newly hired to icu

[TNT_RN09]

I've been a med surg nurse for 4 yrs and I interviewed for a ccu position and I got it. I'm nervous now because I feel like there is so much I don't know and I feel the only thing med surg has taught me is time management,pushing pills,and how to work under high stress lol. I'm starting to second guess myself and thinking about turning theposition down because it seems so overwhelming sigh. I guess my question is how can I better prepare myself for this transition?

[CrufflerJJ, BSN, RN, EMT-P]

They told me in the interview I would get 6 wks orientation,does this seem reasonable?

Every facility is probably different. My facility's Critical Care Fellowship program is 16 weeks of mixed class & precepted time in our ICU.

Plan on being overwhelmed the first time you step into the ICU.....OK, for at least the first week or two. Lots of sick patients, hooked up to multiple powerful drips, attached to multiple machines all beeping/alarming. Then it gets even more "interesting" when your previously "stable" pt takes a turn for the worse. Fun times!

Ask questions, listen & work to understand the answers you're given. If you don't truly understand the response, ASK again. Far worse than asking a second time is to blindly move forward, HOPING that you know what you're doing. If you're not sure, ask. Your pt deserves this level of caring/effort.

Realize that the "ICU way" may be very different from the "med/surg way" of doing things. In general, I'd expect that the ICU RN may have greater autonomy to order basic tests (not out of the blue, but based on pt-specific conditions) than the med surg nurse, be capable of interpreting the results, and would be willing/able to aggressively advocate for your pt based on the results. In my ICU, the RN has a decent amount of autonomy, but also significant expectations to plan ahead (i.e., if you know the doc is planning to place a central line, it might be good to make sure there's recent PT/APTT/INR results available....if your pt had a K of 3.6 at the start of your shift and has dumped 3 liters of urine thanks to Bumex since then, it's probably a good thing to spot check a K level).

Try to get a feel for how experienced nurses in your unit handle situations. Do they respond purely from physician orders, or do they try to "get ahead of the curve", and anticipate the needs/whims of the ICU docs? Once again, every ICU is likely different. Some will be more centrally directed than others.

Please don't be afraid...too much. It's a balancing act between being a "scared newbie wimp" vs a "dangerous newbie know it all." The experienced (hopefully sometimes awe-inspiring) ICU nurses you will encounter all started out as ICU newbies. Hopefully they won't forget this when interacting with you and your fellow ICU newbies. Most of the folks I've seen fail to successfully transition to the ICU have failed for 2 main reasons:

- "know it all", unwilling to accept repeated strong preceptor hints on a safer/better way to do their job, thus putting their pts at risk

- "uncaring idiot" - a space cadet who is highly intelligent, yet doesn't feel the need to do the basic due diligence - refusing to look up the pt's history, lab values, or even listening to report from the previous nurse. They are oblivious to important pt trends during the shift (has O2 demand gone up, did Levo start at 0.02 mcg/kg/min, and are you now at 0.16 mcg/kg/min?)

It's scary, leaving your "comfort zone" for a new environment. It's even scarier to feel your soul shrivel when you're stuck in a rut, doing the same thing...day after day after day after day. Life is too darn short to be unhappy. Congrats to you for being willing to try something different.

Please keep your head up, your mind and heart open, and your hands busy as you start your new position. Ask questions, learn every day, and offer to HELP your coworkers on a daily basis. Helping your neighbors will go a long way at minimizing any stress caused by your inexperience.

You can do it.