Will be shadowing an ICU nurse on Monday. What can I expect and what are some questions I can ask?

[The0Walrus, BSN, RN]

I'm a new grad and work at a pretty big hospital. The ICU NM was kind enough to allow me to shadow a nurse in the ICU since I work in a different dept. She also said she wouldn't mind taking me on if I didn't mind working overnights after my probation period. What can I expect on my day and what kind of questions are appropriate to ask?

[yournurse]

Ahh. Do it, this is a great opportunity for you. It was or maybe it still is hard to get a job in the icu. Since the manager offered, do it! One thing you have to know about ICU nurses is that they’re strong and independent. They’ve seen mostly everything. Day shifts in the ICU are quite busy. I’m going to walk you through my day. Or I’ll give you an example. ICU nurses either have 1 or 2 patients depending on acuity. 1:1s are the ones who have CRRT( dialysis but icu nurses deal with it), fresh hearts (open heart surgery post op), life sharing patient preparing for OR, balloon pumps, proning bed, and more. It’s kind of exciting!!!! 1:2 patient, you’d probably get a septic patient on 3-4 pressors. Or a DKA (insulin gtt). The other day, I had 12 pumps in my room alone. You can also transport patient to MRI/Ct/nuc med. plus I had a patient I was trying to extubate and trying to find a right medication to get him past it. Sometimes you have help, sometimes you don’t. You do everything there, make sure you get things done. You have to be ready if your patient codes, do you have a free line to push épi? Is your pt full code? You have to know that Bc things can happen quickly. Questions you should ask: what do you like about the unit? What is the environment like? How’s team work ? Those are I think the most important things you should ask. Other technical things, like learning how to titrate drugs or ventilator management you’ll learn as you go! Gluck! And I hope I helped. ?

[RNperdiem, RN]

A lot of it will seem familiar if you are a nurse working in the same hospital. The day starts with getting our assignments and report with the offgoing nurses, then after reviewing the chart and meds, vital signs, assessments, meds etc.

ICUs vary a lot in their acuity. Some days we have patients up in chairs texting on their phones because there is a lack of available floor beds to transfer them to and the patients don't need ICU level of care .Other days there are a lot of fresh traumas, transplants, ECMO patients and transports to MRI or CT.

[Horseshoe, BSN, RN]

7 hours ago, RNperdiem said:

ICUs vary a lot in their acuity. Some days we have patients up in chairs texting on their phones because there is a lack of available floor beds to transfer them to and the patients don't need ICU level of care .Other days there are a lot of fresh traumas, transplants, ECMO patients and transports to MRI or CT.

I was going to say something along the same lines. On the day you visit, it might seem like the most boring place in the world to work. Or you might be blown away by the acuity and the (hopefully controlled) chaos you witness in terms of general patient population, codes, drips and bedside interventions, etc.

[JBMmom, MSN, NP]

Not to scare you but I would caution that while the manager may have expressed he or she is happy to have to shadow and then join the team, the nurse you are teamed up with may not share that enthusiasm. Day shift nurses get a lot of shadows- student nurses and paramedics, new nurses on orientations, and others like yourself that are invited to shadow. There just isn't a whole lot of time to spend, so please don't take it personally if you just end up watching and not really getting a lot of instruction or personal feedback. Now, you may hit a great nurse on a great day who has the time and energy to teach, so I don't want to set it up as something you won't like, but know that when they're busy, they just don't have the time to worry about the person shadowing, they need to focus on their patients. I hope it's a great day for you.

[medic981, ADN, RN, EMT-P]

My first nursing job out of school was in the ICU. I had the opportunity to shadow for a day prior to accepting the job offer. Shadowing is your opportunity to determine if the position is what you are looking for, how the unit works, and how well the staff works together.

My best suggestion to you is to look for teamwork between staff as these are the people you are going to be working with. Another item I would take note of is if the nurse you are shadowing is able to take allowed breaks and lunch.

Good luck and best wishes on beginning your nursing career.

[The0Walrus, BSN, RN]

On 10/17/2019 at 6:33 AM, yournurse said:

Ahh. Do it, this is a great opportunity for you. It was or maybe it still is hard to get a job in the icu. Since the manager offered, do it! One thing you have to know about ICU nurses is that they’re strong and independent. They’ve seen mostly everything. Day shifts in the ICU are quite busy. I’m going to walk you through my day. Or I’ll give you an example. ICU nurses either have 1 or 2 patients depending on acuity. 1:1s are the ones who have CRRT( dialysis but icu nurses deal with it), fresh hearts (open heart surgery post op), life sharing patient preparing for OR, balloon pumps, proning bed, and more. It’s kind of exciting!!!! 1:2 patient, you’d probably get a septic patient on 3-4 pressors. Or a DKA (insulin gtt). The other day, I had 12 pumps in my room alone. You can also transport patient to MRI/Ct/nuc med. plus I had a patient I was trying to extubate and trying to find a right medication to get him past it. Sometimes you have help, sometimes you don’t. You do everything there, make sure you get things done. You have to be ready if your patient codes, do you have a free line to push épi? Is your pt full code? You have to know that Bc things can happen quickly. Questions you should ask: what do you like about the unit? What is the environment like? How’s team work ? Those are I think the most important things you should ask. Other technical things, like learning how to titrate drugs or ventilator management you’ll learn as you go! Gluck! And I hope I helped. ?

Thanks! I'm very interested in the pathophysiology of diseases. Unfortunately, since I'm a new grad it was tough getting a job so I do psych nursing at the hospital and nursing home with an agency. Everyday I try to make I get better at least 1 thing. When j went to the NM in the ICU while orienting I asked her if it was possible to shadow a nurse. At first she was like, "but psych nursing is so different. Why ICU?" Then I told her "I really preferred the ICU." Immediately she started laughing hysterically and said "come shadow a nurse if you like!" I think she understood where I came from lol thankfully. Not many people would be so welcoming to a new grad. ?

On 10/18/2019 at 1:24 AM, medic981 said:

My first nursing job out of school was in the ICU. I had the opportunity to shadow for a day prior to accepting the job offer. Shadowing is your opportunity to determine if the position is what you are looking for, how the unit works, and how well the staff works together.

My best suggestion to you is to look for teamwork between staff as these are the people you are going to be working with. Another item I would take note of is if the nurse you are shadowing is able to take allowed breaks and lunch.

Good luck and best wishes on beginning your nursing career.

Thanks!!! Much appreciated for the advice.

[The0Walrus, BSN, RN]

On 10/17/2019 at 9:57 PM, JBMmom said:

Not to scare you but I would caution that while the manager may have expressed he or she is happy to have to shadow and then join the team, the nurse you are teamed up with may not share that enthusiasm. Day shift nurses get a lot of shadows- student nurses and paramedics, new nurses on orientations, and others like yourself that are invited to shadow. There just isn't a whole lot of time to spend, so please don't take it personally if you just end up watching and not really getting a lot of instruction or personal feedback. Now, you may hit a great nurse on a great day who has the time and energy to teach, so I don't want to set it up as something you won't like, but know that when they're busy, they just don't have the time to worry about the person shadowing, they need to focus on their patients. I hope it's a great day for you.

I understand. I want to know what I can do also to become a better asset. I have roughly 5 more months left in my probation period so I have some more time to learn and read and take whatever classes to help.

[SquatsNScrubs, BSN, RN]

I’ve been in the CVICU for 9 months, and worked in med-surg for 1.5 years prior. Our main clientele are cardiac (STEMI, CABG) and thoracic (VATS/lobectomy, minimally invasive esophagectomy) surgery pts. We also get a handful of vascular (AAA repair, fem-pop bypass) along with PCU overflow or comfort measures only pts. Some days I spend hours titrating drips and trying to get my pt hemodynamically stable/extubated, while other times I might have 2 stable patients with transfer orders waiting for a stepdown bed.

Here are some questions I asked when I shadowed:

- How long is orientation?
- What are your ratios?
- What are the shift requirements?

- What is the turnover rate/how long do the nurses normally work on the unit?

Best of luck to you!

[The0Walrus, BSN, RN]

On 10/19/2019 at 11:22 PM, SquatsNScrubs said:

I’ve been in the CVICU for 9 months, and worked in med-surg for 1.5 years prior. Our main clientele are cardiac (STEMI, CABG) and thoracic (VATS/lobectomy, minimally invasive esophagectomy) surgery pts. We also get a handful of vascular (AAA repair, fem-pop bypass) along with PCU overflow or comfort measures only pts. Some days I spend hours titrating drips and trying to get my pt hemodynamically stable/extubated, while other times I might have 2 stable patients with transfer orders waiting for a stepdown bed.

Here are some questions I asked when I shadowed:

-How long is orientation?
-What are your ratios?
-What are the shift requirements?

-What is the turnover rate/how long do the nurses normally work on the unit?

Best of luck to you!

Thank you! I asked if I can return on Monday and they said sure so I'm just gonna take advantage. Hopefully when my probation period is over in 5 months they'll be okay with moving me to the unit. I have 2 nurses who said they'd have no issue and that they're just short staffed which is pretty standard in all units.

[JacobIloved, BSN]

Ask about the nursing process and nursing judgment - a lot of what nurses do include weighing what has been ordered to what is good/necessary for the patient. While we can't directly contravene orders, we can always question them and ask for them to be changed if we think it's appropriate.