Typical ICU shift

Ruby Vee, BSN · Nov 16, 2016

What is a typical shift like in a medical ICU? What types of patients/diagnoses do you see? Is it more or less stressful than a med/surg floor? Any insight appreciated... Considering looking for a job in the ICU at some point in my career and I don't want to try it only to find out I hate it or I'm not cut out for it. Thanks!

Smaller hospitals have generalized ICUs, where you may find a wide variety of patients and the sickest of the sick get transferred to the Big City Teaching Hospital.

The Big City Teaching Hospital may have as many as a dozen specialized intensive care units. Medical, surgical, transplant, trauma, pediatric, neonatal, oncology, neuro, thoracic, cardiac, coronary, burn . . . the list is probably longer. So the patients/diagnoses you see will depend greatly upon the type of ICU you choose.

You will have only 1 or 2 patients, but those patients will keep you busy your entire shift. Complete assessments are done every four hours, vital signs as often as every fifteen minutes (or every five minutes given some procedures or changes), vasoactive drips are titrated, I & O is done hourly, rounds may take an hour in the morning and half an hour in the evening. Then there are q 2h turns, suctioning, charting, dressing changes, the baths, weights, lab draws -- many patients are on insulin drips and glucose checks are done hourly -- or even 20 minutes of the sugars are labile. Some patients are on CVVHD, others are on balloon pumps or have ICP monitoring. Everyone will be monitored for rhythm, some will have arterial lines or pulmonary artery catheters, chest tubes, feeding tubes, NG tubes, Foleys, rectal tubes, wound drains, or even drainage bags to collect drainage from old venipuncture sites. They'll have transfusions, vasoactive drips, frequent antibiotics, pain medications. And they'll have visitors who must be kept up to date, allowed to visit, monitored to ensure that they're behaving appropriately and following the rules, customer serviced and managed.

I love ICU, I've worked in one or another for the past 35 years. But one ICU is not like another -- you have to think carefully about what you like and don't like and choose accordingly.

Salter444 · Nov 18, 2016

Depends on the unit and which facility. But typical day.

1. Arrive and find assignment

2. Find night nurse to get bedside report and review gtts, lines and GCS

3. Assess patient

4. Review labs

5. Chart assessment to stay ahead of the game

6. Pull and administer meds

7. Multi-dis rounds (have questions ready)

8. deal with crazy family

9. Argue with slow pharmacyy

10. Yell at lab for losing your specimen

11. Tell family member not to mess with the vent, IV or dressing

12. shove food in face and ignore phone for 10 min lunch

13. haul patient to CT

14. Transfer orders - yes

15. spend 90 minutes trying to get a step-down nurse to take report

16. Field calls from ED on why you cannot take the new patient

17. spend 15 minutes answering stupid questions from new Step-down nurse

18. Transfer patient

19. Pt arrives from ED and room not clean - give stink eye to ED nurse

20. Tell family of new patient to stay in waiting room so you can situate patient

21. Roll eyes at family member who ask you to get them coffee and then tell her the facility is too cheap to provide coffee

22. Call resident and let them know a 20mg push of ativan could possible kill your 88 year old COPD ESRD patient and have order change

23. Lab calls to question why your Trauma patient has a Hemoglobin of 4. (roll eyes and feel sharp pain in temple)

24. Draw odd labs every seven minutes as resident writes one as he is googling the disease management

25. PEE

26. Try to organize notes and pray your night nurse gets there on time

27. Wait 15 minutes as the night nurse chats away with friend in breakroom

28. Give report

29. Race to car as fast as you can

30. Get to car and see you have the PCA key and phone in pocket (cry softly)

31. walk the 8 miles from the parking garage back to the unit to return the key and phone

32. Ambushed by night nurse who did not bother to listen to report and now has questions

33. Answer questions (right eye twitching from continued rolling)

34. Leave unit, go to garage, find car and go home

35. Wonder *** was I thinking when I decided to be a nurse

6

Ruby Vee, BSN · Nov 18, 2016

Depends on the unit and which facility. But typical day.
1. Arrive and find assignment
2. Find night nurse to get bedside report and review gtts, lines and GCS
3. Assess patient
4. Review labs
5. Chart assessment to stay ahead of the game
6. Pull and administer meds
7. Multi-dis rounds (have questions ready)
8. deal with crazy family
9. Argue with slow pharmacyy
10. Yell at lab for losing your specimen
11. Tell family member not to mess with the vent, IV or dressing
12. shove food in face and ignore phone for 10 min lunch
13. haul patient to CT
14. Transfer orders - yes
15. spend 90 minutes trying to get a step-down nurse to take report
16. Field calls from ED on why you cannot take the new patient
17. spend 15 minutes answering stupid questions from new Step-down nurse
18. Transfer patient
19. Pt arrives from ED and room not clean - give stink eye to ED nurse
20. Tell family of new patient to stay in waiting room so you can situate patient
21. Roll eyes at family member who ask you to get them coffee and then tell her the facility is too cheap to provide coffee
22. Call resident and let them know a 20mg push of ativan could possible kill your 88 year old COPD ESRD patient and have order change
23. Lab calls to question why your Trauma patient has a Hemoglobin of 4. (roll eyes and feel sharp pain in temple)
24. Draw odd labs every seven minutes as resident writes one as he is googling the disease management
25. PEE
26. Try to organize notes and pray your night nurse gets there on time
27. Wait 15 minutes as the night nurse chats away with friend in breakroom
28. Give report
29. Race to car as fast as you can
30. Get to car and see you have the PCA key and phone in pocket (cry softly)
31. walk the 8 miles from the parking garage back to the unit to return the key and phone
32. Ambushed by night nurse who did not bother to listen to report and now has questions
33. Answer questions (right eye twitching from continued rolling)
34. Leave unit, go to garage, find car and go home
35. Wonder *** was I thinking when I decided to be a nurse
6

Some days are like that.

jdub6 · Oct 21, 2017

Depends on the unit and which facility. But typical day.
1. Arrive and find
...
8. deal with crazy family
9. Argue with slow pharmacyy
10. Yell at lab for losing your specimen
...
21. Roll eyes at family member who ask you to get them coffee and then tell her the facility is too cheap to provide coffee
22. Call resident and let them know a 20mg push of ativan could possible kill your 88 year old COPD ESRD patient and have order change
23. Lab calls to question why your Trauma patient has a Hemoglobin of 4. (roll eyes and feel sharp pain in temple)
24. Draw odd labs every seven minutes as resident writes one as he is googling the disease management
6

Some days are like that in ANY specialty (especially appreciate #24-this happens in ED and on the floors as well! You forgot 24.5 though "step away from drawing specimen #5 to answer call from resident about why said specimen has not been sent. Explain the patient is a hard stick, it took 12 sticks from 6 staff to get #4 which is why you drew extra tubes and paged at that time-37 min ago, no reply-to ask if he was really sure this was all he needed. Suggest it would be easier and less painful for all involved to just amputate one of patients limbs and send the whole thing to the lab where they can find their own non-hemolyzed quantity sufficient non clotted specimen for this critically important STAT vitamim D level."

jodispamodi · Oct 21, 2017

wait a minute, pee? you get to pee and dont have to hold it so long your bladder stops telling you its full,lol

jdub6 · Oct 21, 2017

To OP: in my experience ICU is different in that report is much more detailed (expect to know exert detail of the patient and any device and med and lab result). Nursing rounds with the docs-this is time-consuming but a great time to learn about your patient, their plan of care and to ask questions/clarify orders. You will be bored at times.

You spend longer chunks of time at each bedside and wind up doing a lot mote of the physical care (turns, baths, changes) because 1) you're there and if there is a tech they have way more patients than you and 2) you have to be present for the activity anyway to assess skin, watch lines and tubes or watch vitals. In most ICUs about 85% plus will be sick or sedated enough to be total care or max assist (the latter is more difficult.) When they can eat, get to commode and talk/use call bell they are well enough for stepdown!

You'll use a lot of central and arterial lines. You may do less peripheral/IV sticks for this reason.

You'll deal with vents, bipap, cpap, hiflow, cough assist and all manner of respiratory support and will many times do your own suction or change basic settings rather than having RT do it.

You'll do a lot of blood gasses. You may be trained in arterial sticks for this reason. You'll need to know how to interpret them instantly.

You'll do some things (urine dip, glucose, blood gas from art line, stool heme) without orders just as routine often. You'll get used to having full vitals and a lot of diagnostics on your patient at all times-when assessing a change in condition you have a lot of objective info to help. You'll never call a rapid response or code because your team is the response/code team. You'll always have providers right there when you have a concern or question and will not have the same level of independence in assessment/intervention that they do on the floor because you'll never wait an hour for someone to see your patient and enter labs/imaging when they're declining. Similarly you won't need to know standing orders as well because you'll usually be able to get custom orders quickly. You'll also usually have RT and maybe pharmacy close by for emergencies or assistance.

You'll have to take most of your patients to any off-unit tests/procedures-for diagnostics other than IR/OR you will transport and stay/monitor for the duration. If intubated you will take resp. You may take an MD depending on pt stability. For IR/OR/dialysis etc you generally are responsible for transport but will give report to nursing or anesthesia and then get report from them when the procedure is done. OR patients usually will not stop at PACU, they will come straight to you and recover/extubate in ICU. You will get report from anesthesia and usually anesthesia and peri-op staff will transport them to you.

You'll assist with lots of procedures at bedside-line placement; intubation, drain placement, suturing, sometimes full blown surgery if patient too unstable to get to OR. This can mean staying in one position in sterile garb and/or leads for an hour or more (esp in teaching hospitals as an intern tries and tries, tries again for their first art line etc).

You'll work very closely with residents and fellows and PA/NPs (who may function as fellows) as they are at bedside a lot if patient is unstable or having procedures done. Even if stable you'll need lots of orders and update them often and they generally are on unit or very close all shift.

Hopefully you'll be in one of many ICUs where teamwork is the standard-if a patient goes bad or is aggressive or there's an admit everyone will help without being asked.

There's a lot more but i think that's enough for now.