Just a Little Advice After a Year in the ICU

Being an ICU nurse can be an exciting, scary, heart-wrenching, and thoroughly rewarding career. After a year on the unit I have learned so much and still have so much to learn. I love my job and I encourage all of you aspiring to be ICU nurses to keep moving forward with your goals. Nurses Announcements Archive Article

Just a Little Advice After a Year in the ICU

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.

1 Votes
francoml

About francoml, ASN, RN

147 Posts

Share this post

Well said : )

Thank you for the post

0 Votes

I don't think ICU nurses are a breed of their own. It seems the people who think that are the ones who've never done anything but critical care.

0 Votes
I don't think ICU nurses are a breed of their own. It seems the people who think that are the ones who've never done anything but critical care.

I agree especially since I'm a float nurse and I float to all areas including the ICU.

0 Votes
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Well said francoml. It is great advice. You ahve learned a lot and grown exponentially over the last year.

10:58 am by VANurse2010

I don't think ICU nurses are a breed of their own. It seems the people who think that are the ones who've never done anything but critical care.

I think all nurses have their own niche where they fit the best. I think ALL nurses are a breed apart. Nursing has become very specialized over the years and each area has it's own set of skills required to survive.

I think in each area of nursing the nurses are a bred of their own. ER nurses usually do not like critical care. Critical care nurses don't like the emergency department. Many med surg nurses would do anything to not float to ICU. L&D and OR Surgical nurses have their own thing going on and you just can't float anyone there to be helpful. NICU/PICU nurses are a breed unto themselves.

I have spent a lifetime (with the exception of 6 months), 35 going on 36 years to be exact, in critical care/emergency department arena. I have NO floor nursing skill...NONE! It takes a special person to take care of all those patients coming and going all day long. The closest I came to "floor nursing" was a IMCU/step down unit. I love the geriatric population however I cannot stand the way they are cared for...or should I say the way they are not cared for....sigh.

I have been a supervisor, administrator, instructor, a manager, a flight nurse, an ICU nurse and a ED nurse. Each had it's own set of challenges.

Me personally....I do not have the floor nurse set of skills any more. I also avoid OB like the plague. I can resuscitate the mother or the child....leaving them combined terrifies me. It always has....the worst thing that came be heard at a hospital is CODE BLUE L&D. It always makes me a little sick to my stomach. I KNOW what to do....it just makes me anxious. Always has. So much can go wrong! So much can happen..... I prefer to resuscitate something larger than the palm of my hand. Hats off to NICU!

I agree that I think nurses in very specialized critical care areas are a little different that other nurses. They thrive in the critical environment. The anxiety, anticipation, and complexity is intoxicating. They can be aggressive and opinionated. They appear harsh and unbending...intolerant. They are passionate and protective. They don't mince their words.

I'd rather triage a bus load of senior citizens with chest pain and care for an open chest with 13 drips and all the equiptment in the department in thier room than care for 8 patients on the floor. The thought of caring for that many patients fills me with anxiety. Sure I know how to code them...but care for them collectively? Shiver.

Hats off to floor nurses.

1 Votes

Well, I half agree with the OP, I could tell right off the bat that the ICU nurses in my hospital are top-notch and the cream of the crop compared to the M/S unit I was on at the same hospital because they are ON TOP of everything. They know their A and P in and out, they know why they are doing certain important interventions that you may not think twice about on a M/S floor. The unit holds their RNs to a higher standard compared to where I was before, where a lot of nurses did the bare minimum and I had to clean up a lot of what they had or hadnt done the next day or days that I had the same pt. They seem to have a passion for the area they are working in where as the other RNs I worked with were burnt out and looking to work elsewhere. Not to say that there are not M/S nurses that know their stuff and have a passion for it because I feel I was one of those and I wouldnt mind going back and working M/S, I wanted to learn something new, but it was a blatant contrast to me when I started in the ICU.

0 Votes

Thanks for posting. It gave me additional inputs.

0 Votes

This is great advice and very well put. I've been a nurse in the PICU for 1 year now and I came staight from school. The learning curve is soo incredibly steep that I'm still struggling a little. I'd agree that if you're going to start here you definelty should choose a large teaching hospital with a long preceptorship program. The place at I work at is wonderful- I honestly can't imagine a better program.

You also get to see so many interesting cases and types of pathophysiology in large hospitals.

I love the trauma but there aren't enough to keep me around here and so I'm headed for the peds ED... I think I'll like the in-and-out pace better than taking care of so many chronic kids.

0 Votes
Specializes in Critical Care, Emergency, Education, Informatics.

i don't read the "breed apart" as a derogatory comment. Every specialty area can say that. It takes a certain kind of person to thrive in the OC environment of a high acuity ICU, just like it takes a different kind of person to thrive in the ED, Ped, Onc and the like. Each has it's own thought process, Priorities etc.

My own comment to the list. Repeat #3 constantly for the rest of your career.

0 Votes
i don't read the "breed apart" as a derogatory comment. Every specialty area can say that. It takes a certain kind of person to thrive in the OC environment of a high acuity ICU, just like it takes a different kind of person to thrive in the ED, Ped, Onc and the like. Each has it's own thought process, Priorities etc.

My own comment to the list. Repeat #3 constantly for the rest of your career.

I am a special breed who can only keep track of two patients at one time.

0 Votes

I've got a question for you guys, I'm transitioning from EMT-B to RN, starting this fall. If I love what I do as an EMT (but want to be more involved, hence the transition) do you think I'd fit better in the ED or an ICU? I tend to be fairly levelheaded in emergent situations (e.g. I'd feel totally comfortable hopping on for chest compressions in a code). I volunteered in the ED for a couple months, so I know they get everything from drug seekers to dead people (not kidding, I have seen ambos transport dead people..dead when they got there, dead when they dropped them off, still dead 15 minutes later after the attending has tried everything in his power) in the ED. I never really had the chance to check out the various ICUs, but I'm curious about a day in the life of the ICU nurse. Any thoughts on the ED vs the ICU?

0 Votes
Specializes in Critical Care at Level 1 trauma center.

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

I will first start by saying that I have never worked in the ED except for when I am there as a rapid response and that is limited because they handle all their own codes and line placement. They are both awesome fields and it really depends on your way of thinking as well as what your future career goals are. If your are planning on going to CRNA school 95% of schools require Critical Care experience and ED does not count. Beyond CRNA there are a million different career opportunities that can arise out of ED and ICU alike.

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.

In our unit our ICU suites can also function as surgical suits in the event that a patient is too unstable to transfer to the OR. I once had a patient that had a intestinal perforation and the surgical team came up and opened the patients belly at the bedside and then proceeded to take out the intestines and systematically inspect them for a bleed.

This is something you will never experience in the ED or in a small rural ICU. I will admit there are days when I have totally stable patients and I do little more than a bed bath, pass a med or two, and do a few assessments but this is rare (and much needed). You also have to realize that I am incredibly biased toward ICU lol. I am sure there are many people on here that will offer a look into the world of emergency medicine and will have amazing stories.

In the ICU you need to know A&P, pathophysiology, pharmacology, and hemodynamics inside and out. You also need to be very OCD about your patients because you should know damn near EVERYTHING about that patient.

Both will offer their fair share of adrenaline rushes and challenges but ED will focus on stabilizing a patient while ICU will be about actually keeping the patient alive and fixing their complex problems. If you truly love your job as an EMT I would suggest going into Emergency Medicine. If you want to truly push your limits of your medical and pharmacological knowledge go ICU.

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.

1 Votes