MICU skills needed for new-grad

[in2ICU]

I am about to graduate (BSN) and start working in a MICU where I have been a tech (1 year). From my senior synthesis in a stepdown unit, I realize that my biggest challenges will be organization and critical thinking (I expect these only come from experience). So in the meantime, I am trying to learn any and all skills I can - just for more exposure and to make the skill part not a huge focus of my training when I need to concentrate on something else. Below is a list of skills I have done. Some I may be great at, while others I'm kinda weak on, or maybe I've only done it once, but at least I've had the exposure. What am I missing? The nurses where I work love to teach and if I had a list I'm sure I could get most of it accomplished before I start in October. I'm pretty green with regard to assessment skills, but I'm working on that. What else is there?

What I've done:

all VS

IV starts

Foleys (male and female)

wound and stoma care

wound vac

trach management and care

ET tube management

BiPAP/CPAP

suctioning

vent management

ambu bag

O2 for pt travel

ABG

A-line insertion setup/assist (radial, femoral, axillary)

central line insertion setup/assist (IJ, subclavian and femoral)

Quentin/trialysis insertion setup/assist

central line dressing change

CVP

drawing from A-line

drawing from central line

meds in central line

heparin flush

zeroed for A-line and CVP

tube feeds (pump and bolus)

meds per tube

code/CPR - compressions

ECGs

alarm check/settings (on monitor)

injections (SQ and IM)

urine sample from Foley

dignicare (rectal tube) management and insertion

CADD pump setup, clinician bolus

IV pump - hanging fluids and meds

assist with CardioQ (trans-esophageal Doppler)

SCDs

paracentesis assist

tubes/drains: JP, penrose, chest, expandable suction drains

pt transfer with lift

postmortem care

What I haven't done:

FCD - seen it 100 times, but've never put one on

thorough oral care around a tube

enema (I've assisted but never done one solo)

lumbar puncture assist

thoracentesis assist

used intermittent or full suction attachments

attached pt to travel monitor

Doppler for pulse

bladder scan

I hope this post isn't overwhelming. I'd appreciate any feedback and will put your advice to good use!

[CNL2B]

I think you've done plenty as a student -- a lot more than I ever did. Your exposure has been pretty great if you ask me.

Re: the med administration you talked about, I hope you gave that stuff under a clinical instructor. If it was under a staff nurse and you are working as a tech, that is a big no-no.

[in2ICU]

Thanks for the feedback. Yes, the med admin was in clinical! I really, really try to make sure I am following the rules - I'm sure they're there for a reason!

[TigerGalLE, BSN, RN]

You've done more than me and I've been an ICU nurse for 6 months. haha

[I_See_You_RN]

My advice is just to relax and breathe.... almost all of your skills will come in due time. And once you learn a textbook way to do a skill or view a case you'll end up in a scenario where the textbook won't work and you'll be getting a lot of your on the spot training from the nurses and physicians around you. Yes manual skills are important, but your most important job will be monitoring your patient, fully understanding their condition, and anticipating the solution.

In the SICU and MICU most patients have multi-organ involvement so its not much good to study yourself to bits about how to treat heart failure when your patient might also have necrotizing pancreatitis which will throw all that book stuff way off. You have to experience it, you have to go on rounds with the physicians, ask tons of questions of your preceptors and watch your patient hopefully go through all the stages of recovery.

A-line set ups and assisting this and that is absolutely necessary but those are menial tasks. Do your job well, perform your responsibilities but don't get too caught up on those things and end up missing all of your Real learning opportunities.

Good luck!!

PS: If you must, brush up on all your drips, find out the usual concentrations that your MICU uses,... for the pressors... yep their inotropes but what else will they do to your patient.

[JoyfulRN14, BSN, RN]

I just finished my 4th week in the ICU as a new grad, a skill that pops into mind that I learned this week is getting a bladder pressure.

Your normal pressure set up (like for an ART line) is hooked up to the Foley, bladder empty, clamped on drainage bag side. Patient is supine. If patient is moving a lot (as mine was d/t agitation), they made need a paralytic (we used rocuronium on my patient to get an accurate number).

Increased bladder pressure can be an indicator of abdominal compartment syndrome (which we had reason to suspect with this patient).

In my case, he ended up having a pressure of 17 the first time, 27 the second time, and the surgeon ended up coming in and opening up his surgical site from a exploratory lap of his abdomen to relieve the pressure, and putting on a wound vac. (It was a trauma pt, pedestrian vs. auto)

Interesting case!