New grad in ICU.. Need your input!

poopylala, BSN, RN · Dec 20, 2016

Congrats! I'm a new grad ICU nurse and have been off orientation for a month now. Love it! So what is it about IV pumps that scare you? In my orientation week for the hospital, they did an IV pump inservice to get everyone okay to use the pumps. You'll also learn with your preceptor and should get more comfortable as you use them. Doctors are just people. When you see them as a source of knowledge and as a fellow human, it might take away the intimidation. Some can be rude or have huge egos but that can be said for some nurses too.

As as far as tips or tricks, I'll say what everyone else told me- you're going to feel like you may not cut out to be a nurse once you start. I had this on my second day with my preceptor and this is coming from someone who was an ICU tech and a pretty confident person lol it sucks but everyday is a learning opportunity so ask all the questions you can think of while you have a preceptor in the beginning. Every unit and every hospital has their way of doing things so be open to learning a different way than you learned in school. You can always PM me for specific questions and if possible, see if you can get someone's name for fb messaging or their email from the unit so you can ask unit specific questions for how to prepare.

CCU BSN RN · Dec 27, 2016

Every week, starting the night before you start, write yourself a quick post it/memo about what scares you most. At the end of the year, open up your box of post its/memos/letters. Because at the end of the year, you'll still feel dumb but you'll look at all the things that used to scare you, and be like, oh, I can do that with my eyes closed now, wow I used to be scared of EVERYTHING.

You will constantly be learning, SO MUCH, and eventually you'll get a good grasp and then you'll be making a list of things to look up to develop deeper understanding. Very easy to forget how far you've come. I wish I had done the above

practicallyRN · Dec 27, 2016

Thanks!!

practicallyRN · Dec 27, 2016

Every week, starting the night before you start, write yourself a quick post it/memo about what scares you most. At the end of the year, open up your box of post its/memos/letters. Because at the end of the year, you'll still feel dumb but you'll look at all the things that used to scare you, and be like, oh, I can do that with my eyes closed now, wow I used to be scared of EVERYTHING.
You will constantly be learning, SO MUCH, and eventually you'll get a good grasp and then you'll be making a list of things to look up to develop deeper understanding. Very easy to forget how far you've come. I wish I had done the above

Thanks so much! I'm definitely going to do this, it's an amazing idea!

LovingLife123 · Jan 2, 2017

Pumps are the easy part. You will pick that up quickly. I was always worried I'd miss something in my assessments. There's so much to watch and know in ICU.

Make a notebook of everything you need to know so you can reference it when need be. I took notes, read up on conditions on my off days, and signed up for extra shifts to get extra experience.

ICU is hard but good to hone your skills.

bubbles410 · Jan 3, 2017

Hey, I am a new grad ICU nurse currently partway through orientation. Here are my tips to help you get a head start into yours:

1. Always order a replacement drip from the pharmacy when you hang a new drip bag. Pressors like Levo, dopamine, etc., all of these need to be in constant supply and should never run out. You can program your pump with a lower volume than what is in the bag in order to ensure that it beeps well ahead of time so you don't run out. This is very important. This also includes continuous dialysis bags; if those run dry, the machine could clot off, and then the pt will be without dialysis for several hours.

2. Do is&os and vitals within 5 minutes of the hour. It seems little, but it's important, so make it a priority.

3. Respond to every alarm. Since it isn't going to be second nature to you as a new nurse, make it a point to glance in the room and look at the pt & monitor every few moments. Pressures could drop at any time, rhythms could change, etc.

4. Scan meds before giving them. It will prevent errors you should have already caught, but as a new nurse, you might overlook something like an order changing.

5. With your assessment, check the pumps: press 'channel select,' then press 'setup' so you can compare the concentrations of your bags with the pump and check dosing weight. These are sometimes wrong and that is why it is important to check. Then check the bags and lines for dates. They might have expired and need changed.

6. Make sure emergency meds and emergency equipment are in the room with each initial assessment. If your pt codes and you don't have IVP epi or an ambu bag already in the rooms, that's on you.

7. Verify vent settings. In my short experience, people often forget to update changes like fiO2 in the chart. Verify that the pt has the settings they are supposed to be on.

8. Tell your preceptor before you call the provider. They will coach you to make sure you point out all the relevant info and that the call is even necessary to begin with.

9. Always empty the foley bag before change of shift. Senior nurses care about this a lot.

10. Always remember to pause the tube feedings before re-positioning the pt. I'm sure you would have remembered it, but do it before you call someone in the room to help so they will trust your competence.

11. Be super serious about your work, and know that you are going to deal with some aggressive personalities. When this happens, be humble, but stay strong, accept true criticisms and grow from them, and try to focus on your patient and what they need. Utilize your educators if you have any issues with preceptors, and definitely acknowledge your responsibility to the pt at all times.

12. Always check IV compatibility. If it's something small or IVP, use the CVP.

13. Be mindful of your carrier and what is infusing. So say you have epi running, and you have an antibiotic due. Don't run the antibiotic behind the epi or it will bolus the epi. Always be sure you know in what port or line you plan to give a med before giving it, and make sure it's safe. Make sure you know which access is safe to use to push meds in a code.

14. If someone is on an insulin gtt continuous infusion, an on hourly glucose checks, don't forget to do your last check before change of shift. Just do it 20 minutes before the hour change because you will have to take care of it if there's a problem before you give report. I forgot once and my preceptor noted my mistake, and the pt's glucose had dropped to 70. This made me realize how important it is to do that last check.

These are just some of the main things. They may be mostly common sense, but everything is new in the ICU to a new grad, and everything requires thought because it is critical. The supply room will seem overwhelming, but you will know where everything is within a few weeks. Drawing labs from a-lines will seem messy the first couple times, but you won't even have to think when doing it soon enough.

Do everything you do with a purpose in terms of priority. An example of a mistake I have made that I received feedback on was that I planned to give pt 1 an antipyretic for a 38.4 T instead of shooting new cardiac numbers for pt 2, who was on epi, when I was supposed to be weaning the gtt. Had pt 1 been a transplant pt, this might have been an appropriate choice of prioritization. But anyway, this is how much details matter. It's true that it's an incredibly steep learning curve. If you are trying to choose between two pts or two actions and you aren't sure, ask your preceptor for help prioritizing in that instant. They are there to help you learn.

practicallyRN · Feb 9, 2017

Hey, I am a new grad ICU nurse currently partway through orientation. Here are my tips to help you get a head start into yours:
1. Always order a replacement drip from the pharmacy when you hang a new drip bag. Pressors like Levo, dopamine, etc., all of these need to be in constant supply and should never run out. You can program your pump with a lower volume than what is in the bag in order to ensure that it beeps well ahead of time so you don't run out. This is very important. This also includes continuous dialysis bags; if those run dry, the machine could clot off, and then the pt will be without dialysis for several hours.
2. Do is&os and vitals within 5 minutes of the hour. It seems little, but it's important, so make it a priority.
3. Respond to every alarm. Since it isn't going to be second nature to you as a new nurse, make it a point to glance in the room and look at the pt & monitor every few moments. Pressures could drop at any time, rhythms could change, etc.
4. Scan meds before giving them. It will prevent errors you should have already caught, but as a new nurse, you might overlook something like an order changing.
5. With your assessment, check the pumps: press 'channel select,' then press 'setup' so you can compare the concentrations of your bags with the pump and check dosing weight. These are sometimes wrong and that is why it is important to check. Then check the bags and lines for dates. They might have expired and need changed.
6. Make sure emergency meds and emergency equipment are in the room with each initial assessment. If your pt codes and you don't have IVP epi or an ambu bag already in the rooms, that's on you.
7. Verify vent settings. In my short experience, people often forget to update changes like fiO2 in the chart. Verify that the pt has the settings they are supposed to be on.
8. Tell your preceptor before you call the provider. They will coach you to make sure you point out all the relevant info and that the call is even necessary to begin with.
9. Always empty the foley bag before change of shift. Senior nurses care about this a lot.
10. Always remember to pause the tube feedings before re-positioning the pt. I'm sure you would have remembered it, but do it before you call someone in the room to help so they will trust your competence.
11. Be super serious about your work, and know that you are going to deal with some aggressive personalities. When this happens, be humble, but stay strong, accept true criticisms and grow from them, and try to focus on your patient and what they need. Utilize your educators if you have any issues with preceptors, and definitely acknowledge your responsibility to the pt at all times.
12. Always check IV compatibility. If it's something small or IVP, use the CVP.
13. Be mindful of your carrier and what is infusing. So say you have epi running, and you have an antibiotic due. Don't run the antibiotic behind the epi or it will bolus the epi. Always be sure you know in what port or line you plan to give a med before giving it, and make sure it's safe. Make sure you know which access is safe to use to push meds in a code.
14. If someone is on an insulin gtt continuous infusion, an on hourly glucose checks, don't forget to do your last check before change of shift. Just do it 20 minutes before the hour change because you will have to take care of it if there's a problem before you give report. I forgot once and my preceptor noted my mistake, and the pt's glucose had dropped to 70. This made me realize how important it is to do that last check.
These are just some of the main things. They may be mostly common sense, but everything is new in the ICU to a new grad, and everything requires thought because it is critical. The supply room will seem overwhelming, but you will know where everything is within a few weeks. Drawing labs from a-lines will seem messy the first couple times, but you won't even have to think when doing it soon enough.
Do everything you do with a purpose in terms of priority. An example of a mistake I have made that I received feedback on was that I planned to give pt 1 an antipyretic for a 38.4 T instead of shooting new cardiac numbers for pt 2, who was on epi, when I was supposed to be weaning the gtt. Had pt 1 been a transplant pt, this might have been an appropriate choice of prioritization. But anyway, this is how much details matter. It's true that it's an incredibly steep learning curve. If you are trying to choose between two pts or two actions and you aren't sure, ask your preceptor for help prioritizing in that instant. They are there to help you learn.

WOW, thank you for this. It was very thorough and helpful. I really appreciate it :)