Newbie Nurses: How to Rock Your ICU Assignment Like a Boss

New to the world of ICU Nursing and slightly intimidated? Here are some tips I’ve learned so far in my six years at the bedside.

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Newbie Nurses: How to Rock Your ICU Assignment Like a Boss

#1 Adapt and Overcome

Remind yourself that you are capable of handling whatever your shift throws at you. You can always adapt and overcome. A positive attitude goes a long way in your next twelve hours.

#2 Find A Routine That Works For You

Start each shift with what you need and have a plan. By “plan” I mean, literally, plan out your twelve hours as best you can. I found this easiest by creating a layout of my shift with each patient on paper so I could visibly see what I needed to do and when.

For example, I would use one paper to write my report on, and my second paper with my shift plan. Our assessments were every four hours at 8, 12, and 4. If you get a piece of printer paper, (there will always be printer paper somewhere!) fold your paper into sections for each assessment time for each patient. Our unit typically had one nurse to two patients. To do this, I would make my columns length-wise into four boxes, top to bottom. The first section is for my patient’s name and important information (name, code status, admitting diagnosis, and lines. Each section below would then have a box for each assessment time. (See below).

I found out this worked best for me because I had my shift visually laid out, I could easily add things if new orders came through, and I could compare assessments and keep a close eye on changes and trends for both of my patients on one paper. Finding out how you like to organize your paper will make the world of a difference in terms of time management and organization. It might take a few tries to decide how you like your layout. Once I made the main layout for my shift paper, I added in medications, labs, dressing changes, and anything else I could plan out, and added accordingly throughout my shift.

#3 Prioritize Your Sick Patients

Decide which patient to see first. From experience, if my assignment consisted of a very sick, stable, and complicated patient, along with and mostly independent and oriented patient, I would go see my most simple patient first. It’s easier to get a quicker, less detailed assessment done, meet their needs, and have them tucked in or ready for the day or night. I then felt that I could focus better on my more complex patient and felt less stressed knowing that my other patient was seen, assessed and good to go.

Always, always, always see the patient first if they are unstable, and they have immediate needs and tasks that need to be attended to, that cannot wait. Some shifts you will hit the ground running with a list of things that a patient needs because they have a change in status or have become unstable. Never let an unstable patient take the backburner. Your other stable patient can wait, and it will be okay if 8pm meds are given at 10pm. That’s just the way it goes sometimes. It will be okay.

#4 Get Into A Routine

Once you decide which patient to assess first, get into a routine when you see your patient. My routine consisted of vitals first, then head-to-toe assessment, and then my med pass. It is important to assess the patient first in case there are changes noted from report, and that could also affect what medications you do or don’t give the patient. For example, you do not want to give blood thinners before assessing your patient fully, if they are oozing from previous injection sites, new or increasing gastric distention, or bloody stools. You must assess your patient prior to giving them medications because critically thinking is an absolute must that needs to be learned to prioritize patient safety. Your critical thinking skills will sharpen with experience and time.

#5 Never Assume

When in doubt, NEVER assume. In my baby nurse days, I assumed it was okay to turn on and set a blanket warmer, and the next hour I had almost set it on fire. From then on, I learned to never assume no matter how silly it may have seemed to ask another Nurse. A questioning attitude is a safe practice and builds trust with your fellow co-workers as it shows you double check first, before doing something you are not sure about. Guessing and or assuming is always a bad idea and jeopardizes safe patient care.

#6 Watch For Trends

During your shift, watch for trends. What trends specifically? Keep in mind your patient’s vital signs, labs, and assessment. Going back to organizing your shift paper, it is easy to visually compare changes in real-time. One thing that helped me was having a separate sheet for my “hourly’s.” If a patient has hourly intake and output, put that on your sheet. If they are important enough to be recorded hourly, it helps to trend them when you can see them in one place, hour to hour. It’s easier to notice foley outputs of 35mL, 20mL, 12 mL, and 10 mL when you can see it on paper over time and assess the trend, versus adding up your shift output at the end of your shift and realizing their output per kilogram is abnormal. The earlier you notice something different, the earlier you can notify the physician and make changes accordingly.

#7 Keep A Running Record Of Your Shift

During my busiest shifts, I would find it hard to recall at the end of my shift when giving report to the oncoming Nurse because so much had happened if I didn’t write it down. To avoid this from happening and potentially forgetting important information to pass along, I added any changes or labs to the sheet I wrote my receiving report on. Then at the end of your shift, you have your report sheet and any changes that are pertinent to pass along.

#8 Take Care Of YOU!

I know there are some shifts when you don’t even have time to eat or pee but try and prioritize your health on your shift. Drinking plenty of water helped me eliminate brain fog and made me take a short bathroom break to take a few moments and mentally re-set during a busy shift. Prioritize your break. In my old unit, we got 30 minutes out of our entire 12-hour shift for break. Some shifts were not possible to obtain, and I learned some days you just have to eat and chart. Easier to do on night than day shift, and you can always ask a co-worker or delegate a task or two so you can get something to eat and refuel.  Eating and staying hydrated keeps your mind sharp, and alert.

#9 Have Some Fun!

Jam out to an upbeat song at the beginning of your shift with your co-workers and crack a joke with a patient. The little things will lift you and your patients up. Looking for small ways to help your patient feel more comfortable goes a long way as well. Get them 2 warm blankets instead of just one. Brush their hair to remind them that they are more than just a patient, but a person.

#10 There Will Be Instances When You Have No Control

Know that however, your shift goes- as planned or unplanned, that you are human, and did all that you could. There will be instances when you have no control when something pops up, and you get behind on charting or meds. This will be more of an occurrence than not! It is something you will grow and adapt to. ICU nursing is not easy; if it was, anyone could do it. 

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BuckeyeICUNurse

About BuckeyeICUNurse, BSN

Megan is a Registered Nurse in Ohio with experience in neonatal, cardiac, and pulmonary intensive care, as well as invasive cardiac cath lab.

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Specializes in Critical Care, Corrections.

As a current ICU RN, I agree with most of what you spelled out. What worked for me is to look over each patients VS’s, because they are on the monitor in their room and on the units monitors as well. See who is unstable based on VS & shift report. Some times you have to assess those patients first because they do not have stable VS as opposed to the stable pts. Or maybe a previously stable patient is now unstable & requires immediate attention.

Then I like to check my MAR to see who needs what and when. Also go through the orders on each patient. Because the previous shift may have overlooked some thing that needs to be done right now that was not told to me in shift report. Such as an EKG or a blood draw. So I know when to look for those results. 
 

I wrote my pt’s VS down on my ‘brain’ and urine output hourly. Every ICU patient gets those done hourly at least in my experience. And was easier for me to notice trends. That’s what I do with my patients who have a Swan after I’ve ran their CO/CI or written them down off the FlowTrac. 
 

When I have downtime, I make sure our blanket warmer is full because you cannot give your patient a warm blanket if there aren’t any in the blanket warmer. We rarely have a nursing assistant in the ICU at least not on Night Shift. I also make sure the Accu-chek machine has lancets, gauze sponges and alcohol swabs easily accessible so my coworkers don’t have to run to the stock room to grab those. 
No nurse is an island. If you’re caught up, ask your coworkers if there is anything you can do to help them. Some may not ask for help. And some will take advantage of your assistance. You Will figure out which nurses take advantage of coworkers and which ones don’t. However always offer to help because that says more about you than it does them.

Never be afraid to ask your coworkers a question. There is no such thing as a dumb question. The only dumb thing is not asking questions when you need to ask. While I am not a new RN, I am relatively new to the facility where I currently work and even though sometimes I ask my coworkers questions which may seem to be dumb, it helps me learn how things work at this particular facility. 

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Specializes in Pediatrics, NICU.

thank you for posting this. I am a new NICU RN and am really struggling. I feel like I lose confidence every shift and I am incredibly anxious. All my coworkers are nice enough, but they are all friends with each other and kind of ignroe me. I guess it's better than them being mean, but all of this thrown together makes me not like the ICU. I used to work on pediatric step-down/med-surg units which was more enjoyable for me. I have only been working in the NICU for 2 months though--trying to give it a fair chance before I give up...so close to quitting though...my mental health is in the garbage

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