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

Specialties MICU

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i've been on a medsurg/tele unit (and floated to oncology as much as possible) for the past 14 months since i got out of school. i've accepted a position in the icu and now i'm just wondering if there's any advice any of the "old hands" can give me about how to cope at first.

i'm nervous about how different everything is in the unit (charting, monitoring, etc) and i know i'll have some things i have to change and do differently, but i'd like to get a leg up on things.

thanks!

Specializes in Telemetry, ICU, Psych.

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.

Actually, for me it was admitting that I was more like a brand new grad when I went to the ICU. There is a larger difference between ICU and tele/Med surg than many people think. On Tele/Med-Surg, etc. it seems that balancing and executing skills are many goals that a nurse strives for. You have so many things to do for 4-6+ patients and admits and discharges, etc., that you have to learn how to multitask, prioritize, and fit everything in. In the ICU I feel more like a partner in the patient's recovery and the medical team expects me to know more about the pathophysiology and wants my input on the treatment. This has challenged me to learn more about the medical management of the disease process. Also, in the ICU, you can't 'send 'em to the unit' because YOU ARE THE UNIT! The buck stops here, and it is imperative to know what to do in the middle of an emergency (ACLS, AMLS (for my chest and abd pain new admits, etc.).

I'm not saying that one is better than the other, but - in my experience - one is much more technical than the other. Seeing the difference helps me transition depending on where I am working for the day.

Good luck - I love Tele but I'm CRAZY about the ICU!!

CrazyPremed

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Specializes in Critical Care,Ortho,Med Surg.
Also, in the ICU, you can't 'send 'em to the unit' because YOU ARE THE UNIT! The buck stops here, and it is imperative to know what to do in the middle of an emergency (ACLS, AMLS (for my chest and abd pain new admits, etc.).

That is so funny that you say this...I said almost the exact same thing to my preceptor. I also agree that one area is not "better" than another, just different. I do in fact feel like more of a partner as well. I just had my first code 2 days ago, I admit I felt a tad inadequate, but there is definitely a cohesive team in the unit and you are NEVER alone. Thank goodness for this.

:yeah:

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Specializes in ICU, Trauma.

I got hired directly out of nursing school to work in MICU. I am not a young nurse either was 40 when I got my license so I was apprehensive about being older than those who were training me but luckily I was precepted by a nurse who had been a team leader and an ICU nurse for 20 years and her immense knowledge was superb and I learned alot from her. I also learned from several different team leaders who were by my side when a pt was crashing and learned from them. Now I have been an ICU nurse for almost two years and am in the process of going back to school for my masters and have been asked to precept students on the unit. I am just thankful that I had a good preceptor and asked lots of questions and if you have educators on your unit utilize their resources and brains as well... you'll learn lots. I could never work the floors, I love the ICU and have loved it since the day I walked in there in nursing school.

Good luck

Jodi

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Specializes in Med-Surg/Oncology/Telemetry/ICU.

this is all very helpful! :D

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Specializes in Critical Care.

I didn't read all the earlier posts so this may have already been said... My biggest personal mistake during orientation was to not ask enough questions/not facing my fears. Tell you preceptor what you don't know. Ask for those patients that scare you the most while you're on orientaion, because sooner that you think you'll be off orientation and facing one of those 'scary' patients. But, remember... even once you're off orientation, in the ICU you are NEVER alone... just open your mouth and ask for help... you'll get it! Enjoy!

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Specializes in Med-Surg/Oncology/Telemetry/ICU.
i didn't read all the earlier posts so this may have already been said... my biggest personal mistake during orientation was to not ask enough questions/not facing my fears. tell you preceptor what you don't know. ask for those patients that scare you the most while you're on orientaion, because sooner that you think you'll be off orientation and facing one of those 'scary' patients. but, remember... even once you're off orientation, in the icu you are never alone... just open your mouth and ask for help... you'll get it! enjoy!

it's funny that you should emphasize that you're never alone cause i had the hardest time remembering that when i first started on the unit i'm on now. i thought that when i was off orientation that that was it and i was all by myself. it's so not true! :D there's always someone more experiences around and there have been a coupld of times when i've been charge nurse and i've called the nursing super cause i didn't know what to do and yep, she was there for me.

i just need to not stress out prematurely because i know they're assuming i don't know a lot about vents, swanz, etc since we don't deal with them on the floor. i just need to chill the hell out! :nurse:

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Specializes in MICU.

While I by no means intended or have "thrown out" everything my Preceptor taught me. I have started doing things my way. By this if I am in a pt room more than once every 2 hours its ok. My preceptor's way was you do anything and everything possible when you enter the room so you don't Have to go back in for 2 hours. To him that ment if you were goining in at 2:30 and 4:00 is a full reassessment then you take everything in then. because it falls within the 2 hours. This is all when it is a non urgent reason for entering the room, ie a "cleanup" Now I still use his techniques to some degree. If it is 3:00 and I am not busy with a problem I will get my meds and things together to do what I can at that time.

As for ICU nurses being OCD I DO NOT mean that in a bad way. It is what makes us exellent ICU nurses. I ment the attention to detail that we all have. OCD can take on many forms and actions. the ones everyone hears about are the nuts that their food cant touch or wash their hands every 30 seconds of so. Yes as nurses we do wash our hands alot, and at work we should be OCD about it as to prevent infection, but that doesn't mean we are like that about it ALL the time. OCD of ICU nurses is the routine or pattern that we have when we walk into a patients room. As you walk in you are assessing the pt even as you are doing your safety checks you are assessing the pt, we are noticing any changes since the last time we were in the room. That is all I ment by OCD, is our attention to the details that some nurses or people in general don't even think about.

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Specializes in MICU.

"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."

This IS a form of OCD!!!!!

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Specializes in Critical Care.
"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."

This IS a form of OCD!!!!!

No it isn't. It's learning, from experience, that dismissing and disregarding, or responding to, seemingly insignificant changes can mean the difference between life and death.

ICU nurses must go beyond the basics and zero in on the nuances that are often imperceptible to the uninitiated.

The basics come first. When nurses are comfortable with the basics and those basics are second nature then it is time to move on to critical care.

IMHO, of course. YMMV.

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I have been in an ICU for about six months and "on my own," without a preceptor for about three. When I was on orientation, the nurses in my unit were very good about bringing me into their rooms to help out with procedures, setting up a-lines/central lines, or anything else that was interesting at the moment. If the nurses in your unit are not that receptive, spread the word that you are looking to observe, asssist, etc. so they can keep an eye out for things that might be going on. If there is an assignment that is of interest to you, speak up. The more experience you get while you are on orientation, the easier it will be when you are on your own. Even now, I still speak up if I want higher acuity patients that are receiving treatments that I have not dealt with at all or very little.

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Specializes in ICU.
I have been in an ICU for about six months and "on my own," without a preceptor for about three. When I was on orientation, the nurses in my unit were very good about bringing me into their rooms to help out with procedures, setting up a-lines/central lines, or anything else that was interesting at the moment. If the nurses in your unit are not that receptive, spread the word that you are looking to observe, asssist, etc. so they can keep an eye out for things that might be going on. If there is an assignment that is of interest to you, speak up. The more experience you get while you are on orientation, the easier it will be when you are on your own. Even now, I still speak up if I want higher acuity patients that are receiving treatments that I have not dealt with at all or very little.

Great advice. I am a new grad and I think my unit is great. They are all very receptive to new grads and encourage us to take difficult patients during orientation. They are very team oriented and I'm glad that they welcome new grads with open arms. They really do want us to succeed. :heartbeat

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Specializes in SICU/Trauma.

Well first of all don't be to hard on yourself. Your going to be scared and thats good, people who are scared tend to ask questions when they are not sure of something. That is my second piece of advice, ask questions! and know your limit and if you get to it ask for help. Working in the ICU is hard and stressful you must be willing to study but remember don't just do something because you "think" you should.:mad:

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