What makes a great ICU nurse?

Tharius · Feb 9, 2017

A great ICU nurse can't be defined easily. I work at a level 1 trauma center ICU at a University Hospital and the skills I need may not be reflective of those who work in a different ICU setting. In general, being effective in the ICU means to be strong in your clinical assessment, differentiation in diagnosis, advanced equipment management (MARS/CRRT), and damage control when things do not go well. You work as a go-between many of the different specialties that may be following your patient at any given time and need to be well versed in multiple areas of system dysfunction to communicate effectively. You need to have built upon the principles that every nurse has ingrained within and add new skills to advance your clinical practice.

Please ask any questions that you may have!

Scottishtape · Feb 10, 2017

Thank you for your response!

I've been looking at a new grad ICU position at a local hospital. It has an extensive training program involved.

How would a new grad excel in that environment? What types of education should I pursue during my off time to make sure I become proficient? Are there any certification classes that would be especially useful in the ICU?

Emergent, RN · Feb 10, 2017

Attention to detail, confidence, ability to do do the most mundane, labor intensive personal care, but ready to quickly switch gears and perform the highest level lifesaving procedures.

You have to be always on the edge of your seat, never complacent, and able to withstand claustrophobic conditions, kind of like being deployed on a submarine.

You must be able to withstand the scrutiny and social pressures of your highly strung, detail oriented colleagues as well.

Scottishtape · Feb 10, 2017

You must be able to withstand the scrutiny and social pressures of your highly strung, detail oriented colleagues as well.

This is the part I'd really need to work on. I'm pretty sensitive. I am also type A, which I've heard most ICU nurses are as well. I can see head butting happening between a bunch of type A people!

sevensonnets · Feb 15, 2017

I've never seen what you call head butting in my 37 years in critical care. When you work in that kind of environment you've got to be a team. It's not me against all the rest of them. You learn to get along because it's necessary. If not you won't survive in any critical care environment.

calivianya, BSN, RN · Feb 15, 2017

You've definitely got to have thick skin. That's the number one reason I see people having trouble getting through orientation on my unit. I believe you can learn just about anything if you put your mind to it, but if you can't take people snapping at you and talking down to you, you're going to have trouble at first.

The experienced people on my unit have a tendency to give new hires the worst assignments, let them drown, and then talk crap about them behind their backs. A lot of them are very burned out and they take it out on the new people. Once you've been there a year or so, it all tends to turn around and you're welcomed into the fold, but getting there can be a little bumpy.

Scottishtape · Feb 16, 2017

Thank you for your responses. It seems a little daunting.

It makes me want to really advocate for myself during contract negotiations, just in case. I've seen many contracts that don't allow for unit transfers. So far, the nurses I've been in contact with at that hospital have all been really supportive to learning. I hope the ICU nurses are as well. It can't hurt to give it a shot. I've come across a lot of not so great tempered nurses in my time as an LPN, hopefully that exposure will make it a little easier.

fresnovet · Jul 17, 2017

You've definitely got to have thick skin. That's the number one reason I see people having trouble getting through orientation on my unit. I believe you can learn just about anything if you put your mind to it, but if you can't take people snapping at you and talking down to you, you're going to have trouble at first.
The experienced people on my unit have a tendency to give new hires the worst assignments, let them drown, and then talk crap about them behind their backs. A lot of them are very burned out and they take it out on the new people. Once you've been there a year or so, it all tends to turn around and you're welcomed into the fold, but getting there can be a little bumpy.

Calivianya, I was afraid of this and I feel it might happen anywhere you go. I am a veteran and I'm going to disregard humbleness for a minute here just to make a point. I've done the hardest training in the military that have made grown men cry and quit. I left and then pursued school and performed and worked harder than my colleagues. I've learned in my experience that anywhere you go that is new, makes you the new guys no matter what. I understand a certain level of skepticism coming from my new colleagues but to hear that they might be condescending towards me and then talk behind my back is a hard bullet to bite. I would not do that to another new grad (or anyone), which that is based on the principle of "do unto others..." I am not one to forgoe attitudes from my colleagues like that, so what do you think is the best way to handle people like that?

AnnoyedNurse · Aug 15, 2017

Your instructor saw traits in you that she felt would make you a great fit in an ICU. Most instructors will discourage new grads from the ICU so first pat yourself on the back. Good work! She probably saw that you are detail oriented, teachable, and react well in high-stress situations. These are the 3 traits any beginner ICU nurse must have. Everything else can be learned.

Take the critical care course at your hospital combined with AACN's ECCO course (if provided).

Purchase an Essentials of Critical Care nursing book (I think that's what it's called)- published by AACN and study this after your Ecco course is complete.

After every shift on orientation take your patient

diagnosis and search for CE's on AACN's website and read about it and take the post test.

Enjoy your days off and truly distress. Find a friend you can vent with outside of work because it can become overwhelming.

Always believe in yourself. Stay humble. Always ask questions. If you don't know how to do something, say so. Remember, you're there for the patients so try not to focus on the politics of nursing so much. Do the best you can. The first year will be extremely challenging but ICU will always provide a good challenge. Stay teachable throughout your career and always follow best practice and standard of care regardless of what everyone else on the unit does!

Keep up the good work and welcome to the club :)