Responsibilities of a MICU/SICU nurse...

-Midget- · Dec 4, 2006

I'm not yet a nurse, but this is a cool site, which I've seen people recomend.

augigi, CNS · Dec 4, 2006

A day in the life in my CVICU was usually:

1. Take report on the patient and check all infusions with the outgoing nurse.

2. Do a complete assessment of the patient and document (neuro obs, ausculating lung, heart and abdo sounds, skin integrity, peripheral pulses etc)

3. Check all equipment on the patient (nitric oxide tank, ventilator settings, zero all pressure transducers, IABP/VAD, chest/wound drains, IDC etc)

4. Document - complete assessment and equipment checklists

5. Check the drug chart and write myself a list of what is due when

6. Attend rounds and make any adjustments (ordering different nasogastric feeds, changing infusions etc)

7. Reassess patient whenever anything significant changes

- Wound care/repositioning as required

- Suctioning as required

- Adjusting ventilator/IABP as required

- Dealing with family/visitors - lots of teaching about monitors etc

- Organising and transporting if tests such as CT required

- Performing and interpreting ECG as required

Basically, you do everything for this patient. We do not have aides etc in ICU, so we were it for the patient (we had help to reposition if required). Everything you learn in med-surg, in a lot more depth in much sicker patients!

Christie RN2006 · Dec 4, 2006

A day in the life in my CVICU was usually:
1. Take report on the patient and check all infusions with the outgoing nurse.
2. Do a complete assessment of the patient and document (neuro obs, ausculating lung, heart and abdo sounds, skin integrity, peripheral pulses etc)
3. Check all equipment on the patient (nitric oxide tank, ventilator settings, zero all pressure transducers, IABP/VAD, chest/wound drains, IDC etc)
4. Document - complete assessment and equipment checklists
5. Check the drug chart and write myself a list of what is due when
6. Attend rounds and make any adjustments (ordering different nasogastric feeds, changing infusions etc)
7. Reassess patient whenever anything significant changes
- Wound care/repositioning as required
- Suctioning as required
- Adjusting ventilator/IABP as required
- Dealing with family/visitors - lots of teaching about monitors etc
- Organising and transporting if tests such as CT required
- Performing and interpreting ECG as required
Basically, you do everything for this patient. We do not have aides etc in ICU, so we were it for the patient (we had help to reposition if required). Everything you learn in med-surg, in a lot more depth in much sicker patients!

That is pretty much what we do too...

I am currently working in a SICU and somedays it is very overwhelming.

Every 4 hours we have to do a full head to toe assessment.

Every 4 hours we have to print off EKG strips and analyze them.

Every 2 hours we have to assess our patients for pain.

Every 2 hours you have to do treatments such as suctioning, repositioning, etc.

We have to do strict I/O, and we have to calculate those either every 4 or every 8 hours.

Depending on our patient we have to do neuro checks anywhere from every 1-4 hours.

We have to do vitals every 1-2 hours.

Every time you move a patient, you have to rezero all their equipment such as ventriculostomies, A-lines, or whatever else they have.

On our floor we get a lot of different things such as ventriculostomies, A-lines, SWAN lines, Internal temp. monitors, ICP monitors, central lines, etc. We also deal with a lot of meds that are not usually found on other floors such as Neo, Pentobarbitol, Levophed, Dopamine, Insulin, TPN, etc.

Just like the person above me said, the patients you deal with in the ICU are a lot sicker and even simple things like turning them could cause serious issues. I had a patient bottom out one time because they couldn't tolerate being turned. I personally really like working in the SICU, because I really enjoy the challenge of it.

Nursenaew · Dec 20, 2008

I would like to be Nurse @ SICU too.

Actually I'm not good in any Calculation, I'm quite scared with IV, I know it just is basic.

Now I'm a last year student.

But I want to be ICU Nurse, I love learning, My senoir said "ICU must study continuous and have always test", So I like to study and new thing.

Challenge is interested me.

But only calculation !!

:no:

NiteyNite · Jan 6, 2009

As long as you have good critical thinking skills then you can handle critical care. From my own experience when I transitioned from med/surg to ICU the biggest change was going from an environment where my main goal was time management to make sure I completed all of my tasks to an environment where critical thinking is paramount. Time management and prioritization is still important but you have to critically think about what is happening with your patients so you can anticipate needed interventions and fix acute problems. Med/surg is more of an observation environment simply due to nurse to patient ratio.

The technology is a little more advanced. You have bedside monitors, a-lines, swan-ganz catheters, balloon pumps, crrt machines, ventilators, etc... But you should receive training on these things during your orientation.

The drugs are a little different as well. You will be titrating vasoactive medications, sedation, etc... based on your patients' response. This isn't a cut and dry subject, you get good at it by doing it a lot and developing a feel for it.

Another big change between floor nursing and ICU nursing is autonomy. As a critical care nurse you'll be expected to have the knowledge to make certain decisions you might not make on the floor and carry out interventions you may feel like you need an order for. This comes with getting to know your intensevist and what they expect you to do in certain situations. You also need to be comfortable with being a team member in a code and may have to run a code. For instance, my hospital is a smaller one and we only have one in house MD available for codes, if there are two codes at the same time an ICU nurse may have to run one of them.

Don't let all this scare you off. Most ICU's have an orientation period during which you will learn what you need to know. Larger hospitals even have internships you can do to gain experience in a few different critical care areas before deciding which one you want to practice in. Preparing for you CCRN is a good way to gain the knowledge you'll need for critical care and a good book for that is "PASS CCRN." A good book regarding hemodynamics that is easy to understand for a new learner is "Hemodynamics Made Incredibly Visual." Realize that if you go into critical care and you don't feel comfortable with a situation you have a charge nurse and colleagues that you can collaborate with. It's a learning process but you shouldn't be afraid of going for it.

RNFELICITY · Jan 14, 2009

If you have a desire to come to the ICU, go to your manager or the ICU manager and ask to shadow a nurse in the ICU for a day or a few hours. You would be amazed at how willing people are to do this.

malaski · Feb 4, 2009

Thanks, I am interviewing for a few different ICU's and this is good info to know.

dorimar, BSN, RN · Feb 5, 2009

I know a lot of nurses here talked about all the equipment, tasks, interventions,and technology, but only one (nighthynight) really mentioned the critical thinking involved. I truly believe that 99% of critical care nursing is prevention. You need to know what could happen as a result of the diagnoses or the treatments and you are respsponsible for preventing these problems or complilcations. Some nurses who come to ICU from the floor think that it is a cush job because they only have 2 patients instead of 6. It is intensive care, because the care shoud be intensive. You should know everything about your 2 patients--what are their cultures, which way is their white count trending, what about the CXRs, they had problem with rapic afib last week resolved with cardizem, thrombocytopenia, GI bleed, blah blah blah..... you need to know all of this--becaus I promise you the docs won't (they change shifts too). I think that some ICU nurses take care of their 2 patients the same way they would take care of 6 on the floor.

Giang · Oct 28, 2010

wow you guys have great sounding jobs! keep up the good work! i am even more eager to work in the sicu now :)

hcox1975, BSN, RN · Oct 30, 2010

You also have to be aware of drug interactions, correct medication orders, and lab work. I work at a teaching hospital and sometimes the doctors aren't familiar with what is needed for the patients. Once you are familiar with the type of patients you are dealing with on a regular basis, this will become easier. For example, with liver patients there are certain medications they might not be able to take due to how the body clears the drug. Even though you have 2 patients or less, you are extremely busy. These patients are in ICU because they are critical and could take a turn for the worse at any second.

aCRNAhopeful · Nov 2, 2010

I would add that nurses in the ICU do much more "diagnosis" than other areas. Of course I don't mean diagnosing someone with Parkinson's disease or something but you have to "diagnose" the situation. This could mean having to interpret numbers from a swan and art line and determining your interventions based on these parameters (all within your set of orders from an MD..... usually..), determining someone is developing an inferior wall MI and taking immediate action to begin stabilizing the patient and THEN calling the doc, and the examples are endless. You may be dealing with a number of docs and many of whom do not know the "big picture" with this patient as well as you do and it will be up to the RN to coordinate all the different services that patient is receiving.