Starting out in the SICU

[fishinNbanjo]

I am a new grad who will be starting in the SICU next week.

I was just wandering if anybody had any advice for me.

Anything would be appreciated, such as a good reference book that I can buy to look stuff up in, and anything else that would be helpful

Also what exactly I can expect, as right now I am just a little nervous (but excited at the same time).

[dorimar, BSN, RN]

Hey fish,

Best of luck to you! Ask, ask, ask. Read , read, read. Don't expect to know too much too soon. Know that many of the nurses out there took a long time to get where they are. Don't be too hard on yourself, and don't let others be too hard on you. Grow a thick skin. Watch the nurses and find out who to emulate (see my response to "surviving orientation").

Best of luck!

[TennRN2004]

Agree with all Dorimar says, it's good advice. Also, see if you can find out what the top most common surgeries/diagnosis are in your unit. Pull up the standing orders for those surgeries so you'll have an idea of what to expect when you admit that type of patient, and also you can look up the surgery to know why it's being done and what the common complications are. Remember even though you'll only have 1 or 2 patients, you'll have your hands full. Keeping on schedule and organized is key to help manage a chaotic shift. Keep up your vitals and urine output up to date if nothing else on your chart. Carry around a pad of post it notes so you can jot down times you page MDs, intubate or line somebody, just in case you are too busy to chart in your narrative when it's happening, you'll have a timeline of what happened when to refer to when you have time to sit down and write it all down so it'll flow and be accurate. Review your orientation packet on your own time. There may be things you can familiarize yourself with before you actually start orienting. If you have some knowledge, you can better absorb what you're preceptor is telling you, and the more foundation you have to start with, the more new stuff you can start working on during orientation.

Of course as far as attitude and work ethic, always get there on time (early preferrably while you're new to give yourself time to settle in before shift), smile be polite to all, ask questions if you're not sure about something, pitch in to help others, make yourself available if there's something cool going on in another room, ask if you can watch.

Ask management too if you can go watch some surgeries, go to procedures suites if you get patients from those areas-cath lab, vascular radiology, etc. Good luck and at the end of the day remember it will only get better. None of the nurses you see around you could do it all at once when they started and neither will you. But, you'll grow as a nurse and be as good as they are once you get your feet wet and off to a running start.

[smileysenior]

Hey fish,

Best of luck to you! Ask, ask, ask. Read , read, read. Don't expect to know too much too soon. Know that many of the nurses out there took a long time to get where they are. Don't be too hard on yourself, and don't let others be too hard on you. Grow a thick skin. Watch the nurses and find out who to emulate (see my response to "surviving orientation").

Best of luck!

In the past, most nurses entering into the ICU had to have a year of medsurg experience under their belt so it took them a while to be skilled ICU nurses! So dont be hard on yourself if u are going straight from school to the ICU. THICK SKIN! I totally agree with the above post...........ICU has a high burnout rate.........a year because it can be mentally, physically, and emotionally draining. Make time for urself.

[dfk, RN, CRNA]

hey fishin...

first off congrats and good luck...

SICU is or can be rather busy, but well worth it..

the learning curve is tremendous, and provided you get into the right environment (staff/etc...), an unbelievable experience will incur...

with that, i worked med surg, icu, and ccu for approximately 6 yrs before entering SICU (did it for better CRNA school admittance)..

moved my whole self to nyc level I and bit the bullet--

i have to say, i loved the first few days, hated the first few months and was ready to call it quits and move to another hospital (you know how it's ALWAYS greener elsewhere !!!)

but i kept thinking why i came here and stuck with it (going on 2 yrs at the same facility and in the same unit - holy $h!t) - and my outcome proved favorable.. entering CRNA school in august !!!

within this SICU, i learned more in the first couple of months than i would have in two yrs had i stayed where i was...

i guess what i am trying to say, is, listen to other posters as well..

ask away.. always get involved.. walk with the docs when making rounds.. read read read.. get ccrn.. the more knowledge and experience you have, the better off patients and the staff will be..

again, it will be tough (but rewarding), and a VERY different atmosphere than any other ICU.. everything basically is surgery now, not just medical and the like..

hang in there and keep us posted as to how it goes..

pm me if u want any specifics..

ENJOY !!!

[cardiacRN2006, ADN, RN]

I'm a new grad as well that started off in a MSICU. I've been working for a month now. My advice would be to be gentle with yourself. For the first 2 weeks I went home and beat myself over the all the things I did wrong. It's better now, but all I could think of is "what did I get myself into!". If you are new to the facility (like me) spend your first few days learning all the charting, and how it is done. Learn where the supplies are. Get familiar with the pumps. Believe it or not, they don't expect us to be fully functional nurses right away! My expectations of myself were just too high!

Also, be very open to learning. By that I mean, don't shy away from IVs because you learned them in school already. Or on the first day on the floor chart all the VS and I&Os. Always round with the doctors-stand by your pts side! They will ask you questions, and you will be suprised how much you know. Also, it really puts you on the spot and makes you very uncomfortable the first few times, but after that your confidence will start to grow. Their confidence in you will grow as well.

Good Luck to you!

[hrtprncss]

My advice is try to check your hospital's schedule for GRAND ROUNDS, and try to schedule your lunch time when they have it. A lot of hospitals provide free food and it's a great way to learn and keep up with new things. Go to every Grand Rounds as you can...They welcome nurses there, well at least at all the hospitals I've worked at....

Try to see if your employer provides you with an annual budget that you can use for extra classes, besides the critical care/acls/telemetry one which they usually provide anyways. I was able to deduct the cost of CCRN review, and books from the educational budget for the year.

Try to go to as much inservices you can, from drug reps, not only do they give good information, usually they provide great food, and tons of free stuff, like books and equipments with their logo on it.

Develop a great rapport with your preceptor so that even when your orientation is over, you have a resource. That being said, after orientation, still try to follow your preceptor's schedule so that she/he can be there on the days you're working and be there to assist you.

You might not need to buy a lot of reference books, if you have a Clin Spec for the unit, you might be able to borrow materials from them to read, and use them on your down time.

[augigi, CNS]

Try to go to as much inservices you can, from drug reps, not only do they give good information, usually they provide great food, and tons of free stuff, like books and equipments with their logo on it.

That really annoys me - I used to work as a clinical educator for a medical device company, and to be called a "rep" and asked "where's the food?" annoyed the hell out of me! Why can't people attend education to learn??

OK, that rant over, I would agree with all the previous posters, as well as suggesting you write a daily plan. I always (even after 7 years in ICU) write a daily plan for care, meds, assessment, rounds, everything I think I will need to do, so I can schedule things.

The other BIG thing I found hard when I went to ICU was ACCEPT HELP!! I worked in a post-cardiac surgery unit and always felt like I had to do everything myself. I felt like, if I accepted help I was admitting I couldn't do it myself. It was only as I got more experienced I realized that delegating tasks to others is actually quite a difficult task itself, and that if someone offers help, ALWAYS accept it!

Good luck, enjoy!

[augigi, CNS]

Try to go to as much inservices you can, from drug reps, not only do they give good information, usually they provide great food, and tons of free stuff, like books and equipments with their logo on it.

That really annoys me - I used to work as a clinical educator for a medical device company, and to be called a "rep" and asked "where's the food?" annoyed the hell out of me! Why can't people attend education to learn??

OK, that rant over, I would agree with all the previous posters, as well as suggesting you write a daily plan. I always (even after 7 years in ICU) write a daily plan for care, meds, assessment, rounds, everything I think I will need to do, so I can schedule things.

The other BIG thing I found hard when I went to ICU was ACCEPT HELP!! I worked in a post-cardiac surgery unit and always felt like I had to do everything myself. I felt like, if I accepted help I was admitting I couldn't do it myself. It was only as I got more experienced I realized that delegating tasks to others is actually quite a difficult task itself, and that if someone offers help, ALWAYS accept it!

Good luck, enjoy!

[markm739]

All the advice I have read in this thread is great, and on target. Having completed my first year in ICU straight out of nursing school, a couple more things come to mind.

The ICU tends to attract a certain kind of personality. ICU nurses can often be strong-minded, dominant (or sometimes domineering!), opinionated types.

Unfortunately, since they have learned their job well, so many parts are so automatic for them that they forget just how complex it all is to a newcomer, and often can't understand why it takes us a while to remember it all and put it together. My first piece of advice, therefore, is a rather curious one, and is straight from the mouth of my preceptor soon after I got on the unit.

He said that I should act as if I know what I am doing, even when I don't!! He warned me to phrase my responses so as to reflect to people, especially physicians, that I know what I am doing. If I started a phrase with "I think...", or anything which reflected uncertainty, he would interrupt me and have me rephrase it to reflect that I either knew it or didn't.

I think what he means here is that how one carries themselves influences the perceptions of others, and if you can carry yourself confidently and act like you know what you are doing, it will convey a subliminal impression of competence which will be beneficial; it is a fact of life that people go by impressions and outward appearances more than the substance of things at times.

So, what is the best way to accomplish this when you are feeling overwhelmed, having a bad day, etc. and maybe just feel like having a good cry? Let me relate a day I had involving this board.

My preceptor was in my face quite a bit, and often over things which I felt were just his opinion as opposed to absolute fact. I was told by others who watched us that he was being hard on me (one nurse even mentioned it to our unit educator), so this led to some bleak days, as I had never even been on a medsurg floor before, and was learning both basic nursing and ICU at the same time. It seemed at times that he harped on a couple of things I hadn't done, and that all the good and right things that I knew I had done were not noticed.

One week I sank rather low from his being "in my face" all the time; I dreaded seeing him coming around the corner. I began to feel as if I would never catch on, and was wondering if I should ship out.

I got on this board, and read a note of encouragement someone had written to an orientee which said, "NEVER let ANYONE make you feel incompetent!!"

I was at such a low point, having been made to feel like a blooming idiot by this guy, that these words resonated, and I walked away with a new resolve to not let him do this to me; this was a turning point, I wound up surviving orientation, and am happy as a lark now on the night shift!

So, the net out is this: Watch appearances and how you carry yourself and communicate, believe in yourself when it seems no one else does, and hang in there! Also, keep smiling, even when you don't feel like it, and save your tears for the privacy of your car or home; it may convey an image of weakness to one of the hard nosed types who are ready to look for something wrong, and you will be talked about in a condescending way in little groups when not around; I have heard this done.

One more thing: make sure you understand the general workflow of the unit, as in when things should be done by, etc. Always aim to do everything as early as possible, cause you'll then be ahead of the game when things fall apart, and it will be easier to regroup and be out the door on time.

Best Wishes!

[HHW2006]

I started in ICU (medical and surgical) a few months ago right out of school. All of the advice you have received do far is right on target. I am nearing the end of my orientation and there are still days when I question if I am actually ready to be "on my own", but then I stop and remind myself that I am not ever going to be on my own and neither will you. Don't be afraid to ask questions, no matter how ridiculous you think they may be - it is the person who doesn't ask questions that is scary - they aren't smart enough to know what they don't know. As far as reference books - I have the AACN critical care book and it has been very helpful. Also, Fast Facts by Kathy White is a good reference. It is available on her website @ kwhite.com

Best of luck to you!!!!!

[hrtprncss]

That really annoys me - I used to work as a clinical educator for a medical device company, and to be called a "rep" and asked "where's the food?" annoyed the hell out of me! Why can't people attend education to learn??

Good luck, enjoy!

LOL sorry that annoys u augigi, I was giving her an incentive. To tell you the truth, and as of course you know, it's difficult to get people in without ''bait''. I for one, love inservices from the drug companies, it takes me away from the chaos of the unit, I could sit down and have a nice and quiet for a few minutes. Even if it does sound crude, it is a great form of advertisement. It becomes a symbiotic relationship between the two. As a lot of nurses in the unit knows, ''food and gifts'' are what the companies use to get them in the conference room. You'll see a lot of them by the nursing station and say, ''guys we have food in the kitchen, and an inservice'' I'm not saying it's a bad thing, actually it's a good thing, the companies get their points across, and the nurses learn at the same time. Again, I apologize.