New Grad entering CCU/ICU..opinions?

highlandlass1592, BSN, RN · Nov 25, 2008

Well congratulations! I was a new grad to the CCU many years ago. Don't let anyone dissuade you, it can be done. My orientation was 3 months long which was enough, 5 months should be a good fit for you.

Some hints I can share: take the most challenging patients you can while you're on orientation. You'll learn a lot and have a guardian angel there (your preceptor) looking over your shoulder to explain things and help you through. Don't turn down any learning opportunity. Round with the physicians when you can and if the docs aren't open to questions, then ask those questions of senior staff or your preceptor. If you haven't already, become a member of AACN..that will get you subscriptions to critical care nursing journals which will be a huge help. And they have a lot of resources online which can be beneficial.

A tool I've had over 10 years now is called Kathy White's Fast Facts for Critical Care. It's a pockete notebook that goes over just about everything you'll need to get a firm foundation. (website: http://fastfactsforcriticalcare.com/J/) Awesome, awesome resource! I used it extensively when I was a new nurse and then when I was a travel nurse (I worked a variety of ICU's and it had information to help me in all of them) And it's not too expensive for all the information you get.

Be open to obtaining and reading critical care resources. I've got a ton of books which have really helped me over the years; they can be a bit pricey though which is why I recommend Kathy White first.

Keep an open mind. You're not going to know a lot for a long time. One of my profs had a saying: ignorance doesn't mean you're stupid, it just means you don't know something. Keep that in mind.

Study your drugs. Then study them again. Then study again. The more you become familiar with them and how they affect the systems you will be working with, the more they will make sense. Don't ever run a drip on a patient and not know how it can affect him/her.

Read all the EKG strips you can...then read some more..then read some more. I think you get the idea. An EKG class is great, problem is our patients don't read the book they teach us from and you can really see some funky rhythms out there. LOL I'd also recommend trying to find a good respiratory therapist to teach you about ventilator management. They only do respiratory..and many are great teachers. They can show you a lot if you are open to learning.

Keep in mind...you're going to be overwhelmed during your orientation. There is a lot to take in..and it's going to take a while for it all to make sense. That doesn't mean you can't hack it, it just means you need to keep plugging along. Also, you're going to make mistakes...we all do. Just pay attention and try to minimize them as well as learn from them. I don't know if your unit will be performing hemodynamic measurements but that may take some time to understand as well. Don't give up, the concepts will come. When you are learning, if you don't understand something speak up...don't let people assume you know what's going on if you don't. There is nothing wrong with needing clarifications.

It's probably going to take you a couple of years to really get comfortable working in the unit. That is normal. Don't sweat it. It just takes time and experience.

Sheesh, I've probably rambled on a bit. I just wanted to encourage you. You're probably going to encounter a lot of people who say you have no business starting out in the ICU....don't listen to their negativity. You'll grow in the ICU and your skills will come. Continue to work on your time management, skills will be hard at first but it's doable. Just keep that in mind. There are many of us who started out like you will be doing...and many of us are very successful. :nurse: I do a lot of precepting with new nurses and I tell them all this and more as we work together. Heck if you need any advice/ help , feel free to email me. I'll do what I can to help ya along. Congratulations on starting your nursing career! Keep a positive outlook and be willing to get those experiences and you'll do fine. :nuke: :twocents:

HACCGrad · Nov 25, 2008

Thank you so much for the encouragement! I really appreciate it. I am very excited to start my career in the ICU/CCU. I enjoy hearing from nurses who started their career in this area because that lets me know that it truely can be done if one puts the work into it. Thanks again! :nurse:

JanetCCURN · Nov 25, 2008

Couldn't help to notice but...I have been on orientation for about 3 months, new grad RN on CCU 12 bed small but interesting. Its not a teaching facility nor a trauma hospital but we do have open hearts.

Anywho, I just wanted to say that you have a great challenge in front of you that you will love at times and maybe like instead of love at times. I cannot say that I hate it because all through out nursing school I was told to make the most out of my experiences, in other words I drive the boat on making anything my own best experience. But it is hard because you cannot control other people.

Advice, find a fabulous preceptor who you will follow almost 100% of the time, go to codes and help with new high skill level pts as much as you can. I realize half way through my 6 months of orientation that I really need to step up on my pt difficulty. So far I feel like sometimes I take the back seat and sometimes im in front with everyone else. Time management is sooooo key because things change and they change fast.

Hemodynamics is a headache, ive just ordered the little binder that the last post suggested, kathy white? I try to remember that we cannot remember everything but we always have drug books on the unit. I always check and double check because things change fast.

Also noting the dr's orders if I see them come in I make it a point to see what their opinion is on the plan of care, what are OUR goals, they seem responsive to that so far. The more they see who I am, the more relaxed they are when you need something. I guess saying hello/acknowledging them and asking how they are doing really helps so when you need them they know you are a person too. Its building good rapport. They may seem scary at first but we use SBAR when we communicate. Always having your chart at hand, VS, Labs...etc preparation before calling and having your info at hand. A nurse told me never to feel bad about disturbing the dr at 2 am (for instance) thats why they get paid the big bucks. lol. So I always keep that in mind when I see them. They are people too.

I cannot say I am comfortable as a new ccu nurse yet, but i know it won't be for a while. I always feel like I have forgotten about something or that I was not thorough enough. Its just weird to see all the seasoned nurses calm cool and collected. Im over here worrying about little minute things. Im still jumpy though always looking at the monitor for changes.

There are a ton of suggestions, but really remain flexible keep your cool, trust your instinct, follow through, be patient with yourself (I am not gonna master this for a while myself), efficiency takes time, know your units P&P things in nursing school sometimes don't carry on to the unit.

Let me know how you do, this site is a good outlet for frustrations and candid feelings w/o repercussions. I wish you the best!!!

highlandlass1592, BSN, RN · Nov 25, 2008

Couldn't help to notice but...I have been on orientation for about 3 months, new grad RN on CCU 12 bed small but interesting. Its not a teaching facility nor a trauma hospital but we do have open hearts.
Anywho, I just wanted to say that you have a great challenge in front of you that you will love at times and maybe like instead of love at times. I cannot say that I hate it because all through out nursing school I was told to make the most out of my experiences, in other words I drive the boat on making anything my own best experience. But it is hard because you cannot control other people.
Advice, find a fabulous preceptor who you will follow almost 100% of the time, go to codes and help with new high skill level pts as much as you can. I realize half way through my 6 months of orientation that I really need to step up on my pt difficulty. So far I feel like sometimes I take the back seat and sometimes im in front with everyone else. Time management is sooooo key because things change and they change fast.
Hemodynamics is a headache, ive just ordered the little binder that the last post suggested, kathy white? I try to remember that we cannot remember everything but we always have drug books on the unit. I always check and double check because things change fast.
Also noting the dr's orders if I see them come in I make it a point to see what their opinion is on the plan of care, what are OUR goals, they seem responsive to that so far. The more they see who I am, the more relaxed they are when you need something. I guess saying hello/acknowledging them and asking how they are doing really helps so when you need them they know you are a person too. Its building good rapport. They may seem scary at first but we use SBAR when we communicate. Always having your chart at hand, VS, Labs...etc preparation before calling and having your info at hand. A nurse told me never to feel bad about disturbing the dr at 2 am (for instance) thats why they get paid the big bucks. lol. So I always keep that in mind when I see them. They are people too.
I cannot say I am comfortable as a new ccu nurse yet, but i know it won't be for a while. I always feel like I have forgotten about something or that I was not thorough enough. Its just weird to see all the seasoned nurses calm cool and collected. Im over here worrying about little minute things. Im still jumpy though always looking at the monitor for changes.
There are a ton of suggestions, but really remain flexible keep your cool, trust your instinct, follow through, be patient with yourself (I am not gonna master this for a while myself), efficiency takes time, know your units P&P things in nursing school sometimes don't carry on to the unit.
Let me know how you do, this site is a good outlet for frustrations and candid feelings w/o repercussions. I wish you the best!!!

You mentioned that hemodynamics is a headache. I love teaching hemodynamics and was told of a website that might help you: http://www.pacep.org/ It is free and the teaching is awesome. The more you have swans, especially with multiple gtts, the easier it will get. Hang in there! :nurse: