Surviving ICU/nursing... advice for novice?

nurseprnRN, BSN, RN · Apr 10, 2013

1) Do not "depend on others to learn." It's your responsibility. This does not mean you don't ask questions. It does mean that your questions to others are prefaced by, "This is what l read/learned/heard, and this is what I think / have another question about."

2) One day at a time. You'll learn. Every day, write down the three things you learned. They might be small (the lock on the med room door likes to be jiggled just so to open promptly) or huge (the most important thing I have to look out for with a patient with liver failure is ...) but as long as you are learning, you are moving forward.

3) Don't use txtspk. You don't want to find yourself writing "ppl" in a chart and it's hard to read here, which is why we aren't supposed to use it on AN.

4) Don't worry so much about what you think is an "in crowd." This will help: Susan Cain: The power of introverts | Video on TED.com

5) Yes, your development and progress with judgment, prioritizing, and multitasking will be topics of discussion with the management and anyone else who cares to notice. This is part of becoming part of a team and would happen whether you worked for KFC or IBM. One way to improve on these is to seek feedback. When you see the things you want to do, prioritize them in your mind and then ask someone if this plan sounds good to her. Or when you notice someone doing something, ask what factors made the decision come out the way it did.

6) You'll learn how to ask for short-term help, too-- you take the first priority, and ask someone else to do a lower-level one. In your example, the high BP is the priority, and the assist to the bathroom is the lowest, because the BP must be attended to by the RN and the CNA can do the mobility thing. The pain is somewhere in the middle. If the CNA says she's busy, ask her what she's busy with, and then you determine whether the patient who has to go to the bathroom rates higher than whatever she's doing. You still do the BP, but you ask the CNA to either take the patient to the bathroom first, or immediately after she's finished with XYZ. Your call.

RNnur · Apr 10, 2013

Thank you. This is valuable feedback!

lmccrn62, MSN, RN · Apr 11, 2013

I agree what the previous person posted. While the ABC's are what guides us in making priority decisions sometimes other factors can get in the way. I noticed you said that you were in patient 3's room. Since you are already in there consider if anyone else can help if not I would have taken patient 3 to the bathroom. My concern is would this patient get out of bed because they really have to go? Patients often do this and if they fall oh my the fall out. The patient with the high BP on nitro sounds like its invade needing more than Nitro. A final note about being a introvert may be a benefit you can interact with your peers as needed and not worry about getting involved in the usual nonsense. Just do the best by your patients. Everything will fall in place give it time.

tabbycat66 · Apr 11, 2013

ah, yes, so much to say. Day at a time. What you will learn is that , you can only do what you can do. you arent an octopus, lol although at times you need 8 arms working at once! In the beginning, 17 long years ago, i remember feeling the same way, will i ever get this down, and most likely YES you will. Practice makes perfect, the only way you will learn things is to experience them, hands on. When i was new i would look for opportunities for new things, to help out, observe etc. I know nurses are clicky,and until you prove yourself, they probably wont respect you much, its sad how us nurses are. I was never that way, i always try and help and teach someone who is new etc. Try and find someone, a buddy, it helps. I did med surg for a year and it did help me learn the basic stuff so that i was ok to learn the hard stuff in icu. Illl tell you this, i remember i used to write all kinds of iinformation, and tips and just anything i thought was important on index cards and i kept them with me all the time. a good reference when you just arent sure. Dont be afraid to ask questions, just figure out who to ask lol, better safe than sorry. hope this helps

Tracey - critical care RN 17 yrs

RNnur · Apr 11, 2013

Thank you for the insight!

Lennonninja, MSN, APRN, NP · Apr 13, 2013

Never be afraid to ask questions, ICU nurses are scared of new ICU nurses who DON'T ask questions!! If they tell you that it makes you look bad to ask, I'd be scared of them personally. But it depends on what sort of questions you're asking. If it's the same basic things over and over, then they might worry, but if it's good, applicable, in depth questions, they should never fault you for asking.

rcd9229 · May 10, 2013

I think introverted or extroverted really isn't a big deal either way but you do have to be able to work as a team and speak up in Icu. There are tons of quirks in our units, loud quiet goofy....we have all types. The main thing is we all play well together. what's important is that you have some level of critical thinking, in your example, bp is your priority but you are stuck in a room. So if you can't get out of the room, ask for some help. Or sit your patient on the pot, tell em you will be back. And go fix you blood pressure. 5 minutes of high blood pressure is usually not

Going to be extreme. And it depends on the situation. Are they coughing, are they hurting, is it Aline or cuff? And anything you give them is going to take a minute anyway. And if they are on nitro then it should be easy to titrate up and fix. The pain medicine? Ask your coworker or stick your head in the room and tell them to give you a few minutes. Icu is critical care so think that way. And don't freak out. The biggest problems with the newer grads is that they get so task focused that they don't see what's going on with the patient. And I agree with the statements above, if you ask me to help you to set up a pa cath or your ventric because you never have, not a problem. If you ask me how to hang a piggyback or take a urine specimen....that's stuff you should know by now. And if you ask every five minutes if you are doing it right....then maybe you don't need to be doing it. Questions are good, helplessness not so much. And index cards or small notecards are wonderful. I used to do it with my labs. I still carry a pharmacy card with various drip dosages. After a while you know it by heart but that one day they ask you for a dose....and you go blank...voila. Handy card.

Main thing is know your meds, help your team, ( and this doesn't mean you can't be introverted, but asking someone, "can I help you with something?" goes a long way and it'll start bringing you more into the fold, and they will return the favor.) and approach your day with some confidence....

And the fast facts book on hand....not a bad choice either. Always good to have a mini reference

rn444 · Oct 19, 2013

I recently celebrated one year as a Critical Care RN. Its amazing the difference between how I felt when I was starting out and how I feel today. I was gripped with fear that I was going to make a mistake that could hurt someone. I struggled with what seemed to be simple tasks to others ( IV pumps, IV placement, drug titrations). Everyday was a little bit better than the last. One thing that really helped me was seeing senior nurses asking for help and learning new things. It reminded me that one of the gifts of being in the healthcare feild is that there is always something to learn. The scariest nurse is the one who knows everything. I have become more comfortable in the freedom to always ask for help.

my_purpose · Dec 20, 2013

I think we are the same people!!!, lol

-How do you become better at multi-tasking and prioritization while starting in ICU? I would really like to tap in to the wisdom of seasoned nurses…how is this measured most effectively in the novice nurse (is this an innate ability or how is this best measured?)
-Another question (if you are willing to read on) is how would you suggest someone who is naturally more introverted/ slow to warm type personality blend in to a staff that is clicky and may favor extroverts? Can one make it in icu if more introverted? This is something I have always struggled with…even growing up.... befriending the “in crowd”. I was and still am the nerdy/quirky type, even growing up I often dealt with gossiping/verbal slurs …small rural communities can be that way). But I can sit down and read a medical text book cover to cover and I often find sanctuary with those that tend to be “misfits”…I am fine with talking with patients though….I enjoy caring for them but when I feel an atmosphere is judgmental/ gossipy especially when I need to depend on others to learn… I become very anxious and struggle to reach my full potential (something that is slowing my progress down as a new nurse). I am also not shy to ask questions…but I’ve been told that by asking questions it makes me look like I don’t know what I’m doing/unconfident (to be honest as a new grad in ICU I do not know what I am doing at times…another relatively new nurse does not ask as many questions, meshes well with the staff, and is super confident however, I would be absolutely terrified to have her as my nurse since she is not conscientious with care…but she is very fast). After this experience though I agree med surg may have been better to start however, this is not an option for me unless I pick up my family and relocate and ignore the fact that my husband is doing awesome right now (in terms of gaining valuable experience and meshing with his coworkers).
-Basically how can one that has a hard time with the “in crowd” survive when progress for this particular facility (same rural town) is based off of what others say about you? Is that typically how ppl are evaluated in terms of judging prioritization/multi-tasking in nursing? And also how can someone become better with these skills? Eg. Pt 1 paging you for pain medication, pt 2 on nitro drip and notified that Bp 200/100, pt 3 you're currently in this persons room whose a high fall risk, helping them to the bathroom while the nurses aide is tied up…. And you’re to manage this as a new grad independently…any suggestions from seasoned RN’s/LPN’s?

LJ85, ADN, BSN, CNA, LPN · Jul 15, 2014

I just graduated in May and desperately want to land a job in icu or picu. I have worked in home health for the past 5 years as an LPN but I worry trauma or icu might not be for me...how do you know whether or not it will be a good fit?

nurseprnRN, BSN, RN · Aug 4, 2014

If you are so desperate to work in one, what makes YOU think you'd be a good fit?