Tips for New Grad ICU Nurse

TheSameVein, BSN, RN · Oct 24, 2019

Congratulations! I was also a new grad who went straight to the ICU. It is a big bite to chew and can be very overwhelming for the first year or so until you get your footing.

Tips:

1. Don't be afraid to ask questions! Talk to your preceptor and let them know what you're thinking (think out loud at times) so they can help you form those critical thinking skills. If you don't, they'll always wonder "what are they thinking?"

2. Get to know your unit/coworkers. Offer to help your neighbors. Introduce yourself to the staff on your unit because you'll be working with them eventually. If you just stick with your preceptor all of the time, then you won't know people once you're on your own.

3. Try to see as much as you can. If someone asks if you want to watch a central line insertion (and you're available to watch) - go watch it! Even if you've already seen a dozen, it looks great to others if you are eager to learn and experience new things.

4. Be humble. You're new and everyone knows it. It can be easy to get defensive with criticism/feedback, but instead try not to immediately jump to that. Admit when you don't know something, which may be a lot of the time at the beginning. That can be a tough pill to swallow depending on your personality, but it will be beneficial and show that you are teachable.

Good luck! Let me know if you have any questions.

SICUMurse123 · Oct 26, 2019

Accept criticism, learn from your mistakes, and don't run from difficult patient assignments.

JacobIloved, BSN · Oct 29, 2019

Put in work! Some people show up as new grads and immediately "get it", some people take time to warm up to being a nurse. But what differentiates the really good nurses from the okay nurses after a while is the amount of work that you're willing to put in.

You should absolutely celebrate the fact that you are getting paid, and that you are no longer a student. But spend a lot of time, even outside of work, studying your patho and your pharm. The more time you spend now, the better your career will be.

bootsandcats, MSN, RN · Oct 29, 2019

2 hours ago, hoiboy said:
Put in work! Some people show up as new grads and immediately "get it", some people take time to warm up to being a nurse. But what differentiates the really good nurses from the okay nurses after a while is the amount of work that you're willing to put in.
You should absolutely celebrate the fact that you are getting paid, and that you are no longer a student. But spend a lot of time, even outside of work, studying your patho and your pharm. The more time you spend now, the better your career will be.

I totally agree with continuing education. I have been reading up on vents/ art lines/ and codes. Any particular drugs and pathos that you feel like I should focus on?

emmjayy, BSN, RN · Nov 2, 2019

On 10/28/2019 at 11:11 PM, bootsandcats said:
I totally agree with continuing education. I have been reading up on vents/ art lines/ and codes. Any particular drugs and pathos that you feel like I should focus on?

For patho - definitely sepsis. Differentiating the types of shock (cardiogenic vs. septic vs. hypovolemic). Liver failure (all aspects - from how it affects mental status to why these patients bleed like crazy to why you can't keep their sugar under control). How ETOH withdrawal affects the body/ETOH withdrawal timelines. Respiratory failure/treatments/signs of flash pulmonary edema. Renal stuff - what electrolyte abnormalities to expect, common reactions to dialysis and how to treat it, the presentation of a patient who is overdue for dialysis.

Understand your different drips that affect blood pressure and how your heart works - my ICU uses phenylephrine, norepinephrine, vasopressin, epinephrine, dobutamine, diltiazem, and amiodarone very commonly. Less commonly, we use milrinone, dopamine, and esmolol but I know the cardiac ICU uses those drips more frequently. Know how they work and when they are indicated. We mix many of these drips on the fly in emergency situations, so I made a sticker I stuck to the back of my badge detailing how to mix standard concentrations of each drip along with which diluent you use (most get mixed with normal saline, but vaso and epi get mixed in D5W, important to remember). Also it's important to know your sedatives/painkillers!! Propofol, precedex (another one you might have to mix yourself), versed, fentanyl, morphine, dilaudid, phenobarbital, ativan... all commonly used for various indications.

Finally, it never hurts to sit down and interpret all the tele strips for all the patients on the unit if you have some downtime. This will help you get good at interpreting what you see on the fly and knowing what different rhythms look like.