Natural510

I started in ICU, but I was also a nursing assistant for 2 years in the same unit beforehand. Other new grads from my class who got hired there included an ED NA, a step-down NA, and someone with no medical experience at all. The latter has taken the longest to "come around", but she also has done the most studying of meds, diagnoses, procedures, etc in her off-time to catch up. In the end, ICU is all about ambition and attention to detail. If you're the type who is aggressive and likes to take initiative (rather than being told what to do, or doing 'just enough' to get through the shift), then you can handle critical care as a new nurse.

Hospitals & critical care educators are trying to move away from propofol and the heavier sedatives because "research shows" patients undergo withdrawal from it upon extubation. Of course these are the same who will tell you an intubated patient doesn't need to be restrained if their RASS is a -2 and the next step in nursing is to ambulate your intubated patients. All sounds good in theory, but...

I've only seen gravity used with a G-tube, but it's basically the same thing. No reason it can't be done either way.

Many new nurses who can't get into ICU right away will start in an ICU or Cardiac Stepdown unit. It's a step up from med/surg or telemetry in that you'll be dealing with things like chest tubes, sheaths, bi-paps, chronic vents etc to help prepare you for an ICU setting.

I work in a smaller regional hospital in Ohio, and our charge nurses do not take patients, if for no other reason than they have to respond to codes and rapid-responses on other units and could be gone for an hour or more at a time. We're also 1:1 with CRRT, IABP & Arctic Sun. I guess, for all the complaining and people leaving our unit for the larger hospitals, we have it pretty good from what I'm reading here.

Our facility also has a policy allowing us to chart on a patient within 24 hours, so we can come back the next night to add anything we may have forgotten. Not sure if that is an option for you. As a new nurse in a MICU, I can sympathize, and it does get better! Like others said, the trick is to get as much done in the first half of the shift as possible, including charting. You can always "relax" later, if time allows. Many nurses, even seasoned ICU nurses, socialize & play in their phone early in the shift, and end up freaking out/playing catch-up the rest of the shift when something unexpected happens.

A lot of good suggestions here; I will add to not pretend you are in control of a situation when you aren't (don't let your ego overrule the needs of the patients) and don't try to be bossy or think you know more than your experienced preceptor. The fact you're on here asking questions probably means none of this will be a factor, but I remember in school we'd have those "know it all" students who wouldn't take instruction from seasoned nurses (even in ICU) and surprise! they were the ones who were most likely to fail the NCLEX and struggle to find employment after graduation.

It sounds like you've prepared about well as you can. I am also beginning my ICU orientation as a new grad (I worked there as a CNA during school), and picked up that Kathy Taylor critical care manual to help guide me. ALCS & all that is started during orientation. For the most part, from what I witnessed with other new nurses being oriented there, it's all about attitude...ICU nurses are extra diligent can't do "just enough" to get by as some nurses on other units might do.

I've had similar experiences to blackvans, though not quite 1/5. If they want a female CNA for toileting, etc, they just have to wait that much longer to be assited, so it's their loss. It does get irritating, either way. As a nursing student it has not been a problem, and hopefully less so as an RN also. There are some advantages to being male also, other than the lifting/turning thing. For one, some patients do better with men...especially sexist male patients who don't like to "take orders" from women, but also some older female patients (I think I remind them of a favored son or grandson). Anyway, the discrimination can be real, but it seems as time goes on, more and more patients are learning to accept the reality of male nurses. Women have been dealing with discrimination in the workplace since, well, forever, so I figure we can take our licks and keep going too.

Hospitals will also lose reimbursements for revolving-door visits, so in this case it will probably be addition by subtraction if it cuts down on their overall visits.

Man, I used to go there as a patient and told myself if I moved back to the Bay Area and couldn't get in at Kaiser, Sutter would be a solid second option. I guess I'd better stay back East where there are more choices and companies to work with.

There is good and bad in having union representation; the good is obvious, but one of the downsides is the laziest & complainingest employees are usually those who want to use the the union to take on every single grudge they carry...also as an excuse to work less and create more animosity in the workplace. You don't sound very enthusiastic, but you may find you enjoy the responsibility. You're right that many times it's the backbiters and malcontents who most want to be union reps, but you'll get much better feedback and probably more enthusiasm from the co-workers you represent if they have a rep they know is a hard worker and understand what they need to make for a safer, happier workplace.

If you are given instructions by your charge nurse, those are what should be carried out. Explain to the other CNAs that you must do a, b & c before you help them out with their tasks for the evening. Likely what is happening is the other CNAs believe you are there to help "at will" with their assignments, while the RN believes the support role is to take on specific tasks she delegates, which then take the burden off the other assistants. You should voice your concerns to your charge nurse, and ask for clarification of the expectations for your role. It sounds like there is miscommunication in your unit and not everyone (including yourself) understands your job description and expectations.

Yeah, like Brandon the idea of pharmacy hours kinda threw me (as did the old-school concepts of paper charting, smoke breaks, and no hospitalist on site). The advice is great for this (hopefully) future ICU nurse. Keep it coming!

Yea, this is how I'm doing it too. I worked FT as a CNA up until this final semester while doing the RN program, the second year with a little guy at home. Basically it's time management and mind-over-matter, though you will sacrifice sleep along the way. The experience you pick up working as an assistant, especially if in a hospital, will help you understand the material much more as you go through the program.