I'm a new grad in a CVICU, just off orientation, I've done 4 nights on my own so far.
I do well with the "stepdown" patients that we have on our unit, but when I get an "ICU", I seem to fall apart. I miss important things like orders for labs and meds, oral care/suctioning for vent patients, when I'm titrating meds to keep someone's blood pressure up. For example, last night, I didn't suction my intubated patient at all, it didn't even cross my mind, she had so many other things going on.
It's very frustrating, and disheartening.
What I want to know is: where should I be at right now? How can I tell if I'm just not cut out for ICU nursing, and should move to the floor? How long should I give it?
Welcome aboard! I've been a CVSICU nurse for>20 years so I think I qualify as an expert. The main problem I see is that you are focusing on what "tasks" need to get done on your shift not what "process" needs to take place to recover your patient. I go many nights without suctioning my patient more than once,-it is a task. Do they have increasing airway pressures, audible rhonchi, hypoxia, are they coughing? Suctioning for the sake of suctioning is a task in can do more harm than good if not clinicaly indicated. My best suggestion is try to look at your patient and say "what is my priority problem for the next 15min" Learning to set priorities and troubleshoot labile patients takes a while to learn. It may be getting caught up on your charting is the most pressing problem for the moment. Try not to think about what you have to do this shift rather what will improve my patients' status right now. What's most wrong with my patient and what do I need to do about it? Taking step down pateints is a great way of gaining experience. If your unit is anything like mine, the senior staff fight over who gets the fresh open hearts. If you can take the step down patients and help out with the fresh hearts when there is something going on everybody wins. 6mos from now you will be fighting for the fresh post ops.
Wow!! I am truly impressed by your honesty and courage in your post. That you know that you have things you missed tells me that all you need is a way to help yourself manage those things. You have the kind of openness and commitment that I would want in a new grad in the ICU. I don't sense (for lack of a better word) arrogance that I see as a downfall of a lot of new nurses to the ICU.
Set yourself up a system so you don't forget the suctioning. Do you have RT coming around to monitor the vented patients as well? They should also be doing suctioning, so I doubt the patient went an entire shift without suctioning.
I really don't think you need much to feel that you are really succeeding in the ICU! Congratulations and keep up the great work!!
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suanna
1,549 Posts
Hi,
Welcome aboard! I've been a CVSICU nurse for>20 years so I think I qualify as an expert. The main problem I see is that you are focusing on what "tasks" need to get done on your shift not what "process" needs to take place to recover your patient. I go many nights without suctioning my patient more than once,-it is a task. Do they have increasing airway pressures, audible rhonchi, hypoxia, are they coughing? Suctioning for the sake of suctioning is a task in can do more harm than good if not clinicaly indicated. My best suggestion is try to look at your patient and say "what is my priority problem for the next 15min" Learning to set priorities and troubleshoot labile patients takes a while to learn. It may be getting caught up on your charting is the most pressing problem for the moment. Try not to think about what you have to do this shift rather what will improve my patients' status right now. What's most wrong with my patient and what do I need to do about it? Taking step down pateints is a great way of gaining experience. If your unit is anything like mine, the senior staff fight over who gets the fresh open hearts. If you can take the step down patients and help out with the fresh hearts when there is something going on everybody wins. 6mos from now you will be fighting for the fresh post ops.