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Perfect Timing: Brand New ICU RN During Pandemic

Critical   (985 Views | 6 Replies)
by ICURNMI ICURNMI (New) New Nurse

ICURNMI has 3 years experience and specializes in Homecare LPN/RN ADN, ICU RN.

79 Profile Views; 2 Posts

It’s my first time posting here. I am a RN with limited experience (22 months as a home care nurse for one patient).

I finally found the nerve to apply for my dream job in an ICU and was accepted by all 3 hospitals I applied to. Yay!

I accepted a full time position on nights and asked for 30 days to give notice, which was approved. I start orientation March 30 and anticipate being on the floor the following week.

As excited as I was, I am pretty much scared shitless of what the ICU will look like during my training.

Please help me answer the following:

1. Am I insane to start in ICU during this pandemic?

2. What advice can current ICU nurses give me for beginning this journey?

3. Does anyone have a really great brain sheet/jot sheet and/or pocket guide recommendation, so I can try to keep my head straight/look up what I don’t know?

4. Are there any ways to prepare in the weeks preceding my first days?

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LeMa88 has 12 years experience as a BSN, MSN, RN and specializes in Ortho, Med/Surg, ED, CCU- Agency.

8 Posts; 101 Profile Views

I have just started ICU, this is the 3rd month, I am still overwhelmed despite having years of experience in other area. I feel stupid and incompetent most days. Looking forward to hear other answers too before I lose my mind

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217 Posts; 3,989 Profile Views

This is based off of 8 years of ICU, having started as a new grad in CVICU, worked my way through nearly every type of ICU, level 1 trauma hospitals, teaching hospitals, magnet hospitals, *** hospitals, top 10 in the nation hospitals. Less is more. Give your mind time to breathe and think. Starting on night shift is easier/better. But day shift is good to see procedures and better for your work/life balance. Night shift will ALWAYS have better teamwork.

1 - Don't worry, it's going to suck for everyone, everywhere. At least you can ride the sinking ship with the rest of us. There's nothing wrong with crying, failing, crying more, regret, anger. If you don't feel these things you aren't in ICU.

2 - Buy lots of cheap pens, only a few fancy pens (these will be stolen), sharpies (will also be stolen), a nice backpack. Don't waste money on a nice stethoscope, you WILL lose it (stolen). Either steal the disposable ones from work or don't spend more than 30$ on a stethoscope. If the patient is talking, document clear lungs, if they cough document rhonchi. This will save you sooo much time assessing. You'd be surprised how little you need a stethoscope in ICU. Buy nice scrubs with pockets (you deserve it). Wear comfortable shoes.

3 - My Brain - fold printer paper in half
-------------------------------------
[Room Number] [Patient Name] [Code status] [ doctors / treatment team]
[Allergies] [Date of admission]

[Patient History] Learn the accroynms - copd, chf, hlp, MI, CABG, etc
[Why did they come in??]
[What have we done about it]

[Neuro] [IV Lines]
[Cardiac] [Drips and rates]
[Pulmonary] [x] checkboxes of stuff pending
[GI] Includes diet, poop, blood sugar
[GU]
[skin issues]
---------------------------------------------
That's all you need for a thorough ICU brain.

4 - When you take your EKG class, really pay attention, really try to learn your PQRST and what each letter means is going on electrically and physiologically in the body. ICU is all the ABCs - airway, breathing, circulation. Once those are fixed, you don't need ICU care. Understanding pathology and pathophysiology at a really basic level will help you tremendously.
I'd recommend any book from the ....Made Incredibly Easy series. Or the PASS CCRN book when you REALLY want to understand what's going on with your patient.

I don't know what else you can do to prepare. I felt like nursing school was near useless for teaching my how to be a nurse. It's really an on the job training kind of thing. Always ask questions. Ask the stupid questions. I am 8 years in and ask some dumb *** questions and have no shame. Because you're dealing with the sickest patients and your pride or vanity mean nothing if your patient dies because you think you're too good to ask.

Most of all, if you don't like it, if you feel you're not made for ICU, or worse if you hate your job, don't force yourself to stay. Find a different ICU or find a different specialty. ICU has extremely high burnout rates. I think the average time someone spends in ICU is 2 years. Believe me there are way more glamorous specialties that are far less work, less stressful, and will make you feel much happier. My proof of that is I have never heard an ICU nurse say "I love my job". We tolerate our jobs because we're gluttons for punishment. OR nurses and cath lab nurses love their jobs. PACU nurses love their jobs. Don't fear looking for a job you love.

OH I NEARLY FORGOT - Find out if your hospital has access to a website called UpToDate. It is like the wikipedia of medicine and my personal bible of choice. It's extremely expensive to purchase access on your own so it's nice if your hospital has a subscription , or even better gives you one for free. You can thank me later.

Edited by CyclicalEvents

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ArmaniX has 7 years experience as a MSN, APRN and specializes in Critical Care.

330 Posts; 6,812 Profile Views

Just make sure your orientation is not cut short due to the pandemic. I’m sure many classes will be cancelled, no in person 12-lead courses is one example I could imagine.

Good luck!

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ICURNMI has 3 years experience and specializes in Homecare LPN/RN ADN, ICU RN.

2 Posts; 79 Profile Views

11 hours ago, CyclicalEvents said:

This is based off of 8 years of ICU, having started as a new grad in CVICU, worked my way through nearly every type of ICU, level 1 trauma hospitals, teaching hospitals, magnet hospitals, *** hospitals, top 10 in the nation hospitals. Less is more. Give your mind time to breathe and think. Starting on night shift is easier/better. But day shift is good to see procedures and better for your work/life balance. Night shift will ALWAYS have better teamwork.

1 - Don't worry, it's going to suck for everyone, everywhere. At least you can ride the sinking ship with the rest of us. There's nothing wrong with crying, failing, crying more, regret, anger. If you don't feel these things you aren't in ICU.

2 - Buy lots of cheap pens, only a few fancy pens (these will be stolen), sharpies (will also be stolen), a nice backpack. Don't waste money on a nice stethoscope, you WILL lose it (stolen). Either steal the disposable ones from work or don't spend more than 30$ on a stethoscope. If the patient is talking, document clear lungs, if they cough document rhonchi. This will save you sooo much time assessing. You'd be surprised how little you need a stethoscope in ICU. Buy nice scrubs with pockets (you deserve it). Wear comfortable shoes.

3 - My Brain - fold printer paper in half
-------------------------------------
[Room Number] [Patient Name] [Code status] [ doctors / treatment team]
[Allergies] [Date of admission]

[Patient History] Learn the accroynms - copd, chf, hlp, MI, CABG, etc
[Why did they come in??]
[What have we done about it]

[Neuro] [IV Lines]
[Cardiac] [Drips and rates]
[Pulmonary] [x] checkboxes of stuff pending
[GI] Includes diet, poop, blood sugar
[GU]
[skin issues]
---------------------------------------------
That's all you need for a thorough ICU brain.

4 - When you take your EKG class, really pay attention, really try to learn your PQRST and what each letter means is going on electrically and physiologically in the body. ICU is all the ABCs - airway, breathing, circulation. Once those are fixed, you don't need ICU care. Understanding pathology and pathophysiology at a really basic level will help you tremendously.
I'd recommend any book from the ....Made Incredibly Easy series. Or the PASS CCRN book when you REALLY want to understand what's going on with your patient.

I don't know what else you can do to prepare. I felt like nursing school was near useless for teaching my how to be a nurse. It's really an on the job training kind of thing. Always ask questions. Ask the stupid questions. I am 8 years in and ask some dumb *** questions and have no shame. Because you're dealing with the sickest patients and your pride or vanity mean nothing if your patient dies because you think you're too good to ask.

Most of all, if you don't like it, if you feel you're not made for ICU, or worse if you hate your job, don't force yourself to stay. Find a different ICU or find a different specialty. ICU has extremely high burnout rates. I think the average time someone spends in ICU is 2 years. Believe me there are way more glamorous specialties that are far less work, less stressful, and will make you feel much happier. My proof of that is I have never heard an ICU nurse say "I love my job". We tolerate our jobs because we're gluttons for punishment. OR nurses and cath lab nurses love their jobs. PACU nurses love their jobs. Don't fear looking for a job you love.

OH I NEARLY FORGOT - Find out if your hospital has access to a website called UpToDate. It is like the wikipedia of medicine and my personal bible of choice. It's extremely expensive to purchase access on your own so it's nice if your hospital has a subscription , or even better gives you one for free. You can thank me later.

This is exactly what I was looking for. Thank you so much.

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Florence NightinFAIL has 9 years experience and specializes in Medical - Surgical.

267 Posts; 11,924 Profile Views

Good luck. I'm nervous starting a new job during the pandemic too. I'll be going for orientation for PACU but they will be sending me to ICU so I'm not sure how that will effect my orientation. I already had the classroom portion of the orientation cancelled ahead due to covid concerns.

In my ten years of nursing, the best brain sheet is the one YOU make yourself and personalize. It's best to Google "ICU report/brain" sheet and customize to your liking. Things will flow better that way when you have your own system. I also like to look at other nurses' brain sheets and if they have a printable template, I usually ask for a copy to observe.

I also recommend to watch Youtube videos on "ICU nursing assessment" "Giving report in ICU" etc. There are lots of good videos.

Tips to keep in mind:

- Trends are more important than absolute values

- Look things up regularly - policies and procedures

- If you ever have "downtime", chart, chart, chart. Pee, then chart. You should always strive to be caught up in charting because things change very quickly in the ICU and you don't want to be remembering things that happened hours ago

Good luck! Keep us updated on our experience 🙂

ICU report template 1 patient.docx

ICU+Nursing+Report+Sheet.jpg

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15 Posts; 257 Profile Views

On 3/20/2020 at 2:55 AM, CyclicalEvents said:

This is based off of 8 years of ICU, having started as a new grad in CVICU, worked my way through nearly every type of ICU, level 1 trauma hospitals, teaching hospitals, magnet hospitals, *** hospitals, top 10 in the nation hospitals. Less is more. Give your mind time to breathe and think. Starting on night shift is easier/better. But day shift is good to see procedures and better for your work/life balance. Night shift will ALWAYS have better teamwork.

1 - Don't worry, it's going to suck for everyone, everywhere. At least you can ride the sinking ship with the rest of us. There's nothing wrong with crying, failing, crying more, regret, anger. If you don't feel these things you aren't in ICU.

2 - Buy lots of cheap pens, only a few fancy pens (these will be stolen), sharpies (will also be stolen), a nice backpack. Don't waste money on a nice stethoscope, you WILL lose it (stolen). Either steal the disposable ones from work or don't spend more than 30$ on a stethoscope. If the patient is talking, document clear lungs, if they cough document rhonchi. This will save you sooo much time assessing. You'd be surprised how little you need a stethoscope in ICU. Buy nice scrubs with pockets (you deserve it). Wear comfortable shoes.

3 - My Brain - fold printer paper in half
-------------------------------------
[Room Number] [Patient Name] [Code status] [ doctors / treatment team]
[Allergies] [Date of admission]

[Patient History] Learn the accroynms - copd, chf, hlp, MI, CABG, etc
[Why did they come in??]
[What have we done about it]

[Neuro] [IV Lines]
[Cardiac] [Drips and rates]
[Pulmonary] [x] checkboxes of stuff pending
[GI] Includes diet, poop, blood sugar
[GU]
[skin issues]
---------------------------------------------
That's all you need for a thorough ICU brain.

4 - When you take your EKG class, really pay attention, really try to learn your PQRST and what each letter means is going on electrically and physiologically in the body. ICU is all the ABCs - airway, breathing, circulation. Once those are fixed, you don't need ICU care. Understanding pathology and pathophysiology at a really basic level will help you tremendously.
I'd recommend any book from the ....Made Incredibly Easy series. Or the PASS CCRN book when you REALLY want to understand what's going on with your patient.

I don't know what else you can do to prepare. I felt like nursing school was near useless for teaching my how to be a nurse. It's really an on the job training kind of thing. Always ask questions. Ask the stupid questions. I am 8 years in and ask some dumb *** questions and have no shame. Because you're dealing with the sickest patients and your pride or vanity mean nothing if your patient dies because you think you're too good to ask.

Most of all, if you don't like it, if you feel you're not made for ICU, or worse if you hate your job, don't force yourself to stay. Find a different ICU or find a different specialty. ICU has extremely high burnout rates. I think the average time someone spends in ICU is 2 years. Believe me there are way more glamorous specialties that are far less work, less stressful, and will make you feel much happier. My proof of that is I have never heard an ICU nurse say "I love my job". We tolerate our jobs because we're gluttons for punishment. OR nurses and cath lab nurses love their jobs. PACU nurses love their jobs. Don't fear looking for a job you love.

OH I NEARLY FORGOT - Find out if your hospital has access to a website called UpToDate. It is like the wikipedia of medicine and my personal bible of choice. It's extremely expensive to purchase access on your own so it's nice if your hospital has a subscription , or even better gives you one for free. You can thank me later.

SICU RN here, but have nothing to add. This response was right on the money! Heed the advice and good luck!

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