New Grad, First Job (ICU)

Sun0408, ASN, RN · Nov 6, 2012

Follow your states scope of practice, follow your facilities P&P's, if unsure/unfamiliar ASK. You will be learning so much as you start your journey in the ICU, so many new things, really sick people, different doc etc..This will be an overwhelming time, exciting and sad; learn from everything.

If you don't know a med, look it up, unsure about a procedure-look it up, feel weird about a pt-ask..

It will be some time before you are on your own but remember, even then you are not alone..

meandragonbrett · Nov 7, 2012

Don't steal the narcotics. Seriously....some people take that "protecting my license" thing too seriously and out of context.

CrufflerJJ, BSN, RN, EMT-P · Nov 7, 2012

Get malpractice (professional liability) insurance through NSO or Marsh, among others. I've been insured through NSO at Professional Liability Insurance for nurses, nursing medical malpractice. since I was a nursing student. The link for Marsh is:

Nursing Liability Insurance | Malpractice Insurance for Nurses

I think they offer a 50% discount for first year nurses (new grads). Cost is roughly $100/year for the full price.

CHEAP if you ever need it. Even if your employer promises that you're covered under their Liability Insurance, don't believe it. Get your own policy.

More importantly, CONGRATS on starting a new job in the ICU! You'll see amazing things, wonderful things, and horrible things. Sometimes in the same patient.

focker14 · Nov 7, 2012

hahaha...get a plastic binder for it? Just remember the most important rule for an ICU nurse.....LEARN FROM YOUR MISTAKES and pray you don't make one that really harms a patient....In my 8 year career as an ICU nurse, I have made many mistakes and as a soon-to-be CRNA i'm sure i will make more. However, it's what you take from them that will allow you to practice safely....few other things to remember......keep em alive to 0645....you have to swell to get well....and when your crazy patient tells you he sees bugs in the room, look around just to make sure..

tswim · Nov 9, 2012

I agree with the others, and add: Assess, assess, assess, and assess again...

Know that a full assessment isn't done in 2-3 minutes, but over the first few hours you spend with the patient. It's extremely important to get a baseline assessment, and then to continually reassess for changes, big or small... flank bruising there before? new crepitus? cool/pale extremities? Forgot to assess these earlier? >> how do you know if it's getting better/worse

Work on developing solid physical assessment skills, and you'll learn to catch problems (including those caused by mistakes) early; maybe even before they affect the numbers we like to watch on the monitors

Lemon87 · Nov 9, 2012

Great advice here. As mentioned assessment, when you got the patient from cardiac cath, look at the insertion site (from OR? Dressing surgical site) for bleeding and take the peripheral pulses, specially to that extremities. Came with any drips? Mixed by the nurse or from pharmacy? Go back to the order and look at the parameters, don't assume that your acudose or med machine is going to have the same concentration. DOCUMENT. Very basic things but very important. Buckle up! :)

Rl3232 · Nov 16, 2012

As a new grad four months on my own, Never let your confidence go, you will make mistakes but the moment you don't feel capable you lose your critical assessment skills. Trust yourself and Ask Questions, who cares if they roll there eyes and snarl you did the right thing.

aronii07 · Nov 17, 2012

Hello everyone, I'm am really exited to start working. I did my preceptorship at the ICU department were I got the offer, and I loved it. I start next week, I've been told to really take care of my license (especially in ICU, because I'm a new grad)... any tips on how to maintain it? (I know to follow my scope of practice, but other tips that a new nurse would lack)

I'm in the same boat as you, just got off orientation in MICU in September. I love taking advantage of learning from all the patients in the unit, not just my own. Anytime I offer to help with a reposition for another patient I always ask questions of anything I'm unfamilliar with in the room. Goodluck to you!