KellyRN86

Hi, I work in a MICU and as of Wednesday we will be the official ICU for covid patients. There are several other lower acuity floors for covid but if they need to be intubated, etc they will come to us. Any of our normal "clean" MICU patients will overflow to PACU which they have set up as a makeshift ICU staffed with a combo of PACU and ICU nurses from other ICUs. As of Wednesday our unit is also starting to use med surg nurses to "help give us a break" but really it is to stretch the ICU staff when ICU patients overflow elsewhere. What it looks like is this: 4 ICU patients to 1 ICU nurse, and 2 med surg nurses, and that is the team. They are saying the med surg nurses are taking care of the patients and we are doing all the ICU related stuff that they can't do (which, these pts are extremely sick...proned/vented/A lines/drips etc, so that's a lot of stuff for 4 pts). I'm trying to stay positive about it, but they are essentially taking us from 12 ICU nurses for a 23 bed unit to 6 ICU nurses and 12 med surg nurses. My question is, is anyone else having to do this? What are some barriers you've run into, what are some good things, and what are the legal ramifications? They are saying it's "not on our license".... But the med surg nurses have been given a 4 hr crash course in basic ICU stuff, so they aren't technically competent and so how is it fair to them? And how is it fair for us if we have 4 vented patients? If anyone has input I would appreciate it.

Right now all of the hospital staff where I work has to wear a mask at all times. There are only two entrances open to the hospital now, staffed by 1-2 people whose only job is to direct you to use hand sanitizer then hand you a surgical mask to wear the rest of your shift. You wear it for all your patients as well. In the ICU most of our covid pts are on airborne so we wear an n95 (we get one per week unless it gets gross). It all stemmed from a patient coming in for a reason completely unrelated to Covid (more an Ortho reason) and he ended up deteriorating and being covid positive and exposed so many people. It does get annoying wearing a mask the entire shift but I appreciate that they care enough about us versus their image. Especially since visitors are almost completely restricted except very specific circumstances, who cares if you are wearing a mask??

I definitely think that you can acquire this ability by immersing yourself in a more acute environment! Coming from med surg myself, I also was able to remain calm in emergent situations but would think back to what I should have done or could have done better. Then when I switched to ICU I felt like it was going to take forever to feel comfortable and to feel like I know what to do without feeling like I need to go get someone else who knows what they are doing lol. I've only been in ICU for 7 months. One of my preceptors said that it will take a good 2 years to feel really comfortable, and I definitely was super anxious and unsure if myself in the beginning. But I will say that in my daily practice I've definitely started to feel more confident/comfortable and feel like I know what to do in situations that previously I felt kind of frozen in. I still have a long way to go of course, but I definitely can tell the difference. My first day by myself I had a pt who was desatting on the vent and I remember going in and staring at the monitor like oh s***! And then I took a breath and was like you know what to do!! Suction, reposition, chest PT... that ended up fixing the situation but you might have to lavage, bag them, and always remember to get help, call respiratory, etc. Now when something like that happens I feel much calmer and just act on the situation right away. I work with an awesome team of ppl who are always willing to help me and answer questions. I remember my first code off orientation, I was not alone, there were already 3 other nurses in the room with me before it happened and were there helping me with different things. That's really important too, try to find an ICU that has a reputation for good teamwork! You'll do great!

Hi! Regarding the pay increase, anyone I've known who transferred within the same facility did not get a pay raise if it was still a bedside nursing position, even if the pts are higher acuity. It is more based on years of experience, merit, etc. In terms of the transition from a med-surg type position to dealing with more critical pts, I transitioned from med surg to ICU about 7 months ago. I know you're not going to ICU right now, but my suggestion would be to read up on cardiac rhythms and meds, respiratory care stuff (like bipap, ABGs, and anything that you would normally have upgraded a pt for, like on med surg where I was they really didn't like pts to be on high flow nasal cannula, the acuity was higher), not sure if you will get DKA pts on that floor or if they would go to ICU but you can read up on that, too. Also not sure if you will get stroke pts or if there is a specific stroke floor, but Neuro stuff is good to brush up on. And once you start, anytime you take care of somebody with something new going on, it's always helpful to go home and read up on it in your own time, it helps things to "click", especially if it's still fresh in your mind. Good luck! ?

Congratulations, that is awesome to hear!! Good luck!!

Hi! I was in a similar situation, worked on a medical/oncology floor for 9 years, have my chemo and OCN certs but wanted to switch to ICU. I got hired and actually just finished my orientation this weekend so I'm still brand new to ICU. My terview for the MICU didn't have any kind of clinical type questions, more like a couple of your typical strengths/weaknesses, tell us about a time when you had a conflict with a co-worker, etc. I will say that I played up my experience with chemo and blood products and central lines. Especially about the seriousness of administering chemo, and ones that you'd have to titrate. If you've ever had patients that were starting to crump and you recognized subtle changes in their assessment or labs you can talk about that. Like oncologic emergencies, which MICU would probably be the place those pts transfer. Your experience is definitely relevant and valuable. Also talk about teamwork, not sure if I just got super lucky or if it's just how ICUs are bc of the acuity and the amount of care the pts require since they can do barely anything for themselves, but I've noticed everyone pitches in and helps one another, goes into a crashing pts room to help out without having to be asked, etc. That's definitely something they'd be looking for. Good luck!

Don't give up! I'm assuming you have a preceptor with you? They should be going in the room with you when you do patient care, until you feel comfortable and they are confident that you can do some things on your own. Don't be afraid to ask questions... It's the nurses that don't ask questions that makes me scared...you are brand new and there's no way you're supposed to know what you are doing! Nursing school is just a foundation and things are a lot different in the "real world" and you really learn how to be a nurse on the job. I would jot down things throughout the day that you're not familiar with and any questions you have, and then on your off time start reading up and trying to learn things outside of work. It will help you apply it in real life and put 2 and 2 together. It's normal for new nurses to be task oriented and not really see the big picture yet. Try to keep a "to do" list so you can keep straight all the things you need to do, and then if you have time try to read progress reports and stuff that providers write, this will help you connect the dots. Honestly it will probably take you 9 months to a year before you feel comfortable. One day it will just hit you, "hey I've got this!" like a light bulb goes off. Also, keep the lines of communication open with your preceptor and manager, and if you feel like your preceptor isn't helping you or it's not a good fit personality-wise, ask your manager if you can be with someone else. You will be fine! You've got this!!

Yes, it's normal! I just started in ICU and I am scared to death! Lol. (Just finished day 3 of orientation) Besides the fact that ICU is pretty daunting, you're starting a new job with new ppl and have to learn a whole new routine. I've spent the last 9 years in med surg/oncology but I feel like a new nurse all over again. I have a couple of critical care books that I've been trying read through and I keep a notebook so when I go throughout the day I can jot things down that I want to look up later. The nurses I work with are super supportive and helpful and it looks like the critical care nurse educator will be working pretty closely with me and I'll be taking the ECCO course as well. If you didn't have any fear, that would be abnormal and scary in itself, it's those nurses that aren't scared that think they know everything and are hard to teach. Stay humble and ask questions and you will be fine!!

Hi! So I've been med surg for 9 years (mainly medical pts) and switched the MICU at a different, much larger hospital...this week! Today will be my 3rd day. It's a bit overwhelming and I need to get used to the pace and the Q1hr things. I have wonderful preceptors who are awesome at giving me feedback constructively whether it's positive or negative, so that's good. Yesterday was the first day I really kind of took care of a pt and documented everything and when I was giving report (something I am usually really good at) it was super choppy bc I'm not used to giving the ENTIRE back story...on med surg we give a very brief background of why they are here and any really important things like a fall or rapid response or blood products, but I've noticed in ICU they want a day by day, what happened each day kind of story. My advice is take breaks when you can and make sure you eat, and drink water!! Write down in a little notebook things that you come across that you need to read about more in depth, and don't be afraid to ask questions!! I will have the ECCO class coming up soon which I think will help me too. Good luck!!

This pt sounds inappropriate for med surg. Especially with a CIWA score of 23. Reason being, that high of a score triggers more frequent assessments and is very difficult to manage on med surg. What was his code status? I come from med surg and we had a pt similar sounding (etoh, encephalopathy, resisting care although not violent per se) and the docs were basically just letting her sit there, full code, not giving any meds, fluids, anything. Our big question was how can you let this pt lay here like this and not do anything and she is a full code?? We actually got the director of medical affairs involved when no doctor would listen to us, and then things started to happen. So for your pt in particular, things to remember for next time, if you start an IV and you're able to, try to grab some labs. Even if they aren't ordered, you can let the doc know you obtained them and see if they want them...I would have grabbed a tube for a cmp/bmp, a CBC, and an ammonia level...I wonder what his ammonia level was bc that could also be contributing to his catatonic state and violence. Then document that you did the iv/labs, called the doc, suggested labs, and what the response was. Document everything you suggested and what the response was. I definitely think you should have called about the seizure. Sometimes I see people not call a doc bc previous nurses were reporting "everyone knows about it" but really...can you be sure? The worst that can happen is the doctor gets snippy with you but at least you've done your part, let him/her know, and documented it. The slipping meds into foods, he is not alert and oriented and so you do what you have to do, especially if he needed lactulose eventually if his ammonia level was high...I'd be pouring that into some applesauce or something! When a previous person said it violates the principle of autonomy...he was not alert and oriented I gather? We crush meds and put them in food all the time to get people to take their meds, even when they are confused. This is common. Anyway my advice here, to summarize, is document document document, go up your chain of command when you feel something isn't right or the pt isn't getting what they need, don't assume the doctor knows something and don't be afraid to call them, don't ever be afraid to ask questions. You were right to question this pt.

-When pts walk around barefoot. -One time I was giving chemo and the chemo disposal bucket was tucked away under the counter and I came back in the room and the visitors had a toddler that was playing with the bucket!! -pts that ask for "dilontin" or "dilala" or whatever other name they come up with instead of Dilaudid -pts that are sitting in bed, calm as can be watching TV and tell me they are having a panic attack and need their Xanax -pts that are IV drug users that get upset when you have trouble getting a new IV site on them -ppl that smoke in the room. I don't care that you're a smoker, but you are putting everyone's lives in danger because of the O2 that's all around! -when ppl ask for a cup of ice and then I bring them a cup of ice and they scoff at me and say uh aren't you going to bring me something to drink? Um you didn't freaking ask for anything to drink, you literally asked for ice!! -i could go on all day :) I do honestly love my job though and can't imagine doing anything else but bedside nursing, at least not anytime soon. I've been a med surg nurse for 9 years, but actually starting on a medical ICU this week, so having pts that are too sick to talk and walk and set their alarm for pain meds will be culture shock for me I'm sure!

I've been working on the same med surg/oncology floor for almost 10 years, since graduating from nursing school. We are going to be moving in a couple of months and I need to start looking for jobs. ICU is something I've always wanted to do, and I feel like now is the perfect opportunity to make the change in my career. However, I am worried that my Med Surg experience won't be viewed as relevant/valuable even though I know I am a strong nurse. I guess my question is, has anyone been in a similar situation and were you able to transition right to ICU from Med Surg, or did you find that you were encouraged to do something else in between (like a step down unit) before applying for an ICU position? (I really just want to jump right in, but I'll do what I gotta do.) Also I am curious how to make my resume paint the picture of someone who would be a worthwhile candidate to interview for an ICU job...I have my BSN and 2 board certifications (Med Surg and oncology) and am chemo certified, and I have my ACLS and NIH certification...I've also been a charge nurse for about 7 1/2 years as well as a preceptor. Looking at different sample resumes, some have a "skills" section but my skills are skills that pretty much any acute care nurse would have so I feel ridiculous listing them because they aren't specialized (the only specialized thing would be administering chemo). Some resumes also list subjective things such as "team player" or something about critical thinking or time management, but again I feel as though that's something you should have anyway so I feel a little silly putting it on a resume. I'm sure I'm overthinking this as I tend to do with most things, but any advice would be appreciated! Thanks!

Wow! I am sorry, this sounds awful. I have been a nurse 5 1/2 years...have always worked on the same med/surg floor (it's mainly just medical actually). When I first started out, on orientation, my preceptor wanted me to eventually take up to 8 pts because this happened at times and they wanted to make sure I could do it. Typical was 1:7...1:6 was wonderful...now over the last couple of years 1:6 has become almost unheard of. Typical is 1:5 on day shift AND night shift and if a nurse has a higher acuity pt then they have 1:4. We have a 24 bed unit and fully staffed we should have a charge RN and 5 other RNs, 3 CNAs and a unit clerk. If we are short a nurse, the charge takes patients. I frequently am charge, and especially now with people getting sick and calling out, I've had to take a 4 pt assignment and keep everyone else at 5. It sucks, but I personally am not comfortable giving the nurses 6 patients because it really is not safe, and if they drown, I cannot help them because I have my own patients. And as charge nurses, we also come in half an hour early to get report specifically so we can split up the patients based on acuity...the scenario you described above would not happen on our unit, someone would be in huge trouble for making an assignment like that. It might sound like we baby the nurses when we are in charge, but hey, we have the lowest turnover rate in our hospital and an incredible team and everyone truly is willing to help each other out. It can be stressful...it is common to flip your assignment with all the discharges, admissions, and transfers...and med/surg is crazy in general...but good units do exist! Actually there are a couple of nurses on my floor who work on med/surg floors PRN in another hospital nearby, and they say our floor is hellacious compared to the other hospital's med/surg floor. So, there are DEFINITELY better places to work, even if you stay in med/surg. It's worth looking before you burn out completely and possibly leave the nursing profession. Good luck! :)