Meressa

Congrats on the news of your hiring folks! I just had to share a bit here. I went right into SICU fresh out of nursing school too and have done basically nothing else but critical care ever since (18 years now). I could not imagine doing anything else and would not want to. Just remember to ask questions, ask more questions, and then ask MORE questions. Question every tiny detail of what your preceptor teaches you. Make sure you understand exactly why she turned the Fi02 on the vent up to 100% when you told her your patient's lungs sounded like a washing machine and his Sa02 was dropping into the 80's. Why did she call the MD at 2am and hope for a Lasix order maybe? Why did she titrate the Dobutamine drip when his cardiac output started to take a dip? What does that fluctuation or lack of it in your patient's pleural/chest tubes mean? And don't stop asking until you are sure you understand how to apply what you assess to action. Those are the kinds of things that ICU nurses focus on. We tend to be a very detail-oriented, often anal-retentive lot even. And one other bit of advice that others here also mentioned. STUDY, STUDY, STUDY on your own. If you have internet at home, after a shift go study the topics that came up for you on that shift and try to apply it to what happened with your patient specifically. These two things helped me more than anything I think and this is what I also teach my own new orientees. Best of luck to you! With the sincere desire to succeed, I truly think you can do it. An Old ICU Nurse

I used to work in a 15-bed SICU where we also took all the CABG/valve/AAA surgeries. This was my very first job right out of nursing school, so I remember all too well how the CV surgeons in particular could make you feel. But, I caught on real quick after that first surgeon made me cry. Eventually, I promoted to a Preceptor and then Case Manager. I always taught my new grads, in particular, one big thing. NEVER let them see you cry, no matter how they might upset you. Once you do this, you are seen as weak and it takes a lot longer time to get them to realize that you DO know what you are doing and can be trusted with their patients. However, if you stand up for yourself & keep your patient's needs as top priority (and yes, it can be done tactfully in most cases), they tend to learn to respect you and your skills. Despite that horrible first few months with those CV surgeons, a year later I would actually even have them call from the OR and ask who the nurse assigned was for a patient they were sending me who was unstable, etc. (when they had seen new faces on the Unit). In cases like this, I always at least made sure a seasoned RN was there to help out a newer nurse. While I do NOT think this is appropriate at all for them to be allowed to choose their nurse & I often resented my Manager allowing it, even if at times it was eventually me they wanted with their patient, I do think it ties into how you approach them. From our end, that is all we can control. We cannot control how they behave in response. Now, I am a seasoned RN myself, but the newcomer at my new position on a 20-bed ICU. Most of my first few weeks here were just standing back & listening to how the other nurses approached the pulmonologists we deal with every day. Now, I know exactly how I can approach each one & only 6 months later, I have a pretty good relationship with each of them. One you can easily say, "Dr. X, his urine output has only been 40 ccs in the past 3 hours and his lungs sound really wet this morning. His K+ is 3.6. Would you like me to diuresis him & give a few runs of K+?" You quickly get dose orders for both generally. Another you have to say, "Dr. G, his urine output was 40 ccs for the past 3 hours. His lungs are coorifice throughout. I am suctioning out large amts of white foamy secretions, and his K+ level at 6AM was 3.6." and then STOP & wait for his response. This is the doc that you can get along quite well with IF you remember that he does NOT like to have treatments suggested to him. And, if you do suggest treatment, he will likely do something very different than what you had asked for . It is all about learning your doctors I guess is what I am trying to say. Listen and learn what they want/need to hear from you. Some will very much appreciate your knowledge and skills. Some will appreciate what you tell them, but insist on letting you know THEY call the shots. But, every single one of them, regardless of specialty, will have to be SHOWN in time that you can be trusted. So, new grads, hang in there. It does get better, I promise.

I agree totally with the HIPPA issues gang, among other things that poorly planned visitation times can cause. I am an RN on a 20-bed ICU. A large majority of our patients are respiratory (pneumonia, COPD, ARDS, MO failure) and on the vent with sedation. Our unit is not actually physically locked. Our visiting hours are 10AM-2PM and 6PM-10PM every day. I guess it could be much worse, but these times can be horrible for staff. In our hospital, 10AM is the time when ALL QD or BID meds are given. So, for us this means busting chops to get your 10AM full assessment and meds done completely for both of your patients well BEFORE the 10AM visiting time starts. If your patients are very care-intensive, this often means by the time you finish your initial am assessments, it is time to start the 10AM one (around 9:15AM). Otherwise, you are going to have to deal with working around visitors or even asking them to step out so you can do a 10AM treatment. THEN, in many cases, if you have to ask them to step out, they complain when visiting time is over saying they should be given some extra time cause they were forced to step out during the time they would have been visiting. Then, we come to the 6PM visiting time. This is actually worse for staff than the am one. I mean, come on. We have no room we can go to for report, and even if we did, it is not conceivable on our ICU. I mean, who would monitor the patients while both shifts are in report? So, typical for an ICU, report is done just outside the patient's room (in the hallway where we have our desks/computer terminals-one for every 2 patients). It never ceases to amaze me the families, esp if their loved one has been with us for awhile & they have gotten to know the staff pretty well, who will just come out into the hallway and plop right down in any empty chair, even during report. Of course, each of us has at least 2 patients, so joy joy! They also get to hear just how the patient next to their loved one is doing! And, what if that neighboring patient has AIDs or some other such terminal illness that is totally no one else's business? Amazing, huh? One thing I have done at times, IF by chance I have a patient not on a vent or sedation or with arrhythmia issues, one that I do not have to eyeball constantly, is to move the family into the room with the patient and close the door during report. I mean, give me a break, isn't that why they are there in the first place? We have a monitor in each hallway also, so I can still see if someone has a problem. But it is seldom safe to close the patient's door, so we still have the same problem with families overhearing the 7PM report, even if they are in the patient's room. I used to be a traveling nurse (for 3 years) before I decided to move back to my hometown last year. I worked at a large downtown hospital in Atlanta,GA for about a year as a traveler and loved their visiting policy. 15 min visiting times four times a day. Unless we expected a death or some unusual circumstance was going on, there were no exceptions. In fact, the doors that accessed the entire ICU floor and all of the 5 ICU's were locked & staff accessed the Units with a magnetic card on the back of our name badges. So, four times a day we hit a button inside the unit that unlocked the doors. It was wonderful and staff never had a single complaint about it. Of course, this WAS in a 1500-bed inner city hospital in which security for staff & patients was also an issue. I have been an ICU RN for close to 15 years now, so I have seen every end of the gamet visitation-wise. Anyway, I adore the ICU I am working on and the staff I work with. My Director is awesome. I can honestly say that this is the only complaint I have. So, I spose I am lucky huh? I have only been here about 6 months, but once I have some time under my belt, I do plan to bring up this issue and see if I can help to come to some kind of workable resolution. Like maybe shortening the visiting times to 2 hours twice a day rather than 4 hours. And, starting them at less care-intensive times, like 11AM-1PM. And, most of all, NOT starting the evening visitation till AFTER 7PM report is completed (maybe start at 8:30PM to give oncoming shift time to assess their patients before they are barraged). That being said, I am STILL all for flexing those times in cases such as when you are terminally weaning a patient from the vent and family should be with them in their last hours. But, somewhere there has to be a compromise for everyone, right? And, sheesh! I could go on forever with my wonderment of how I can try to enforce visiting hours for my patients who really need it when the nurse next to me lets her patient's family come in and out all through the day as they desire. That is not nearly so bad on the ICU I work on now, but I have seen it become utterly impossible on other Units I have worked on. Please don't misunderstand me. On the personal front, my own Dad suffers from CHF & COPD. He is in and out of the hospital at least 3-4 times a year. I can totally understand a family wanting to be with their loved one and I too have gotten aggravated at times with visiting hours, but I always make myself step back and remember that my Dad is there for the nurses to care for him and that comes second to my needs, no matter what. Sorry for the tirade folks. Can you tell I am very passionate about this topic? It never ceases to amaze me the number of times, like someone else said, that you finally get the Ativan or Diprivan gtt titrated just right, get your patient turned, suctioned, no longer bucking the vent, all nice & comfy...and in walks the son who just HAS to yell "Wake up!". Rant over..thanks for listening. Meressa, ICU RN

Hello everyone! Please bear with me. I have been a lurker for quite some time & have thoroughly enjoyed this site, but this is my very first post! I just had to say that I have also worked under the kind of managers ya'll have talked about here, however please know that there is hope out there and some real good managers along with it. I am an RN in a 20-bed ICU and my manager (called Director of Critical Care here) is totally awesome. She manages all of our ICUs (3-20 bed ICUs and a 4-bed SICU). Back a week before Xmas this past year, I had a car accident on my way to work (hit a patch of black ice and totalled my brand new car). I was critically ill for over a week, and after two surgeries to fix the leg that was pinned inside my car, I am now home on Medical Leave for a total of 4 months. My manager has been right by my side, totally supportive, helped me to work out my insurance benefits being continued, even paid me for Xmas Day (double time holiday pay) to be sure my benefits continued. She calls or emails me at least once a week to check on me, and has assured me that my job will be waiting for me when I am ready to return April 1. Never in my 19 year health care career have I ever met such an amazing manager. I wish each of you could have such a supportive person on your side. And, NO, you cannot have her for your own, but I will be happy to share if anyone wants to come here! Meressa, RN, ICU