New in the ICU

TstormRN · Jul 23, 2012

I'm right there with you! I just started in a CVICU as a new grad and I am very nervous too!!!! These upcoming months are going to be very exciting but I would definitely welcome any advice as well!!!!

CTXRN · Jul 23, 2012

Good Luck, Keep in touch and let me know how everything goes when you start.

tsicuRN1 · Jul 23, 2012

1. Read! A lot! Buy all of those critical care nursing books and just read them all! Since you'll be in CV, memorize ALL of the vasoactive gtts and also be able to interpret hemodynamic profiles! You are expected to know this, even as a new grad.

2. Confidence. Even if its an act! Other nurses will respect this, and the fact is that you DO know what you are doing, you are just going to doubt yourself for a very long time. But don't let other nurses doubt your abilities too.

I started out in a pretty busy ICU as a new grad and the first 6 months were the most challenging and difficult times I've ever had, but also quite

rewarding and inspiring! You will exceed if you believe you can.

Good luck.

CTXRN · Jul 23, 2012

1. Read! A lot! Buy all of those critical care nursing books and just read them all! Since you'll be in CV, memorize ALL of the vasoactive gtts and also be able to interpret hemodynamic profiles! You are expected to know this, even as a new grad.
2. Confidence. Even if its an act! Other nurses will respect this, and the fact is that you DO know what you are doing, you are just going to doubt yourself for a very long time. But don't let other nurses doubt your abilities too.
I started out in a pretty busy ICU as a new grad and the first 6 months were the most challenging and difficult times I've ever had, but also quite
rewarding and inspiring! You will exceed if you believe you can.
Good luck.

Thanks, guess I better start reading!

RNerd81 · Jul 23, 2012

Good luck on your new adventure...I hope things go well. As for advice...1. Never be afraid to ask questions. I am a seasoned preceptor, and the scariest orientees are those that think they know it all. None of us knows it all, especially not a newbie. 2. Take care of yourself. Get plenty of sleep, exercise, and eat right. These things will make the stress of the transition much easier to deal with. 3. Do read. Just as one of the other contributors advised. It is extremely helpful to read up on things specific to a patient you are taking care of, or have just taken care of. A good preceptor will also let you just decompress and read up on something for a while during a shift. Of eight or twelve hours, one hour of reading is negligible...and can pay dividends in the long run. 4. If you run into frequent personality conflicts with a preceptor, or have one that is condescending or belittling, request a new preceptor. Grasping ICU concepts is difficult enough, you should not have to deal with an inept preceptor. Certainly involve your Nurse Manager, CNS, or Nurse Educator early on if you start to notice conflict in your preceptor/orientee relationship.

grogan.lacey · Jul 24, 2012

As a nurse who has worked in both critical care and ER the best advice I can give you is to be confident, so that the old birds don't eat you, but also be humbled and know when to ask for help. Before you know it the environment will be like second nature to you. Always do what's best for the patient and nobody will ever get on you for that!

Good luck

CTXRN · Jul 24, 2012

Thank you all for the advice. I try to exude confidence although I'm trembling on the inside. I'm trying to ask more questions. Never asked many in school, I just did the research on my own to figure things out. Work in progress.

adrnln · Jul 25, 2012

I started in an ICU almost a year ago right out of school. My orientation was about 4 months. I had not had any prior work or clinical experience in an ICU. I will be honest that it was very hard and overwhelming. I had moments where I was not sure if I was going to "survive" orientation. You have to have tough skin and come to terms with the fact that you may feel stupid on a regular basis until you get the groove. Other nurses may give you an attitude and that can be just as difficult as learning the job, but you have to stay sure of yourself. They hired YOU for a reason! Check out icufaqs.org. They also sell a book. It is clutch.

Biffbradford · Jul 27, 2012

Be a sponge - absorb everything you can.

Try not to stress out (easy for me to say). Stay cool and don't take things personally when it gets hot in the kitchen.

Double check your work so you don't make any stupid mistakes (like grabbing Dopamine instead of Dobutamine).

Don't be afraid to ask questions or bring someone else in for a second opinion. "Got a sec? Tell me what you think about this situation."

Enjoy the ride! :yeah:

Ruby Vee, BSN · Jul 28, 2012

i'm a preceptor, too, and i have to disagree with one point rnerd81 made: asking for a new preceptor. in my icu, there aren't enough preceptors to go around. they make an effort to make good matches between orientee and preceptor, but not all matches are made in heaven. that being said, you as an orientee are expected to make the best of your situation and to get along with your preceptor. asking for a different preceptor is a black mark. most times you'll be told to work it out. if you do get a new preceptor, they'll be tasked with documenting, documenting, documenting because the presumption is that you aren't working out.

acting confident is a double edged sword. no one wants to work with someone who seems to be afraid of everything, but there's nothing more frightening than an orientee who seems to know everything. the trick is to get it right somewhere in between.

expect that you'll have to study in your off time. i had to study at home when i was a new grad, and every time i switched specialties. you will too. i've had orientees refuse to study -- none of them made it off orientation.

try to absorb everything you can. carry a notebook or something, and write down questions you have or terms to look up.

introduce yourself -- to your preceptor, to the charge nurse, to the cna, to the providers, to the echo tach, to the renal consult. be ready to chat a bit . . . about where you're from or where you went to school or the weather. i'm shy -- i understand the shy orientee and appreciate the social one. what i wish someone had told me when i first started is that a little chatting helps to solidify the team and being part of a team makes work so much more fun.

while i won't say there are no bullies in nursing, i will say that they're not as common as you might think from reading allnurses. if you don't go looking for them, chances are you won't find them. what you will find are people -- people you can learn a lot from and people you can learn what not to do from. some of them are shy and not chatty. some of them are having bad days or bad weeks or, like me, a bad year. a nurse with a dying parent, a leaking roof, an upside down mortgage or cancer might conceivably be scowling about something that has absolutely nothing to do with you (and may have no idea that they are scowling), so try not to take things personally.

most of us preceptors want to do the very best by our orientees. i have orientees that have been with us for several years, and when one of them gets a glowing letter from a family or is asked to orient to charge or is complimented by the opposite shift, i'm proud. when my orientee makes a mistake or gets into trouble, i take that to heart as well. if you have a question, ask it. if we're not communicating as well as you'd like, let's sit down and figure out how we can do better. if you don't like my style, i'll try to modify it. please don't take criticism personally; it's part of your job to make mistakes and it's part of mine to correct them. some of us are more skilled at handing out criticism than others, but most of us mean it to be constructive.

good luck -- i hope your first year is minimally awful and that you learn lots.

CTXRN · Jul 29, 2012

I'm a preceptor, too, and I have to disagree with one point RNerd81 made: asking for a new preceptor. In my ICU, there aren't enough preceptors to go around. They make an effort to make good matches between orientee and preceptor, but not all matches are made in heaven. That being said, you as an orientee are expected to make the best of your situation and to get along with your preceptor. Asking for a different preceptor is a black mark. Most times you'll be told to work it out. If you do get a new preceptor, they'll be tasked with documenting, documenting, documenting because the presumption is that you aren't working out.
Acting confident is a double edged sword. No one wants to work with someone who seems to be afraid of everything, but there's nothing more frightening than an orientee who seems to know everything. The trick is to get it right somewhere in between.
Expect that you'll have to study in your off time. I had to study at home when I was a new grad, and every time I switched specialties. You will too. I've had orientees refuse to study -- none of them made it off orientation.
Try to absorb everything you can. Carry a notebook or something, and write down questions you have or terms to look up.
Introduce yourself -- to your preceptor, to the charge nurse, to the CNA, to the providers, to the Echo tach, to the renal consult. Be ready to chat a bit . . . about where you're from or where you went to school or the weather. I'm shy -- I understand the shy orientee and appreciate the social one. What I wish someone had told ME when I first started is that a little chatting helps to solidify the team and being part of a team makes work so much more fun.
While I won't say there are no bullies in nursing, I will say that they're not as common as you might think from reading allnurses. If you don't go looking for them, chances are you won't find them. What you will find are people -- people you can learn a lot from and people you can learn what NOT to do from. Some of them are shy and not chatty. Some of them are having bad days or bad weeks or, like me, a bad year. A nurse with a dying parent, a leaking roof, an upside down mortgage or cancer might conceivably be scowling about something that has absolutely nothing to do with you (and may have no idea that they are scowling), so try not to take things personally.
Most of us preceptors want to do the very best by our orientees. I have orientees that have been with us for several years, and when one of them gets a glowing letter from a family or is asked to orient to charge or is complimented by the opposite shift, I'm proud. When my orientee makes a mistake or gets into trouble, I take that to heart as well. If you have a question, ask it. If we're not communicating as well as you'd like, let's sit down and figure out how we can do better. If you don't like my style, I'll try to modify it. Please don't take criticism personally; it's part of your job to make mistakes and it's part of mine to correct them. Some of us are more skilled at handing out criticism than others, but most of us mean it to be constructive.
Good luck -- I hope your first year is minimally awful and that you learn lots.

I am very comfortable with the environment and people, as I have been a tech in the unit for 3 months. Which make me even more nervous because everyone has an extremely high expectation of me, I just hope I can meet them.