Tips for a new nurse going into ICU

Indy, LPN, LVN · Jul 31, 2012

Get a Kathy White's Fast Facts for ICU book. Get a Gayhart IV drug book. If you have a smartphone, epocrates is pretty good to have for fast lookup of drugs. While you are at it, explore their drip calculator and know how to use it, just in case you wind up with a drip that's not programmed into the IV pumps.

Get a good size lunch box, pack lots of snacks and liquids. If you want them to like you, bring good coffee from home once in a while. Step back and realize that the vent patients you saw in home health are stable. You will see a lot of unstable ones in the ICU so things will be a bit different. While you are there, if you happen on a buddy who will be blunt with you and give good advice, nurture that relationship. And then just work your booty off. :-)

MedSurger · Jul 31, 2012

You ROCK. Thank you!

I plan on taking all of your advice.

OnlybyHisgraceRN, ASN, RN · Jul 31, 2012

I'm a nurse new to ICU and my advice is to always look up unfamiliar diseases at home. You have to know your path to succeed in ICU. Never be afraid to ask questions. Alway ask for help if you are unsure about something. Find a buddy to chat with or vent to, you will need to let it out.

Good luck to you. :redbeathe

LouisVRN, RN · Jul 31, 2012

I don't work ICU. I'm a Med/Surg Charge nurse. But we get to see the intensivists/ICU charge nurses whenever there is a rapid response/code. And what I've learned is this...ask a lot of questions. Most of them have been doing it for years and welcome questions, especially when next time you can show them that you've learned from their answers. Ie. during my first code I was asking the intensivist what supplies he would like, obviously the code team had taken over caring for the patient, the next code everything is setup ASAP: suction, a central line kit outside the door, portable O2, the furniture is all moved in the hall.

RNforLongTime · Aug 1, 2012

Be prepared to ask a LOT of questions! Ive been an RN for 15yrs and an ICU nurse for 10yrs and I STILL don't know everything!! A good textbook to have is Thelans Critical Care Nursing textbook....it's pricey but jam packed with info. Lots of Critical Care courses use this textbook to teach their course. Be prepared to do a LOT of studying on your own time. I still have to look things up. Good luck!!

Piglet08 · Aug 2, 2012

Listen more than you speak. You'll learn more that way.

Realize that as you're being trained as a critical care nurse, you are still a nurse, and responsible for knowing what you're doing. That means, if you don't understand why a med or procedure is ordered, ask, and if it doesn't make sense, keep asking. I realize not all workplaces will support you in this, so you do have a heavy responsibility to educate yourself on your own time so you CAN pick things up as quickly as possible. But sometimes doctors make mistakes in orders, or the patient's condition changes since the order was written, and if you don't understand what's going on you won't be able to head off a problem. It might not be your fault, exactly, but still, you're often the last set of eyes and ears at the bedside, the last safeguard. If something doesn't make sense to you, it might not be because you just don't know. It might be because you DO know, and something is wrong.

Follow policies. Don't be a hero. Keep your backside covered. Don't overinvest your emotions in your work. Example: our policy is now that pharmacy mixes medication drips unless there's a life-threatening emergent need for nursing to do it. A coworker had a patient on an insulin drip, had been calling pharmacy for a couple of hours that the bag would run dry at such-and-such a time, and of course, that time arrived and she didn't have her new bag of insulin. She was so invested in those blood sugars, she had spent alllllll day titrating the drip, and was furious that it was all going to go to waste. She charged off to the med room, stating she was going to mix it herself. I threw myself in front of the med room door and talked her down. Insulin is NOT that kind of emergency. Half an hour with no insulin drip would not threaten the patient's life. God forbid, something went wrong with the insulin drip, and they see that it was something she mixed herself, she'd be hung out to dry, whether it was her fault or not. Another example: a different coworker, once again deeply invested in an insulin drip, let herself feel rushed in hanging a new bag. I wasn't there, I don't know the whole story, but she wound up spiking the insulin onto the antibiotic piggyback tubing and running it very briefly at the antibiotic rate. This happened because she did not follow the policy of doublechecking new bags of dangerous drips with another nurse, because no one was available right that minute and she let herself think it was a crisis. She realized her mistake very quickly, and hollered for help and 'fessed up with no attempt to cover it up, and learned from it, and the patient was okay, so all was well. But it was scary.

Piglet08 · Aug 2, 2012

Oh, one more thing. Don't act on verbal information. What I mean is, if the lab calls you to say that your patient's result is this or that -let's say a low potassium- you, being a good, caring, diligent nurse, know your patient has a potassium protocol and you want to just run and get a bag and get it going.

Don't do it. Waaaaiiiittt.... for the printout, or the result to pop up on the computer, or some other kind of evidence that the lab told you that. They could be wrong. Mistakes can happen. They might have told you someone else's result, and if you acted on it, it's gonna be a "he said, she said" thing, and you're the one who actually did something TO the patient, so you're the one in the hot seat. If it's a superhorriblyscarybad result, tell the lab person to get it in the system stat so you can act on it.

I learned this from a friend who got that kind of call, with both her patients on heparin drips, and she swore up and down that the lab person said this and not that; she had no proof that it was the lab tech and not her making the error, and she gave a heparin bolus to the patient who actually had an elevated PTT, and the patient ultimately needed a craniotomy. I was the nurse caring for the patient that night, and it was a bad scene.

OnlybyHisgraceRN, ASN, RN · Aug 2, 2012

Listen more than you speak. You'll learn more that way.
Realize that as you're being trained as a critical care nurse, you are still a nurse, and responsible for knowing what you're doing. That means, if you don't understand why a med or procedure is ordered, ask, and if it doesn't make sense, keep asking. I realize not all workplaces will support you in this, so you do have a heavy responsibility to educate yourself on your own time so you CAN pick things up as quickly as possible. But sometimes doctors make mistakes in orders, or the patient's condition changes since the order was written, and if you don't understand what's going on you won't be able to head off a problem. It might not be your fault, exactly, but still, you're often the last set of eyes and ears at the bedside, the last safeguard. If something doesn't make sense to you, it might not be because you just don't know. It might be because you DO know, and something is wrong.
Follow policies. Don't be a hero. Keep your backside covered. Don't overinvest your emotions in your work. Example: our policy is now that pharmacy mixes medication drips unless there's a life-threatening emergent need for nursing to do it. A coworker had a patient on an insulin drip, had been calling pharmacy for a couple of hours that the bag would run dry at such-and-such a time, and of course, that time arrived and she didn't have her new bag of insulin. She was so invested in those blood sugars, she had spent alllllll day titrating the drip, and was furious that it was all going to go to waste. She charged off to the med room, stating she was going to mix it herself. I threw myself in front of the med room door and talked her down. Insulin is NOT that kind of emergency. Half an hour with no insulin drip would not threaten the patient's life. God forbid, something went wrong with the insulin drip, and they see that it was something she mixed herself, she'd be hung out to dry, whether it was her fault or not. Another example: a different coworker, once again deeply invested in an insulin drip, let herself feel rushed in hanging a new bag. I wasn't there, I don't know the whole story, but she wound up spiking the insulin onto the antibiotic piggyback tubing and running it very briefly at the antibiotic rate. This happened because she did not follow the policy of doublechecking new bags of dangerous drips with another nurse, because no one was available right that minute and she let herself think it was a crisis. She realized her mistake very quickly, and hollered for help and 'fessed up with no attempt to cover it up, and learned from it, and the patient was okay, so all was well. But it was scary.

Awesome advice!

PlumeriaSun · Aug 2, 2012

Oh, one more thing. Don't act on verbal information. What I mean is, if the lab calls you to say that your patient's result is this or that -let's say a low potassium- you, being a good, caring, diligent nurse, know your patient has a potassium protocol and you want to just run and get a bag and get it going.
Don't do it. Waaaaiiiittt.... for the printout, or the result to pop up on the computer, or some other kind of evidence that the lab told you that. They could be wrong. Mistakes can happen. They might have told you someone else's result, and if you acted on it, it's gonna be a "he said, she said" thing, and you're the one who actually did something TO the patient, so you're the one in the hot seat. If it's a superhorriblyscarybad result, tell the lab person to get it in the system stat so you can act on it.
I learned this from a friend who got that kind of call, with both her patients on heparin drips, and she swore up and down that the lab person said this and not that; she had no proof that it was the lab tech and not her making the error, and she gave a heparin bolus to the patient who actually had an elevated PTT, and the patient ultimately needed a craniotomy. I was the nurse caring for the patient that night, and it was a bad scene.

Great advice Piglet!

Good Morning, Gil · Aug 2, 2012

If you're getting that much orientation, you should be fine. Are you getting 9 months? That's insane, but pretty awesome. My guess is you'll be more than ready to be off orientation when it's all said and done.

Best of luck to you! I started in ICU as a newer nurse, have been there almost a year now (including orientation, which was close to 3 months), and it's going well. It will be intimidating at first, naturally, but you'll learn quickly, and gain confidence as you gain experience. Namely, just read that ICUfaqs.org site; that's what I did when I was brand new, and studied my rhythm strips, too (you need to know these really well, and your hospital will probably enroll you in a class, and critical care classes). The knowledge will serve you well when you start. Also, get your ACLS as soon as possible since you can't push drugs during a code until you have it nor can you travel independently off the unit with your patient (which even if you work nights, you will be doing; I can't count the number of times I've gone down for a stat CT at night). And, once I had handled a code or two, I felt comfortable travelling off the unit, and handling codes. After a code or two, and other acute situations, you'll feel comfortable. It's really just knowing your ACLS protocols, which aren't rocket science, and knowing what to do when your patient's going south. Emergent situations become routine once you know what you're doing. You just need to be able to work quickly, but accurately, of course. And, always ask for help if you need it or if you second guess anything. Also, don't get complacent with meds, etc; I still triple check, but efficiently, even with the computer system, and its served me well. Best of luck to you! Enjoy the process!

OnlybyHisgraceRN, ASN, RN · Aug 2, 2012

If you're getting that much orientation, you should be fine. Are you getting 9 months? That's insane, but pretty awesome. My guess is you'll be more than ready to be off orientation when it's all said and done.
Best of luck to you! I started in ICU as a newer nurse, have been there almost a year now (including orientation, which was close to 3 months), and it's going well. It will be intimidating at first, naturally, but you'll learn quickly, and gain confidence as you gain experience. Namely, just read that ICUfaqs.org site; that's what I did when I was brand new, and studied my rhythm strips, too (you need to know these really well, and your hospital will probably enroll you in a class, and critical care classes). The knowledge will serve you well when you start. Also, get your ACLS as soon as possible since you can't push drugs during a code until you have it nor can you travel independently off the unit with your patient (which even if you work nights, you will be doing; I can't count the number of times I've gone down for a stat CT at night). And, once I had handled a code or two, I felt comfortable travelling off the unit, and handling codes. After a code or two, and other acute situations, you'll feel comfortable. It's really just knowing your ACLS protocols, which aren't rocket science, and knowing what to do when your patient's going south. Emergent situations become routine once you know what you're doing. You just need to be able to work quickly, but accurately, of course. And, always ask for help if you need it or if you second guess anything. Also, don't get complacent with meds, etc; I still triple check, but efficiently, even with the computer system, and its served me well. Best of luck to you! Enjoy the process!

Is this your hospital policy? I travel off the unit with my patients alone without ACLS... Just curious.

BTW- I take the course next week, they fill up fast in my area....