New ICU nurse!

thenightnurse456 · Feb 26, 2015

Congrats to you! What an amazing achievement, your family must be so proud.

What type of ICU? MICU? SICU? Or a specialty like CTICU? Or general? I would enquire what types of patients your unit encounters the most ie: sepsis, CABG, transplant and I would research so that I felt more comfortable in caring for the patient. Knowledge is power, and you never stop learning in this profession.

Use your orientation/preceptorship wisely. Don't stop asking questions, this is the time period to ask the stupid questions. Keep a note book so you won't forget.

Time management only comes with practice and experience. It will come, don't rush to try to be fast. Your new, the other staff know this. Be efficient, not dangerous.

Get a brain sheet and customise it to how you like it. Use it to keep you organised during shift and to make report seamless at change of shift.

Trust YOUR assessment. You may be new, but you are an RN and you do bring skills to the table. If you find something, act on it. Go with your gut. If your spidey sense is tingling, something generally is going on.

ICU specific things? Spend a good amount of time organising your patients room. This includes:

- completing relevant safety checks. Is my suction ready to go?

-alarm parameters on the monitor are acceptable.

-clearing rubbish/clutter/obstacles in the room. When you have a code, you don't want a series of chairs blocking your way.

-ORGANISE YOUR IV LINES. Seperate them. Label them. It may seem tedious, but when your in a code, you wanna know which line was infusing a pressor and which was your KVO saline line!

I'll think of more things, but right now I have to sleep!

Julesmama28 · Feb 26, 2015

Thenightnurse456, thank you for your reply! Our ICU is a general ICU, we get everything that won't go to CVICU. There is also a step down unit that has moved to another floor since ICU is getting so big. I want to say it's a 20 bed unit...not sure though.

Great tips! I have a tendency to want to rush things sometimes, I need to remember that. I should get 12-16 weeks with my preceptor plus outside education hours off the floor. I'll be doing nights after the initial orientation. So pumped!

RN BSN 2014

Onco_NT · Feb 27, 2015

I just officially graduated with my BSN in December, passed NCLEX in Jan and landed an ICU job in Feb! It's been a whirlwind but I am so ready to get going! A little background on me, I have worked as a CNA off and on for the past 17 years. I took the round about way to finishing my degree because I had 8 kids and two sets of twins in between all my schooling. â˜ºï¸ I have always wanted to be a mom and a nurse so I'm excited I have finally done both!
I have been working for the VA system first as a valor student and then as a graduate nurse and RN. They offered me a full time gig but this va is very small with little to no critical care experience to be had. So, I jumped ship and am preparing to start next month at another hospital's ICU. I did 144 hours senior specialty at the ICU so I feel like I have a grasp of what ICU nurses do.
So, here's my question, what can I do now to study and prepare for my new job? I start orientation next week!
RN BSN 2014

Congrats!! I graduated in Dec 2014 with my BSN as well.. I typed a longggg description of advice from my first two weeks as a new nurse but it got deleted lol so in short.. I just started a new grad program in a SICU and have found all of what was stated in the previous comment to be true! You have quiet a bit of practicum hours in the ICU so you are more prepared than you think but you will feel like you know nothing all over again, it's ok though I promise...these things will come with time as you learn protocol ah get used to the flow of your unit.. I keep a mini notepad booklet an jot down anything I want to remember from that day.. An I ask tons of questions!! No matter how dumb or simple they might be.. New, quiet nurses that think they "know it all" scare preceptors.. Now is the time to learn! You will be fine :-) Goodluck! I wish you the best!

Onco_NT · Feb 27, 2015

Congrats to you! What an amazing achievement, your family must be so proud.
What type of ICU? MICU? SICU? Or a specialty like CTICU? Or general? I would enquire what types of patients your unit encounters the most ie: sepsis, CABG, transplant and I would research so that I felt more comfortable in caring for the patient. Knowledge is power, and you never stop learning in this profession.
Use your orientation/preceptorship wisely. Don't stop asking questions, this is the time period to ask the stupid questions. Keep a note book so you won't forget.
Time management only comes with practice and experience. It will come, don't rush to try to be fast. Your new, the other staff know this. Be efficient, not dangerous.
Get a brain sheet and customise it to how you like it. Use it to keep you organised during shift and to make report seamless at change of shift.
Trust YOUR assessment. You may be new, but you are an RN and you do bring skills to the table. If you find something, act on it. Go with your gut. If your spidey sense is tingling, something generally is going on.
ICU specific things? Spend a good amount of time organising your patients room. This includes:
- completing relevant safety checks. Is my suction ready to go?
-alarm parameters on the monitor are acceptable.
-clearing rubbish/clutter/obstacles in the room. When you have a code, you don't want a series of chairs blocking your way.
-ORGANISE YOUR IV LINES. Seperate them. Label them. It may seem tedious, but when your in a code, you wanna know which line was infusing a pressor and which was your KVO saline line!
I'll think of more things, but right now I have to sleep!

@thenightnurse: Do you have any specific advice for a new SICU nurse? All of what you stated before is great and any additional advice would be appreciated! :-)

thenightnurse456 · Feb 27, 2015

@thenightnurse: Do you have any specific advice for a new SICU nurse? All of what you stated before is great and any additional advice would be appreciated! :-)

Hey!

SICU is great because you get very critical patients, but often times they can have predictable outcomes as they progress post op. And it's often a much faster turn over then MICU. Ie after 24 hours (every where is different) if all is well, a post CABG patient will go to the step down floor. Do you know what I mean? Your going to have a lot more predictable/positive outcomes then in a MICU where you'll see a lot more multi organ septic failure/ we don't really know what's going on with the patient. It's a lot less detective work.

In terms of SICU your going to be seeing patients straight from OR that need intensive monitoring. As well as patients who deteriorated on the floor /PACU and have to be transferred to the ICU. Also when patients are coming to the SICU post op, they bypass PACU do not pass go, do not collect $200. That means you are a PACU and ICU nurse in one shift.

My advice would be to find out the types of surgical patients you will be caring for- research the surgeries. Make a binder of notes on the common ones. Also, a good tip is to know the theatre list/day for the surgeons off by heart. That way you'll know what you could be dealing with that day. "Oh tomorrow Dr Pepper is doing a few craniotomies. I might be looking after one of them".

Keeping with the notebook/binder theme; it's great to keep copies of common policies and procedures for quick reference. (I know your going to have a long preceptorship, but sometimes when your doing a central line dressing on your own, it's good to refresh your memory with the units' policy!)

In SICU your going to have a tonne of lines/tubes/wires/drains of every description. Keeping up with the I+O is critical. Keep all these accessories organised, so that in an emergency you are organised.

Assessments: Be thorough. Be detailed. Yes that patient is here post a #NOF, so you'll assess the wound/pain/vascular system- but look at the whole patient. They are 88yr old. They have a hx of AF and diabetes and they are obese. What could this mean? So many things could potentially go wrong with this patient and it's important that you do the best assessment you can to prevent a small problem from becoming a huge situation.

Onco_NT · Feb 28, 2015

Hey!
SICU is great because you get very critical patients, but often times they can have predictable outcomes as they progress post op. And it's often a much faster turn over then MICU. Ie after 24 hours (every where is different) if all is well, a post CABG patient will go to the step down floor. Do you know what I mean? Your going to have a lot more predictable/positive outcomes then in a MICU where you'll see a lot more multi organ septic failure/ we don't really know what's going on with the patient. It's a lot less detective work.
In terms of SICU your going to be seeing patients straight from OR that need intensive monitoring. As well as patients who deteriorated on the floor /PACU and have to be transferred to the ICU. Also when patients are coming to the SICU post op, they bypass PACU do not pass go, do not collect $200. That means you are a PACU and ICU nurse in one shift.
My advice would be to find out the types of surgical patients you will be caring for- research the surgeries. Make a binder of notes on the common ones. Also, a good tip is to know the theatre list/day for the surgeons off by heart. That way you'll know what you could be dealing with that day. "Oh tomorrow Dr Pepper is doing a few craniotomies. I might be looking after one of them".
Keeping with the notebook/binder theme; it's great to keep copies of common policies and procedures for quick reference. (I know your going to have a long preceptorship, but sometimes when your doing a central line dressing on your own, it's good to refresh your memory with the units' policy!)
In SICU your going to have a tonne of lines/tubes/wires/drains of every description. Keeping up with the I+O is critical. Keep all these accessories organised, so that in an emergency you are organised.
Assessments: Be thorough. Be detailed. Yes that patient is here post a #NOF, so you'll assess the wound/pain/vascular system- but look at the whole patient. They are 88yr old. They have a hx of AF and diabetes and they are obese. What could this mean? So many things could potentially go wrong with this patient and it's important that you do the best assessment you can to prevent a small problem from becoming a huge situation.

Thank you soooo much for such a detailed response!! I've only been working 2 weeks and you've mentioned a lot of what I'm seeing already.. I agree with it being more predictive an acute compared to MICU which is more chronic an investigative, as you stated..I purchased the ICU book to grasp concepts into what this is or what this indicates etc (also heard it recommended several times) an I will definitely take all of your advice an keep doing my own research and note logging both on an off the unit :-)