New Grad in Neuro ICU

[jb_mmmm, BSN, RN]

Hi everyone! I just got my RN license (yay!) and will be starting my new grad residency in the neuro icu. I wanted to inquire about any advice that anyone has about being a new grad and/or a neuro icu nurse in general. All tips are welcomes, and thank you so much!

[Rosie_one]

Congratulations! Welcome to the dark side haha.

Have a lot of patience. You will be dealing with a lot of confused/delirius/agitated patients.

You will sometimes feel, "is there a point to this". I work in a major trauma centre specialising in neurosurg and a neurosurgeon said to me once, that you could get 20 patients with what appear to be the same brain injury, all interventions, some wont make it, some might be severely disabled and one might walk away and live a productive life...they just don't know who. I remember that when I feel works getting to me and we're just torturing people.

Don't be blasé about hourly neuro obs, patients deteriorate quickly, just because neuros were stable for 2 days doesn't mean they'll stay that way.

Always do a set of neuro obs with nurse that is handing over patient. You'd be surprised how peoples' idea of the GCS scale/assessment varies.

If you don't already, get a very good understanding of the Monroe-Kellie Hypothesis and how it relates to the patient you are looking after. It'll make everything make sense.

Working to Cerebral Perfusion Pressures (CPPs) and not MAPs. I came from a CVICU background, so different way of thinking.

You will get great experience in failed extubations and reintubating as neuro are high-risk patients due to nature of their injury.

Families will be difficult and require a lot of care, as often take a lot of time to come to terms with 'brain death'. Most don't get it.

[Clarysage, BSN, RN]

Rosie_one, thank your for that answer. I am not a new nurse, but I am new to neuro. I am starting a position in neuroscience ccu in just under 2 months. I am much more familiar with cardio, and am reading all I can about neuro before I start. Just from treating so many stroke patients and TBI's I am familiar with some of the differences. But working in LTAC, I see the results on the other end. Thank you for the reminder of the Monroe-Kellie Hypothesis (haven't thought about that since clinicals many years ago), and the importance of hourly neuro checks. Just from my time shadowing, I am able to appreciate the importance.

[NurseJosh]

I am also starting in our Neuro CCU in one month and I appreciate the input above. Thank You! ?