What do I need to work in an ICU?

hollyster · Jun 5, 2005

Hoping some of you ICU nurses--past and present--would describe the qualities that work well for the ICU nurse.
I'm contemplating a move, but I have no idea if I'll fit in.

The qualities of a unit nurse, partial insanity, the ability to turn mds to ice with a glance, the usual forty gallon bladder(they did not put any bathrooms in the unit because the pts would not need them, heck with staff), we do not leave the unit for lunch. But places deliver, for some strange reason the delivery people don't like to come inside the unit:chuckle In my unit you will notice a lot of the nurse's stating that "they are going out to smoke" only two of the nurses actually smoke the rest of us do it because it is the only acceptable excuse to leave the unit:rolleyes: other than a road trip with a pt.

The units that I have worked in are just like any other cross section. I will say that the personalities are more forceful than in other areas. You will have a lot more autonomy and for some it is a good thing and others it makes them uncomfortable. And be prepared for a lot of gallows humor, that is the only way a lot of us can handle the stress and we mean no disrespect to the pts. I have not worked on a floor but from what I have read the unit staff are much more team players since we do not have techs or aide we have to rely on each other.

Do not worry you will fit in. I am sorry your other position turned out the way it did. Take Care

mattsmom81 · Jun 5, 2005

As an ICU nurse you will be expected to approach situations more like doctors than nurses, IMHO, as I've found the docs expect much more out of you. You must know how to talk their language to get what you need quickly for your acutely ill patients. You must thrive in an environment that changes from moment to moment and work well under pressure. You will have less patients, but will be expected to have indepth knowledge of them and follow their labs and asessment data closely.

You also have to learn to deal with patients and family members in extreme crisis which in itself can be a daunting task.

If you find yourself enjoying your more complex patients and wishing you could know more about their diseases, etc...ICU may be for you....and there is always something new to learn! We work with lots of hitech equipment, which gives us information about our patients, so an ICU nurse must get comfy with interpreting and troubleshooting a myriad of monitors and computerized machinery too. We do a myriad of bedside procedures...temporary pacemakers, Swan Ganz placements, pericardiocentesis, emergency endoscopy, opening up a chest in tamponade post cardiac surgery...so we get good at creating a sterile field and assisting the doctor often under emergent conditions.

Its true that sometimes nurses in ICU develop huge egos, unfortunately I've had to work with a few like that.

You should be confortable with ACLS and managing codes because you will likely be the first responder in the hospital...the ICU and ER nurse and RT generally manage til a doc can get there.

If reading this makes you excited ICU may be for you! :)

austin heart, BSN, RN · Jun 5, 2005

I agree with ALL of the above.

It is also a good thing to have a good working knowledge of critical drips and drugs...What they are, how they are used and effect on patiants.

LilRedRN1973 · Jun 5, 2005

Concur with all of the above and.....get comfortable talking to patients who don't talk back. That is one thing I noticed some of the nurses in my unit don't do...and have even teased me about it. I talk to my patients ALL the time....especially when touching them or doing a procedure. I know if I were laying there and could even remotely sense what was going on, I would want someone to talk me through what they were doing. And if I have the time (usually right my 4am assessment and bedbath), I will do things like shave a female patient's legs while talking to them about their family who visited, etc.

I also spend downtime trying to find ways for my patients to let me know what they want when they are vented and cannot verbally communicate and/or write. One gentleman was alert and aware, but was unable to use the spelling board, picture board, write, or verbalize, so what we did was I said the letters of the alphabet and when I got the letter that was in the word he was thinking of, he would tap the bed. After the first 2 letters (a-i), I figured out he felt like he wasn't getting enough air and had RT come in to help.

Also, a person who is willing to help out their podmates is a great ICU nurse. When I'm finished with my assessments and charting q 2 hours, I will go around and see if anyone needs help with bed baths, turning, etc. My unit is tightknit and willing to work as team. I love the night staff because they all work together and everyone does their fair share.

Melanie = )

hollyster · Jun 6, 2005

Concur with all of the above and.....get comfortable talking to patients who don't talk back. That is one thing I noticed some of the nurses in my unit don't do...and have even teased me about it. I talk to my patients ALL the time....especially when touching them or doing a procedure. I know if I were laying there and could even remotely sense what was going on, I would want someone to talk me through what they were doing.
Melanie = )

I had a pt that was a DNR she went into an agonal rhythm so I walked into the room and started singing Amazing Grace(I always ask a family member if the pt has a favorite song or hymn.) Unknown to me one of the cardiothoracic mds and the other nurses were standing just outside the door listening to me. I kept singing what hymns I knew and after five minutes she flipped into SR and had a weak pulse. I told the pt to rest, pt was obtunded for days. When I walked out of the room they were all laughing at my bad singing and the md said "Holly, you sing so bad that poor woman came back because she thought it had to be the devil himself to sing that bad."

It took me a long time to live that down but I always talk and sing to my pts.

UM Review RN, ASN, RN · Jun 6, 2005

the md said "Holly, you sing so bad that poor woman came back because she thought it had to be the devil himself to sing that bad."

:rotfl: Too funny!

I would like to be able to have some quality time with my patients. Is that possible in ICU? I imagine that it would be, since there's so much one-to-one care involved. So that aspect appealed to me. I would be preceptored if I did this, and the training is good. I checked the job board--there are two openings.

I have no clue about drips. Well, maybe a couple: I've run Cardizem, and had patients on Nitro, Dopamine, Dobutamine and Integrilin, though I don't recall starting those. And we can't titrate.

I'm very good at starting IVs. I floated to the Unit a couple of times, and figured out some of the machines pretty well by myself. No knowledge at all about vents. Have to renew my ACLS.

Also, I'm not really having any problems with my present unit per se, I just realized that I'm eligible to move soon. Wondering if ICU would be a good direction to grow in.

So I was thinking about all the possibilities--different shift, different unit, which direction do I want to take, or maybe just stay where I am for awhile.