PGH_BSN

I started in a level 1 trauma ICU right out of school..I'm approaching 10 months there soon. - Most difficult aspect for me was earning the respect from the other nurses that have been there for a while. Being a new grad, you're kind of a different breed going into the ICU right off the bat. They expect you to know certain things and look at you weird if you ask an off the wall question. The other things I struggled with is ensuring everything got done in a timely manner and have the sense of urgency. On my orientation, I was getting TBI head protocol in one room with a proned patient in the other room. It's just how our floor operates with the acuity. There were times I wanted to cry because my preceptor would let me drown before helping me. It worked out in the end because I am now a confident nurse that looks at challenges as problems and I want that every day. - The best piece of advice I can give you is to be a sponge on orientation. Do not walk in there thinking you know things, because that is how people on orientation get fired from our unit. Take everything in, and always listen before speaking because even if you've learned a skill 1000x before, you could possibly learn something new. Also, don't be afraid to solve things for yourself. You're going to need to when you're off orientation and by yourself. They'll tell you if you're messing up. Good luck to you, ask anything and maybe I can help. What kind of ICU are you starting in?

In our level 1, we mainly use propofol and fentanyl in conjunction for sedation. The reason we would take someone off of propofol would be because 1. their BP couldn't tolerate it, or 2. their triglyceride levels are rising. In that case, we may switch them over to precedex. The thing with dex is that it takes time to build up in the patient's system, so you have to bolus following protocol at the beginning of the treatment or else you're going to keep going up and up on the dosage thinking it's not working until they're zonked and bradycardic.