Tips for new grad working Neuro ICU

  1. I just started working the neuro ICU at Loyola who has a dedicated neuroscience area in the hospital. This is my first job as new RN and I was just wondering if anyone had any pointers to make my transition into the world of neuro ICU. I did my management clinical in CCU and I loved it, picked neuro because fascinated with the brain and I just love it, I have talked to other nurses who say it is the most demanding of all ICU's and I should not work there as a new grad.

    Comments are very much appreciated.
  2. Visit oldnurse newnurse profile page

    About oldnurse newnurse

    Joined: Jul '05; Posts: 170; Likes: 2
    Clinical Coordinator
    Specialty: 12 year(s) of experience in Gerontology


  3. by   Gennaver

    A little while ago I scanned the whole Neuro ccu forums and found a couple of threads with similar starting questions. In case you do not get too many replies quickly maybe you would like to parouse through the forum here too. :0)

    Congratulations and good luck,
    student nurse
  4. by   mjbeare
    It is very difficult to go straight from nursing school to an ICU. Even more specialized is a Neuro ICU. The care is based fully on assessment skills. It is up to you as a nurse to recognize neuro changes before it is too late for something to be done. Going for a stat head CT becomes a regular occurance, as you have already discovered I'm sure.
    1. My best piece of advice is rely on the input of your co-workers who have been there longer. Anytime you sense a change in your pt, bring the charge nurse into the room to observe with you. Call the Neurosurgeon right away, don't wait until its too late. Give him/her the chance to make the decision on what to do based on your assessment.
    2.Never get slack on doing hourly neuro assessments. Check those pupils, LOC, and reflexes EVER SINGLE HOUR!
    3. Do your reading on neuro specific conditions. Know why and when Mannitol, 3% Saline, steroids, paralytics, and Nimotop are used. Know the anatomy of the brain so you can understand where certain strokes occur and what physical symptoms may result.
    4. When you are helping a neurosurgeon with a procedure at the bedside (bolt, monitor, drain...etc) let him/her know that you are new so they don't get frustrated with your speed. In general, they will be much more understanding if they know you are still learning.

    These are just a few things that I learned in my first two years in the Neuro ICU (which is the GREATEST place to work in my opinion).
    Have fun, learn lots!
  5. by   pfitz1079
    Good advice, here's one more.

    Get a St. Jude medal, but remember, just because a cause is hopeless, doesn't mean it's lost.
  6. by   wonderbee
    I'm learning what it means to be a new grad in a neuro/trauma ICU and you may not want to hear from me but this seemed like a great opportunity to spill my guts. I just completed my second clinical week. I had great grades in school, passed my boards and am struggling from hour to hour to keep my head above water. I stay an hour late most nights with my preceptor tightening up my computer charting. I usually only take 15 minutes for lunch. I've peed...??? Heck, I don't pee and we're talking a 12.5 hour shift. I never realized the bladder could do that. I've looked at lines built up with multiple ports and wondered, oh my gosh, where to I put this connector??? Is this drug compatible with that one? Which way do I turn the stop cock? I forgot to do what??? You get the picture. Total deer in the headlights but I see potential.

    It's a rough rocky road orienting to basic skills AND a unit nurse at the same time. I'm not saying it can't be done but I'm giving myself some wiggle room in the event it's just too much for me and that's the advice I give to you. Think of the worst case scenario. For me it means going to a step down unit. Knowing that frees me to let go of ego and allows me to get beyond my fears. I want to deliver excellent care. If I can't do it in a unit, there are other options. Be prepared to go home with doubts. It's not unusual and it doesn't mean you're not where you're supposed to be even though it sure doesn't feel like it. You might catch more colds and flu too. I've been sick 3 times in the last two months with colds and flu. My immune system is stressed out majorly.

    My clinical orientation is 8 weeks and it is too short. I hope your is longer by at least x2. Do you feel comfortable talking with your preceptor? The better the communication is between you, the more likely you will be successful. Don't pretend to know what you don't know. Bad idea. I've done it and got caught with my pants down. Won't see me do that again.
    Last edit by wonderbee on Mar 6, '06
  7. by   GoalFocused1
    I might be in a similar position. I have an interview soon on that unit. Do you have any recommendations? I have reviewed the neuro science department information, the Loyola website for mission etc, posts out here. Anything additional??

    Thanks and Best Regards!
  8. by   paolountalan26

    I am a new graduate nurse who will have my interview next week at a major hospital for the Neuro-ICU position. I just have some questions:

    1. Will it be very difficult for me to work as a new grad in the Neuro-ICU?
    2. What are the usual cases i will encounter daily?
    3. What is the essential skill i need to have in order to be a successful Neuro-ICU nurse?
    4. What's the most frustrating thing and the best thing about being a Neuro-ICU RN?
    5. What interview questions do they usually ask???
    6. What's the most stressful thing you've experienced in this unit??

    I am so anxious about my coming interview. Hope someone could help me. I really want to get the job.

    Thank you in advance and God Bless you all!!

  9. by   xx--RN--xx
    Lots of great tips already here. I'll make my advice very simple:

    1. Establish a neurological baseline at the begging of shift with bedside report.
    2. Do neuro checks. If unchanged from #1 then repeat #2 in 1-2 hours. If changed, go to step 3.
    3. Do something about it. (quickly ask a coworker to double check if you are not sure, call doctor, CT of head etc)

    Once CT is done and no surgical intervention then start at number 1 again.
  10. by   Nurserton
    I agree with mj & xx. Use your peers/charge as resources. Assess, assess, assess, and don't second guess yourself if you see a change or an abnormal. Don't ignore it or shrug it off, it may be a viable assessment finding, which is why they're critical care to begin with. I work neuro step down, and I can tell you just last week we caught a patient with a change in LOC, increased NIH stroke scale score, and pupillary changes.We took her down for stat CT per protocol, and next thing you know we were transferring her into ICU and the neurosurgeon was on his way in to place a ventric. Does that sound intimidating? Probably. But it wasn't. It's what we do every day. We look for that stuff. Our excellent nurses caught it and did what we had to do. So when we see it, we're on it. You will quickly learn key assessment pieces and when in doubt, always ask! You are NEVER alone in an ICU, you have yeaaarrrrrssss of the BEST experience in the hospital to draw upon, working right along side you. The patient I described above was actually my new grad's, and she was terrified, but we all swooped in and handled business.