Serious about critical care, RN

[pinkflamingo72]

Hi all,

I have been orienting on a step down/critical care unit for the past 6 weeks. I transferred in from subacute/long term care and feel like I have been making progress. I have been studying as hard as I did in nursing school in order to prepare for this job, learn medications, boost my assessment skills, and understand the telemetry side of things. However, my supervisor and preceptor say that because I did not work Med-surg, I missed out on valuable time management and prioritization development. I no not disagree with this, however I feel that I can make it on critical care. I work hard on the unit, but lack the experience many other nurses have developed when they transfer from a med-surg unit. I am willing to put in the time and effort to succeed in critical care, to be a proficient critical care nurse. I know that books can only take my nursing so far. I feel cornered, frustrated, with my lack of progress.

How can I reach this goal? What, in your experience, has helped new nurses to succeed on a critical care unit? Tricks? Tips? I appreciate and value your guidance.

[Biffbradford]

Welcome to Allnurses! :) Where do YOU feel that you can make some improvements? That would be a good place to start.

[pinkflamingo72]

I know I need to work in time management, getting in and out of patient rooms in a timely manner, and prioritization of patients (I have up to five as a nurse on a critical care-step down unit). What are ways that I can get in and out of a patient's room with medications and assessments? I have tried doing vitals and assessments together, then giving medications, but still have trouble making it to 930 am rounds with the hospitalists. Thank you

[Biffbradford]

Hard to say. Be courteous but curt with your time. Get in, get it done, and get out. Even in the ICU where you 'only' have 2 patients, you have to pick one to start with. Do you see the 'easy' one first? Or the 'hard' one? I usually go with the sickest, or busiest first so I don't get bit in the *** by something small now that can grow to major trouble later. Nip it in the bud! Then you can relax and get to the 'easier' of the patients.

[pinkflamingo72]

thank you!

[icuRNmaggie, BSN, RN]

What kind of patients do you have on a typical day?

What IV drips are allowed on your unit?

Do you have a tech, monitor tech or secretary? Are they helpful or not.

How frequently are you doing VS and who charts them or do they import from the monitor.

How do you organize your day?

Did they provide a worksheet to use for report and organizing tasks?

What are the times for routine med passes?

Did you know that nobody should be interrupting you when you are giving medications? "Please take a message. I will call them back. Thank you."

Do you find yourself making 999 trips to the pyxis/accudose?

Are visitors monopolizing your time?

This 9:30 hospitalist meeting is when you say what your patient needs, report off everything concisely, get diet consults, pain meds, whatever and you ask for transfer orders for the stable pts. So block out 15 minutes for that and get there early and go first. No chit chat. Keep them focused.

What do you see as the biggest barrier to getting the task work done in a timely manner?

Your preceptor and manager should be coming up with suggestions to help you manage your time not just critiquing you.

I will gladly make suggestions when I know more about this stepdown.

[pinkflamingo72]

What kind of patients do you have on a typical day?

Patients tend to be CHF/fluid overload, renal failure (its most likely will end up getting dialysis), MI rule out, detox (etoh, barbiturates, etc.), stroke rule out, rhabdomyolisis (drug induced, elderly who have been on the floor for several hours following fall), pneumonia with pleural effusion/infiltrate, pancreatitis… we are part of a two hospital system and get a fair amount of detoxing patients who end up on ativan drips, librium tapers, and use various restraints and sitters.

What IV drips are allowed on your unit?

drips are ativan (up to 15/hr), dopamine (for hr and renal perfusion, can't titrate for BP), dobutamine, heparin, nitroglycerin, cardizem, electrolytes (banana bags, potassium, mag…)

Do you have a tech, monitor tech or secretary? Are they helpful or not.

we have patient care techs and usually have a secretary. We are responsible for monitoring our own strips and patient rhythms (documentation for these every 2hours). The secretary is helpful, and the techs are better than any I have worked with before.

How frequently are you doing VS and who charts them or do they import from the monitor.

Nurses are responsible for 8am vitals and 8pm vitals and for charting these. Techs get vitals all other times and chart the vitals they retrieve. Unit protocol is vitals and assessments every 4 hours. vitals do not show up on the monitor. If the patient is on a drip and vitals are needed every hour or more frequently, we can set it up so bp goes off every hour and shows up on the monitor

How do you organize your day?

come in, get report, look up patient info (history, adm diagnosis, meds/times, labs, covering MD, consults, tests, diet, pen meds given)

Did they provide a worksheet to use for report and organizing tasks?

no, I make my own

What are the times for routine med passes?

8-9, 11-12, 2-4.

varies depending on the needs of the patient. Frequently, IV mag is ordered as STAT as soon as the order is entered by the doc.

Did you know that nobody should be interrupting you when you are giving medications? "Please take a message. I will call them back. Thank you."

Do you find yourself making 999 trips to the pyxis/accudose?

The doctors frequently put in new orders, and i find it difficult to keep track of them. The docs are supposed to notify the nurses of new orders/changes but this rarely happens. Med adjustments are typically made during the med pass process, and don't go through right away on the hand held we use making it difficult. I usually make two trips per med pass per patient and feel silly that i have to go back into the pixies. If the floor is fully staffed, it can take 10 mins or more, with the valuable time spent waiting in line to get these (newly ordered) meds.

Are visitors monopolizing your time?

at least one patient tends to be "needy" or have a needy family.

What do you see as the biggest barrier to getting the task work done in a timely manner?

>>frequent order changes/adjustments, waiting for the MD to call back, especially if the assigned md is from outside the hospital.

Your preceptor and manager should be coming up with suggestions to help you manage your time not just critiquing you. >>There is so much I do not know, coming from a rehab/LTC facility. I am little more experienced than a new grad, and it is difficult for me to figure out what I do not know, what I need to know. I have asked preceptor and supervisor if there are classes I can take, how I can better prepare myself for critical care, and practice my critical thinking. I am working hard to learn, and spend my days off studying form 8a-6p. But there is only so much I can learn from books, and only so much I can absorb and remember at a time. The advice I receive is to "work on my critical thinking and ask more questions…" But this is difficult for me to pt into practice because how can I work on critical thinking if I don't know where to start?

I am on my 11th week of orientation (32hours/week). I feel like i have already made a lot of progress, but am disappointed in the perceived lack of progress my preceptors and supervisors feel I am making. I am sure you understand when I say I feel like I am failing while I am not succeeding in the critical care setting in their eyes.

I love this unit, the hospital, the staff. Patients will always be patients.

I want to make it clear to my supervisors and preceptor that I am committed to success and patient care, but am unsure of how to go about this in a way that is not too aggressive.