New to ICU. What do you hate to see a new ICU nurse do?

madricka, BSN, RN · Jul 6, 2016

I'm sure you know a lot of this already since you're not a new grad but for you & others who are reading:

As many others have said:

* Help others! I have seen too many new nurses poking around their own bedside, not really busy at all, while the new trauma admit is desperate for help getting organized. Start infusions/lines, do orders, get meds, anything you can. It will come back to you in spades when you need it most.

* Label your lines and keep them neat/tidy. I hatehatehate coming on shift and finding a tangled mess of lines, nothing labelled and I have to spend 15 minutes sorting everything out.

* Leave your bedside for the next shift how you would like to see it when you come on. Restock anything that needs it, hang new med/IV bags, etc.

* Ask for help or use experienced nurses for feedback. Don't ever be afraid to look stupid, your patient's life depends on it. You will be a better nurse as you gather information, be a sponge!

* Take criticism lightly. And snippy comments. Sometimes ICU can be a highly stressful environment and particularly bad shifts might cause staff to get snarky. Remember it has nothing to do with you, they're just stressed. In an ideal universe people would cope well with stress and communicate beautifully in a supportive way -- unfortunately, we're not there yet. Grow a thick skin and let it bounce off, don't snip back.

* If you are going for break, let your family member(s)/friends know that you are leaving, who is covering and what time you will be back. Reassure them that their loved one will be safe and looked after while you are gone. If possible, introduce them to the covering RN. Families/friends get VERY anxious when their person's nurse leaves, provide them the reassurance they are so desperate for. Little things like this will help them relax a bit. I've seen nurses just leave for break after giving report to covering RN and the families panic and wander around thinking their person isn't being watched.

* Family/friends need support too. In many cases, a LOT. Some will scream in your face (often for something that you can't fix) -- usually they are just afraid and feeling helpless. Don't argue back. If you feel unsafe, absolutely call security -- but learning diffusion techniques goes a long way. Listen to them, that's usually what they need. They are terrified their person is going to die. They are often sleep-deprived. Suggest they take breaks, eat, go home to shower/change, rotate watch with other family/friends. Don't hesitate to call the chaplain if you think it would help. Suggest family meetings with staff for updates.

* Protect privacy as much as possible within the unit.

Axgrinder · Jul 9, 2016

This may be below the par of what you are looking for, but it seemed to be a bone of contention amongst many shifts in many facilities I worked in the past.

ICU pt's tend to need to be bathed on both shifts since many of them are trached, tubed, and restrained. I hated finding my pt's unturned and disheviled - laying in poop. There always seemed to be one or two RN's whom always handed over filthy pt's at shift change without fail. Make sure your replacement doesn't have to spend the first couple of hours setting the pt's to right's upon taking over.

It's sort of a little thing compared to ensuring all the Rx meds, and I&O's are correct, but it can tick off some RN's mightily.

Also, make sure all IV bags aren't about to run dry, the tubing is all current, and is not tangled into spaghetti.

Sometimes codes happen, and this can't be controlled obviously. In this instance make sure the incoming shift knows that was outside of your control because you were just trying to keep the pt alive. Not everything can be in our control, and some shifts we just fly by the seat of our pants as unhappy passensers.

IPMC15 · Jul 9, 2016

These are all great responses. Any tips on codes? I've noticed that it is TREMENDOUSLY helpful for your own sake to glance at that clock and note the time for charting purposes later (obv you won't be charting right away). I've also been studying a lot on my ACLS and the one medication that just keeps stumping me for some reason is the amiodarone. Any little tricks for remembering pharmacokinetics for amio or little things to remember about it?

Chilled1121, BSN · Jul 9, 2016

As a new nurse who went to critical care shortly after graduation. I can tell you a few things that have helped me.

Do not be afraid to ask a question because you want to feel like you "got it." If you don't know or are not sure ask or look for a resource. It's a matter of patient safety.

Always help. Help your techs. Help your nurses. Help other patients. Help the family. The unit runs best as a team. I call it controlled chaos.

If you feel like something is off but you can't put your finger on it let someone know. Ask another nurse. Ask the charge to take a look. Ask one of the critical care floats. There have been many times when I just say hey come take a look at this. Does this make sense for what's going on or do I need to intervene?

If if you feel that one patient has taken up a lot of your time to the point where you haven't seen your other patient, that's when you ask for help. You need another hand or another intervention. Patients are critical but if they are heading the right direction it shouldn't be nonstop for most of your shift to the point that your other patient is barely touched. Maybe they are circling the drain and need a different antibiotic or a blood gas or labs redone or different vent settings.

It is a continuously learning process and I feel like one day I got it and another day I'm a new nurse all over again. The hard days are really hard. What helps me is to realize I get to clock out at the end of the day (even if it is later than usual) and be with my family. These people don't get the luxury.

I hope that all helps and congrats!

8-ball, BSN · Jul 9, 2016

One of the most important things is to ask WHY? Ok so someone told you they never do XYZ or when you do task X you always stop X gtt. Whatever the scenario if a reason isn't provided ask WHY. This helps you learn and helps you understand and be able to teach others. If doctors order a new med and you don't know why figure it out, I always ask the residents why they order things I don't understand, it helps me be a better nurse.

Also I have been an ICU nurse for 6 years but I still keep a little ICU book on me that I got years ago during orientation, I still look at it. It has my gtts and what they are for, labs, other scenarios ect. There is always new stuff to learn.

FYI I agree with everything everyone else said

dollydettol · Jul 10, 2016

New to ICU lady , quit this conversation whilst your ahead, you hAve opened Pandora's box, hunny,,,

btw I piggy back K sometimes in cardio you need it ASAP

dollydettol · Jul 10, 2016

Amen to that, you took my heart then,,back not only to all those on the last walk ,but my own,in my own ICU when daddy left me,,,

IPMC15 · Jul 10, 2016

Huh.? What exactly did I "open"? Also I'm a guy not a lady...

dollydettol · Jul 10, 2016

Sorry,, my mistake

it was when you started the K piggy back conversation,,,,I thought gee this is going on and on,

never thought it would get to your original question,,,

tips on starting ICU which I was keen to read, having done many years on ICU but here in the uk

lol

no offence ment

reminds me if someone puts a recipe post it always doubts great then the readers demolish it, oo would add salt, ooo would add garlic etc,

madricka, BSN, RN · Jul 10, 2016

During codes... when you go to your first few after starting in a new unit you might just be shadowing the team. If this is the case, stay out of the way but watch how each person has a seamless role. Move bedside clutter out of the way (chairs/tables/people/etc). Observe who is running the code (sometimes it's thrown on a new resident who is in a total panic and flipping through an ACLS book! lol). Someone should be timekeeper/announcer and recorder (often there is a clipboard with a code sheet for quickly documenting interventions/meds/times/responses/vitals). This is a good role to take if you're new.

Also, while the crash cart is open (after the code, obviously) take time to familiarize yourself with the contents -- where everything is and how it's arranged so you're not in a panic looking for something during an actual code. Find out what to do with the used med tray (usually you call/send to pharmacy for a replacement -- though the replacement might be kept on your unit, find out where). Find out who is in charge of restocking the cart and what the protocol is for checking the cart each shift. Push the cart, get a feel for it. Know how to use every item on/in the cart.

Depending on your facility you might end up with the hospital-wide code pager (our unit had it on nights, CVICU had it on days) -- if you do have to carry it, learn the procedure for test pages and actual pages.

Find out if your facility permits/encourages family members to be present during the code. If so, where do they stand? What support do you need to provide? Where is the quiet room for them to have privacy during/after? Do they need debriefing with staff or chaplain? How do you quickly get the chaplain (are they in-hospital or need to be paged in?).

A lot of this will be hospital-specific but good information to have before a code is called while short-staffed on nights and you're standing there with hysterical family members. One thing also to consider: if your patient codes while you are transporting them to CT or MRI (this happened to a colleague, in a stuck elevator with only her and an RT! The patient survived but everyone was scared!). Things to think about, being prepared mentally will save you anguish later.

spacemonkey15 · Jul 10, 2016

Remember how it feels to be the new guy, before you know it, you won't be and someone new to the unit will be looking to you to help them find their feet.

OnceMorewithFeeling · Jul 11, 2016

I love all of the comments about helping your co-workers out and I agree! If you've got the spare time and you know that your neighbor is in the weeds, step in and give them a hand.

I will add, try to think ahead about what the patient and her/his nurse might need for the next shift.

As a day-shifter, I might notice my patient's BP creeping slowly upward over the course of my shift. If the SBP has been in the high 130s for the last two hours, and the parameter is to keep it less than 140, I will call the NP or MD to discuss and get some PRNs ordered before I leave. That way, the RN that follows me doesn't have to call a grumpy surgeon at midnight.

My night-shift colleagues do the same for me. If I come in and find out I've got to take a patient for an 0800 MRI, the transport monitor is already in the room, the extra-long MRI tubing has been attached to my lines, and extra bags of any infusions that may run low are hanging from my IV pole.