New Grad CVU/ICU advice!

Da_Milk_of_Amnesia, MSN · Oct 7, 2013

Advice ? Use the search button in the at the top of your screen. This topic has been beat to death a million times over. :banghead:

Esme12, ASN, BSN, RN · Oct 7, 2013

that wasn't nice......everyone is entitled to ask a question.

OP as a new grad expect to be overwhelmed. This will take time...a lot of time. You are trying to acclimate to basic nursing and adding complex patients to the mix.

Here is a great website to start with....ICU FAQs

Congratulations on the Job!!!

Bringonthenight · Oct 7, 2013

I'll be nice:

Be a sponge- use your orientation wisely by jumping into the "deep end". It's better to do it now with your preceptor then if your on your own after orientation and freaking out.

As it's a CCU familiarize yourself with the anatomy and physiology of the heart.

Take an ECG class.

Take ACLS

Find out what the most common surgeries etc are that happen on your unit and study up.

Participate in codes- don't stand back and watch.

At the start of your shift check your lines with OCD tendencies and label them- you'll thank yourself when your not accidentally pushing something you shouldn't through a line running neo!

Adding to the above- know which line is KVO at all times for when you need to push an emergency drug.

Another thing that may seem tedious- make sure you check all your emergency wall equipment eg: your wall suction at the start of every shift.

When your not sure ask- it's a huge learning curve.

There's heaps more but that's all I've got right now

Good luck :)

my_purpose · Oct 7, 2013

I'm also a new grad in the ICU since August.

Here's an lol: Never shhh the nurses, no matter how inappropriate they are being. It, on my unit, is a huge no no!

Study, like you are still in school. Ask questions, never shake your head as if you know (even if you do), because there is always something else to be added to what you think you know. Ask questions, ask questions, ask questions. For me the most difficult thing is report, only because I'm so busy throughout my shift that I don't have time to prepare. Find time to look at your H&P, your labs (treat what you can before the next shift) and be kind to yourself, while you are progressing in knowledge.

My voice is soft, so my preceptor suggested that I put base in my voice while giving report. Be assertive, borderline aggressive. Don't take things personal, it will drive you crazy!! Smile every day, even when you get your ass handed to you because the shift was so unpredictable.

Share your thoughts and feeling with those whom you can trust only! (that being family, no one on your unit or in the hospital or keep it to yourself, which I don't recommend!)

Have tough skin, you'll need it.

nursecait · Oct 7, 2013

Da_Milk_of_Amnesia , I wasn't looking for anyone to be rude and I can obviously use the website. I was looking for what I said "words of wisdom" and things that you wish you knew when you started. Everyone started somewhere, you were also a new grad and a new ICU nurse at one time so remember that. And everyone else thanks for the support and advice I really appreciate it :)

Esme12, ASN, BSN, RN · Oct 7, 2013

It's going to be tough.....ICU nurses can be.....abrasive. They are strong willed intelligent professional and used to being pushy to get what they need for their patients.

You will do fine.....when you have questions come here and ask...you can PM me as well. You are going to feel very over whelmed at first...it's a TON of information. ((HUGS))

nursecait · Oct 7, 2013

Thanks so much!!!

Esme12, ASN, BSN, RN · Oct 7, 2013

You're welcome....:)

tigerRN2013 · Oct 8, 2013

I got hired into an ICU 3 months ago and tons. A few key advice points I wish I had known:

Always know your pt's code status

Always know which doctor/team of doctors is the primary doctor/team for your patient so you know who to call if something starts to go wrong

Pay really close attention to your patient's labs

Don't just chart anything abnormal, ask yourself why it is abnormal and what you are going to do about it.

Check your alarms first thing in the morning.

Study a lot in your free time so you can begin to get a better grasp on everything you are dealing with at work

Never be afraid to ask questions

Think critically: ask yourself 'why is the patient in the hospital today?', what is the best possible outcome for this patient?, what can I do to work towards that?, What is the worst possible outcome for this patient?, What can I do to prevent that?

It takes time to feel comfortable (at least I hope it gets better with time), so be patient with yourself. I leave work almost everyday feeling stupid and useless and like a very needy coworker. My patients really like me though and I know I'm learning a lot and getting better, so I keep going back. 90% of success is just showing up (no matter how nauseated with nervousness you may be).

Da_Milk_of_Amnesia, MSN · Oct 8, 2013

- Eyes open and mouth close - The worst answer you can give to a seasoned ICU RN is "I know" - The worst thing you want to sound like is a know- it- all. Nobody likes a know-it- all, or a 'One-upper'

- Adjust your alarms so you aren't listening to them all day/night

-Ask questions if you don't know whats going on.

- Understand the 'why' of what your doing. Just doing something because you're told is a good way to kill someone or screw things up

- Stick every single patient you can find with an IV, even the hard ones. There will be a day where you dont have a central line and need to start pressers and have to do it peripherally and need a good vein!

- Be able to look at the whole picture

- Know how the drugs work, normal doses, and what ones to have a dedicated line for

- Be able to predict whats going to happen (as best as you can) a.k.a 'Staying ahead of the curve'

- Know your hemodynamic and what changes happen with what shock state.

- Have really good assessment skills.

- If something doesn't look right, chances are it's not

- Don't be scared to take the sickest patient on the unit!

- Watch labs, don't be afraid to draw off an ABG or Labs if you're concerned about something.

- Tell family members not worry about the 'numbers' - alot of these people get fixated on the stupid monitors, so i tell them it means alot more to me than it does to them and that it's going to make them cross-eyed if they stare at it too long

- If a family member claims to be a nurse, then hold on for the ride because they tend to be the most, annoying, and demanding (And don't anyone try to deny that, you darn well know we all are when it comes to our family)

- Don't practice defensively because you are scared of a lawsuit, just be smart and follow the rules which brings me to my next point...

- Know you standards of care and policies.

- Dont get involved with unit politics and gossiping. Hate to say it but females are caddy and will be nice to your face then stab you back when you turn around. Come to work, do your job, keep out of trouble and go home.

- Keep yourself emotionally un-attached. Welcome to the ICU, depending on what type of ICU it is you will be subjected to awfully sad, and ethically challenging situations, the farther you keep your emotions away from it the better. In other words, leave work at work.

- Maybe this is just me, but be honest with family members and orient them to their reality. In my opinion, the worst thing you can do is try to sugar coat things with people. If they don't get it, make them get it. A lot of people have unrealistic expectations of what is going on with their family member and they need to be able to wrap their head around it. Honesty is the best policy, but remember to do it tactfully (or at least try your best to do so).

- Above all else, be confident. The worst thing you can do is lose your cool when a patient decides it's a good idea to start to circle the drain, which always happens to be at 645.

-Remember all you gotta do is 'Keep 'em alive until 705 (AM/PM)!!'

Ruby Vee, BSN · Oct 8, 2013

- Eyes open and mouth close - The worst answer you can give to a seasoned ICU RN is "I know" - The worst thing you want to sound like is a know- it- all. Nobody likes a know-it- all, or a 'One-upper'
- Adjust your alarms so you aren't listening to them all day/night
-Ask questions if you don't know whats going on.
- Understand the 'why' of what your doing. Just doing something because you're told is a good way to kill someone or screw things up
- Stick every single patient you can find with an IV, even the hard ones. There will be a day where you dont have a central line and need to start pressers and have to do it peripherally and need a good vein!
- Be able to look at the whole picture
- Know how the drugs work, normal doses, and what ones to have a dedicated line for
- Be able to predict whats going to happen (as best as you can) a.k.a 'Staying ahead of the curve'
- Know your hemodynamic and what changes happen with what shock state.
- Have really good assessment skills.
- If something doesn't look right, chances are it's not
- Don't be scared to take the sickest patient on the unit!
- Watch labs, don't be afraid to draw off an ABG or Labs if you're concerned about something.
- Tell family members not worry about the 'numbers' - alot of these people get fixated on the stupid monitors, so i tell them it means alot more to me than it does to them and that it's going to make them cross-eyed if they stare at it too long
- If a family member claims to be a nurse, then hold on for the ride because they tend to be the most, annoying, and demanding (And don't anyone try to deny that, you darn well know we all are when it comes to our family)
- Don't practice defensively because you are scared of a lawsuit, just be smart and follow the rules which brings me to my next point...
- Know you standards of care and policies.
- Dont get involved with unit politics and gossiping. Hate to say it but females are caddy and will be nice to your face then stab you back when you turn around. Come to work, do your job, keep out of trouble and go home.
- Keep yourself emotionally un-attached. Welcome to the ICU, depending on what type of ICU it is you will be subjected to awfully sad, and ethically challenging situations, the farther you keep your emotions away from it the better. In other words, leave work at work.
- Maybe this is just me, but be honest with family members and orient them to their reality. In my opinion, the worst thing you can do is try to sugar coat things with people. If they don't get it, make them get it. A lot of people have unrealistic expectations of what is going on with their family member and they need to be able to wrap their head around it. Honesty is the best policy, but remember to do it tactfully (or at least try your best to do so).
- Above all else, be confident. The worst thing you can do is lose your cool when a patient decides it's a good idea to start to circle the drain, which always happens to be at 645.
-Remember all you gotta do is 'Keep 'em alive until 705 (AM/PM)!!'

There was lots of good advice in this post, but two points I disagree with:

If the patient's family member claims to be a nurse, dig a little deeper. If Dad is on ECMO and daughter is a home health nurse, much of her practice really isn't relevant to Dad's situation. In fact, she's probably about as informed about ECMO as most of her non-nursing family members. She'll need education, but may grasp the situation a whole lot faster.

If the "nurse" in the family is a nursing administrator who hasn't been near the bedside in 35 years, that's a whole different situation. Most of what she wants will be about as sensible as what YOUR administration wants -- do more with much, much, much less and the like. My sister, a nurse administrator, was given to throwing tantrums about the view from Dad's hospital room window and bringing out a cot for my mother to sleep on in his room. She threatened to "have people's jobs" over their "poor customer service". But she threw those tantrums when Dad was in V tach.

Or the "nurse" could be a housekeeper in a hospital, because isn't everyone who works in the hospital really a nurse?

And other nurses, real nurses, are polite, respectful and appreciative. They work with the staff, understand what's going on and explain it to the rest of their family and sometimes can observe changes more quickly than you because they have experience and know the patient.

But the piece of advice that I found really terrible is the "females are caddy" line. (It's "catty", by the way, not "caddy." If you're going to insult an entire gender, at least know what you're calling them.)

If you go into a new job expecting to find catty female colleagues who will willingly stab you in the back, it doesn't set you up for positive working relationships. Instead, go looking for colleagues who are more knowledgable and experience than you and who will willingly have your back. You're more likely to find them.

Participate in gossip of the "Cathy's having a baby! It's her first!" variety. It's positive and it helps you to get to know your co-workers. Negative gossip is a negative, but it's like that in every workplace and not just the ICU. There's nothing worse than holding yourself above gossip to make everyone resent you. Just make sure it's the positive variety.