it as much as you can so that you solidify what you've learned and the next time you see it, you'll remember it. Also, like another of the posters mentioned, remember to follow whatever routine your preceptor has. It's probably going to be a bit different than what you're used to but most ICU nurses are OCD and they have a way of getting things done. It is hard to let go of your old routine and just go with whatever your preceptor does because you WILL see things that he/she does that you have been more efficient at in your old routine. However, if you focus on that, it will become a hinderance to your learning. If you take the time to see what your preceptor does and let thm explain to you what they do and why, you'll find that you will learn a lot of new tips and tricks and you'll end up being able to take things from your old tried & true routine and put them with the new tips and tricks you've learned from your preceptor to modify your routine so that it will work well for you in the ICU.

nursekatie22, RN · Oct 2, 2008

thanks a lot for all the good tips! i really want this transition to be as smooth as possible and i'm scared that they're just a dumb med/surg nurse who doesn't know anything (they don't think a lot of out m/s unit for the most part). i'm just going to try to not get too nervous. :wink2:

xtine618 · Oct 9, 2008

My MICU orientation is going to include shadowing a respiratory tech for a day. Our RT dept and our techs are AWESOME and learning about vent settings is important. They can tell you what to anticipate as far as changing the setting and things like that. Also, my preceptor and i go aver ABGs A LOT. It's helpful b/c it lets you start thinking about pH imbalances and has plenty to do with why your pt is on a ventilartor and why they are on that setting. You are an expereinced nurse, so this may be old news to you, but if you are not proficient in ABGs I would suggest boning up on those as well as requesting if you could follow an RT around for a day or so. Good luck!

WindwardOahuRN, RN · Oct 12, 2008

I am also just finishing orientation in a MICU. I love my job, and the best advice I can give is if you are unsure of anything ask and if you don't understand the answer you are given keep asking till you understand. Just remember while on orientation you will do better if you follow your preceptors way as most ICU nurses are OCD, but after you get on your own you can find your nich. Hope this helps.

Wow. That's a revealing comment.

"while on orientation you will do better if you follow your preceptors way as most ICU nurses are OCD, but after you get on your own you can find your own nich (sic)."

It's not OCD, dear. It's knowing, from EXPERIENCE, that little things done or not done can make a HUGE difference in patient outcome.

Your "own nich" is based on just what? Knowing more than your preceptors? And are you planning on NOT following what you were taught by your preceptors after your orientation is finished?

Great. Just great. :banghead:

xtine618 · Oct 13, 2008

Wow. That's a revealing comment.
"while on orientation you will do better if you follow your preceptors way as most ICU nurses are OCD, but after you get on your own you can find your own nich (sic)."
It's not OCD, dear. It's knowing, from EXPERIENCE, that little things done or not done can make a HUGE difference in patient outcome.
Your "own nich" is based on just what? Knowing more than your preceptors? And are you planning on NOT following what you were taught by your preceptors after your orientation is finished?
Great. Just great.

I think what she meant by "finding your own nich" means following her own system of getting the job done. Not all nurses do things exactly the same way and follow the same exact schedule, so I think that's where that comment was headed. For instance, in my orientation, my preceptor doesn't like to chart during the day. Instead, he takes notes on his cards and print out his vitals towards the end of the shift and puts them on the flowsheet then. I like to chart throughout the day. My newbie brain can't remember all the things that went on during the day. And I think by OCD, she meant attention to detail. And let's face it, that strict attention to detail and meticulous knowledge of their patient and everything going on with them may look like OCD to the untrained eye and newbies like myself, but that is what's needed to get the job done.

I don't think that she meant she was going to throw her preceptors teachings to the wind as soon as she's done with orientation, but maybe find her own "tempo". My preceptor, who is wonderful, encourages me to observe other nurses during the day and pick and choose things that I would like to incorporate into my "style". He wants me to have my own system, and if it's not exactly the way he does it, then that's okay. As long as I take care of my patients, and am efficient, careful, and perform within my scope of practice he doesn't have a problem with it. I think that's where she was going with the comment. :twocents:

BeachBumRN1472 · Oct 14, 2008

Hi, I'm in a similar situation, I've been a Nurse since May '07 on a Med Surg floor. I just transfered to the ICU at the end of August. This was a very informative post.

What have you found the biggest challenge in this transition? I tend to find that many seasoned nurses in the unit forget that you are not a brand new nurse, just simply a new ICU nurse. After they get to know you it changes of course.