What does it take to succeed in the ICU?

Ra3liana · May 20, 2019

I have been an oncology/med-surg nurse for 8 years and recently got the position in ICU. I'm starting classroom orientation next month. One thing I know is that you have to be very familiar with different types of abnormal EKG rhythm. That's the first topic I will get tested on once I start my orientation. Will give you more information later on! Keep an open mind to your idea and never doubted your ability. It's never about ability, but motivation. I regretted waiting too long to make the decision to transfer.

beekee · May 20, 2019

Thank you! Confidence has always been my downfall, even though I know I’m a very good nurse.

Here.I.Stand, BSN, RN · May 20, 2019

1) Excellent critical thinking skills and 2) assertive enough to advocate for your pt’s while being kind/empathetic/“caring” enough to help people through the worst time of their life.

Wishing you my best on this journey, should you choose to go for it!

marienm, RN, CCRN · May 22, 2019

My unit has had a couple of nurses transition to us from acute care areas. They have done well! Some thoughts:

1) You need to be really willing to learn all over again. There is a lot of new gear & procedures in the ICU that I don't expect you to know how to use, but I'll expect you to become proficient with pretty quickly after being shown how.

2) You'll have fewer patients, but I think the expectation of the level of nursing care is higher. For example, we do mouth care every 2 hours with vented patients and change sheets 2 to 8 times a day (with our burn patients who have wet dressings). Some perform & chart a full assessment q4. You need to take the initiative to do these things.

3) Use your resources! You've been a nurse long enough to have a feeling when something isn't right. If you're not getting what your patient needs, talk with your charge nurse to see whether your 'radar' is on point or not. (I'm at a teaching hospital. I spend a fair amount of time teaching the *residents* what to do, or at least when to call their chiefs!)

3a) On the other hand, learn what you are allowed to do independently and then DO it! You (probably) don't need the charge nurse's approval to titrate a vasoacitve drip, and delaying doing so because you feel like you need permission could hurt the patient. (Definitely ask charge if you genuinely aren't sure what to do, though.)

I never worked on the floor, but I have a lot of respect for the nurses who do. If you decide to transition, I hope it goes well!

Monkies, BSN · May 22, 2019

I absolutely LOVE critical care and the ICU. My biggest piece of advice is develop excellent self-care practices! You are dealing with pts who can turn in a heartbeat, and potent medications/treatments. No matter how educated, practiced, or experienced you are, if you don't make an effort to practice self-care the stress will sneak up on you.

Aside from that:

* Hone your assessment skills, head to toe.

* Review your vasoactive medications, what to expect vs unexpected, including how the medications affect change when used in combination.

* Know your cardiac rhythms, standard and the "not so standard but headed down hill" rhythms.

* Questions are your best friends. If you don't know, ask. Even if you do know, ask until you are 100% and you become the one to ask.

The rest you can pick up as you go.

beekee · May 22, 2019

Thanks everyone for the tips. I have pretty good spidey sense. It’s tough to develop really strong critical thinking on the floor, because I’m often just in task mode due to the sheer volume of work to be done. However, I think it’s definitely one of my strengths, if I get the chance to think.

My main concern is the new procedures. I’ve never placed a ng, or an IV (we have a team that does them all). I’ve suctioned a trach once....and have done no other trach care. These are the things that are giving me pause. I’ve never been that great with my hands. ?. I try to remember that lay folk learn how to do a lot of these types of things and they manage just fine, so I can too.

Nurse8988 · Jun 2, 2019

Hi there! I think a great novice ICU nurse is one who is detail oriented(triple checks everything especially when administering medications), receptive to learning, puts patient safety first, and one who cares for the patients and self. Everything else such as critical thinking, procedures, line placement, can be learned, but it's hard to teach work ethic, kindness, diligence, etc. ICU nursing is challenging but doable and rewarding. All the best.