Just a Little Advice After a Year in the ICU

[francoml]

I have been an ICU nurse for about a year now. I have learned a million and one things and still have a lot left to learn. I just wanted to offer a little help to new grads trying to get into the critical care scene and newly hired nurses in the ICU.

First....

If you want to be an ICU nurse go for it. It is one of the biggest learning curves you can take on but if that is your passion don't let anyone shoot your dreams down.

Second....

Apply to a large teaching university hospital. Usually those hospitals will have an internship program that lasts 4-6 months which includes one on one patient care, constant supervision by a preceptor, and critical care classes to teach you critical care medicine.

Third....

Study on your own time. Pharmacology, pathophysiology, A&P, ect. This will all be things that help you tie the whole picture together.

Fourth....

When in clinical (students) or once hired as a new ICU nurse, participate in everything you can if your patients are stable. If they are intubating a patient, ask if you can record or push meds. When coding a patient be the first one to hop on the chest and due compressions, bag the patient if needed, record everything that is going on ect. Watch the nurses place lines with ultrasound and ask them to teach you. Basically, as long as your patients are taken care of and stable, go around and ask if you can watch and learn or help out with procedures.

Finally....

You have to love what you do. You will see more death then any other form of acute care nursing. Some of the things you will see will tear your heart out. You have to go into this career path knowing that there is a very high turn over rate in this field because of how stressful it can be. That being said, there is nothing more rewarding that seeing the 19 year old girl who should have died, walk out of the hospital with a full recovery. It is the "little miracles" that keep you coming back for more even though the day to day can be gut wrenching.

I hope this helps, ICU nurses are a breed of their own. It has been the only job that I have ever had that I truly wake up in the morning and am excited to go to work. You will either love or hate working on a unit and you will most definitely develop a dark sense of humor. I wish all of you students and new grads the best of luck in your nursing careers and always remember, there is a lot of people out there that are "dream killers." Don't listen to the negative people out there. You can accomplish anything you want as long as you put everything you have into it.

[nettie123]

Thank u francomi for this piece of advice. I actually need help because i'm in a dilemma right now. I am starting the Rn - bsn program next week. I registered for the full time class because it is possible with the job i have right now. However, I have an interview for an internship with ICU department at one of the best hospitals in the metroplex. Being a new grad, I've always wanted this. But I don't know how tedious it is going to be combining an internship with a full time rn-bsn program at texas tech. Please is there someone out there who has done or is doing the rn - bsn program at texas tech health science center?

Is it going to be doable or do I just go for part time program? Pls I need all of your advices. Thanks

[nettie123]

It's with Parkland. The best hospital out here to get such experience. I think I'll take your advice about the rn - bsn program as I don't think I'll be able to handle a full time class and internship. My rn - bsn program is with texas tech lubbock ( online). Thank you and I will contact you if I need help with anything.

[francoml, ASN, RN]

Oh that is sweet. When you said texas tech I assumed you were going to be in lubbock. Parkland is amazing! I wish you the best of luck in your career.

[BusyBee91]

Ohhh that is a very polarizing question on the differences between ED and ICU lol.

I will give you a small window into a night in the ICU. I work in a 32 bed Medical ICU and it has been the biggest learning curve I have ever experienced. We take the sickest patients from a 500 mile radius and all of our direct admits skip the ED completely and come directly to us. An example of the toughest patients I take. Patient with end stage AIDS developed a massive infection (atypical pneumonia) which lead to septic shock and acute kidney failure. Patient was placed on CRRT, intubated on a high flow ventilator (250 breaths a minute), completely paralyzed with a vecuronium/fentanyl drips and placed on a BIZ monitor, due to failing cardiac output and hypotension the patient was started on Flowtrack hemodynamic monitoring with the following drips; epinephrine, norepinephrine, vasopressin, phenylephrine, and dobutamine. Beyond the pressors the patient was on multiple antiviral drips and antibiotic drips. I believe the most active drips I had with this patient was 13 between pressors, fluids, paralytics, sedatives, antibiotics, antivirals, electrolyte replacement, and blood products. The key to all of this, an ICU has complete autonomy when titrating all of these medications. There is no doctors orders stating, epinephrine at ..... or vecuronium at ..... or vasopressin at ..... The order states use these medications and titrate them based on your hemodynamic monitoring to maintain blood pressure.

That being said, I really hope some one can give you and in depth example of ED on here so you can make a better decision.

Oops, I certainly didn't intend to ask a loaded question.

re: ICU- it sounds fascinating and really really really cool. Thinking I need to figure out how to do THAT as a new grad..how neat. Do you know if there are generally programs for students or new nurses that help to bridge the gap between school and working in an ICU? Do they even hire new grads? If not, what is a good way to start working up to that? Super excited by your description. I'm near Cowley Shock Trauma in MD, which has a great reputation for level one trauma, from what I hear.

[francoml, ASN, RN]

I recommend starting ICU as a new grad as long as you are willing to put in the time outside of work to learn everything you need to know. I started in the ICU as a new grad and it was an awesome and humbling experience.

First off, when you do your clinical in school learn everything you can and volunteer to do everything you can. Ask a million questions is all areas, not just ICU. I would also suggest networking as much as possible when are at your practicum sites. If you can impress these people during your ICU rotation they will remember you when you go back to apply for internships in the ICU.

Second, some schools let you pick elective classes in specialty areas. If this is possible for you choose ICU and again be super helpful, as a million questions, and let them teach you (even it is something that you already know).

Third, if you are willing to move, the chances of getting into an ICU are much better. Some ICUs hire mostly new grads while others hire almost none. I don't know about Cowley but there are a ton of level one ICUs that want new grads. If possible apply all over the place as many will give you large sign on bonuses and relocation assistance.

Hope that helps, keep shooting for the stars my friend.

[TheLiberation, ASN, BSN, RN]

In regards to ignoring all the naysayers I would like to ask something.

I'm due to be a new RN grad in December however I have been an LPN in nonacute care for a few years now. I have immensely enjoyed several specialties but I have always seemed groomed by my own opinion and the opinion of others that I am to do critical care. Obviously rotations to the ICU for more than 1 lucky day do not occur in nursing school.

When getting out of school you are told that the best route is the med surg 1-2 years first route. And that does make sense to me because I believe it will help me learn the fundamental things best and the prioritization, etc. However I have had a few tell me to just jump right now full throttle. But if I'm so unsure of myself, how can I commit myself to a unit the requires such a heavy knowledge base and a precise set of assessment skills.

Just want to get people's opinions. Please feel free to get as diverse as possible!

Thanks!

[francoml, ASN, RN]

This is something you will have to do some soul searching on. I believe it is very doable to jump straight into ICU as a new grad and many people excel when put in that situation. The thing is, there are a fair amount of new grads who are unable to adjust to the learning curve of the ICU. Everyone is going to feel a little unsure of themselves at some point but being an ICU nurse does take a certain level of confidence in ones self. I would just take a look in the mirror and decide if you have the internal will to take on a huge challenge or if another unit best suits you. Either choice is okay, there is no shame in getting into ICU after a few years on a med surge unit. That being said, if you feel you can step up to the challenge, I wish you all the luck in your future career.

[ICUKeesh]

This is something you will have to do some soul searching on. I believe it is very doable to jump straight into ICU as a new grad and many people excel when put in that situation. The thing is, there are a fair amount of new grads who are unable to adjust to the learning curve of the ICU. Everyone is going to feel a little unsure of themselves at some point but being an ICU nurse does take a certain level of confidence in ones self. I would just take a look in the mirror and decide if you have the internal will to take on a huge challenge or if another unit best suits you. Either choice is okay, there is no shame in getting into ICU after a few years on a med surge unit. That being said, if you feel you can step up to the challenge, I wish you all the luck in your future career.

Thank you for your insight! I am a new grad who wants to go right into ICU. Its articles like this that inspire me to shoot directly for what I want :)

[HouTx, BSN, MSN, EdD]

I went in to a Trauma ICU as a new grad & loved it!!! Got my CCRN as soon as I was eligible - moved on to MSN (critical care CNS & nursing education) after 5 years of bedside/unit educator experience.... worked in all types of ICU settings &, with the exception of Neo, I have enjoyed them all.

Over these many years (decades?? LOL) I came to realize a few things. In order to be a 'happy' ICU nurse, you need to be a "control enthusiast". Managing titrations for hemodynamics & heart rate/rhythm, Maintaining ICP parameters, Keeping oxygenation just right with mechanical ventilation & other titrations?? Those are re-assuring to me. I get nervous if I don't have access to all the "stuff" going on with my patient. My nightmare? Pregnant trauma patient - a teensy little being that I can't even see, let alone monitor..... (shudder). I don't understand how nurses can cope with all those 'walkie talkie' patients that have no monitors at all - YIKES!!!

But I also realize that a lot of what goes on in ICU is not pure nursing at all... it's technology. We love the machines that go 'Bing' (Monty Python reference for you young ones) & hand to hand combat with the Grim Reaper. That's the easy stuff. Advocating for patients & families who are dealing with life-changing or terminal events.... that's the hard stuff. That's what nursing is all about.

[francoml, ASN, RN]

hand to hand combat with the Grim Reaper.

That is what I am talking about.... Thats why I come back day after day.

[francoml, ASN, RN]

There is no better feeling as a nurse then to know you truly beat death...Running a code yourself, making all the decisions, getting the patient back and then managing that patient in the ICU until they make a full recovery. Very rare but when it happens you never forget it!

[ORcutie]

This is a great summary of some parts of nursing, there are so many.

Nursing is so complex. I just retired after 35 years of nursing. And as an operating room nurse for all but a year and a half of that time, I saw such changes over the years. I loved what I did and am grateful that all OR nurse do not "eat their young". I learned so much from the doctors and nurses I worked with.

We need to encourage young women and men to become nurses.