New Grad needing advice from experienced nurses!

missnurse01, MSN, RN · Jul 28, 2012

Hi everyone!
I am a new grad who just got hired in the ICU within a large medical facility which I am very excited about, but I am also terrified because during my student clinical rotation there was a lot of hand holding and I never got a super authentic experience as a "nurse". I am really motivated to do well in this position and will put in all my hard work and effort to succeed. I do not start for another month, but I want to start preparing. Any way I have a few question which may seem silly (please don't judge, I'm just a baby nurse!), but if some nurses can help me answer them I will great appreciate it with my whole heart! :)
1. As a student doing care plans, I literally had to read through every single inch of the patient's chart, however, I don't ever recall seeing the nurses I follow do this regularly. My question is what part of the chart do you always make time to read besides obviously the MAR/lab values/new orders part?
2. When I do my first assessment of the shift I usually do this: assess LOC, assess pupils, listen to lung/heart/bowel sounds, assess radial pulse and upper extremity strength, assess pedal pulse and lower extremity strength, and of course do a general visual inspection to see if anything looks out of the ordinary. Should I add anything else to this?
3. When you start your shift, what is your flow of things to do? (Ex: look at the chart first briefly, get report, introduce yourself to pts, etc) I know everyone is different and you just gotta see what works for you, but I just want to know what others do to get some ideas.
4. In school, we learned that before suctioning a pt with an ET or trach tub, you need to hyperventilate them w/ 100% O2. However, I don't think I have ever seen a nurse do this before. Is it usually done?
I'll probably think of more questions, but right now these are at the forefront of my mind. Thanks!

Hi!

First off, yes you will be totally overwhelmed but that is normal and will diminish with time. It's okay!

Second: just like in nursing school, each nurse you orient with will have a different routine. So you will be able to see what works best for you. Many nurses go see their pt's first, obviously a great idea in critical care. Some make their 'brain' for the night-an initial cursory inspection of the chart to review labs, orders, meds, etc-so you know right away if something is due shortly. The previous nurses are dying to get home so getting report is usually first. At the beginning of the shift I try to read at least the docs notes from the day to see where the pt is. More in depth reading comes when tasks are done later on.

Yes, you are supposed to give 100% o2 breaths. All will be gone over with you in detail. Although they will question to see what you know, they also expect you not to remember everything. Always just feel free to ask!

Good luck!

Pediatric Critical Care Columnist · Jul 28, 2012

4. In school, we learned that before suctioning a pt with an ET or trach tub, you need to hyperventilate them w/ 100% O2. However, I don't think I have ever seen a nurse do this before. Is it usually done?

Mechanical ventilators have a setting that allows the vent to deliver oxygen breaths. It's just a flick of a dial or press of a button, so perhaps that's why you've never seen it done... Blink and you miss it. Although there are some patients that you would never hyperventilate with or without supplemental oxygen. Children with cyanotic heart disease would be in that group, COPD patients would too. People with raised ICP... under certain circumstances... Hopefully you'll learn when to and when not to during your orientation.