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Surviving Critical Care as a New Grad Nurse

*Original post released on 1/6/2021

For this week’s article, I wanted to take the time to share some of the things I learned while working in a critical care unit as a new grad nurse. Hopefully some of these informative tidbits will help you survive the critical care area of nursing as a new grad nurse too. The information below won’t be organized in any particular way, so your your time to go through each point and apply it as it suits you and your situation. Let’s dive in!

  • Learn and know where all emergency equipment, medications, and other essential equipment items are located
  • Invest in a few solid resources initially
  • Save all MD, resident, NP phone numbers or invest in a small pocket phone book to keep at work because you never know when you’ll need to get in touch with someone (plus, some providers only verbally disclose their personal numbers).
  • Expect to give help to other staff in order to get help from them in return.
  • Read recent progress notes from providers to catch up on a shift’s events and changes to the plan of care. Things do get lost in translation during change of shift report at times. Word to the wise, though, MD notes are not always accurate (Ex: I’ve had MDs chart the presence of pulses on a foot that was amputated).
  • The ICU is mainly driven by ABCD stabilization (see image)
  • Leave room to grow, but learn from your mistakes along the way so they don’t happen again.
  • Learn about the equipment on your unit and how to use it!
    • Monitors
    • Ventilators
    • Arterial lines
    • Pulmonary artery catheters (PACs), CVP, trialysis catheters
    • Bladder scanner
    • Ultrasound
  • Learn about commonly encountered conditions for the critical care setting:
    • Diabetic ketoacidosis (DKA)
    • Sepsis
    • Myocardial infarction
    • Acute respiratory distress syndrome (ARDS)
    • Hypertensive crisis
    • Dysrhythmias (especially Atrial Fibrillation)
    • Cerebrovascular accident (AKA: stroke)
    • Acute and chronic renal failure
    • Heart failure
  • Stay organized, work clean, and don’t leave a mess for the next nurse!
  • Always order a new drip for the oncoming nurse to prevent delays or lapses in medication administration (pharmacy can take a while sometimes).
  • Understand that nursing is a 24/7 job. If you can’t get everything done, it’s okay, but don’t leave silly/lazy items for the next nurse without a valid reason.
  • Get on a set schedule as much as possible and maintain this on your off days. This is incredibly important for those who work night shift, unless you’re able to switch between day and night shift mode without issue.
  • Engage with coworkers and build rapport with them. You’ll need someone on your side when things get rough during a shift or if you need to clean/move a patient.
  • Seek out any and all training opportunities to expand and enhance your skills (Ex: ACLS, PALS, TNCC, etc.)
  • Attend codes when not assigned “code duty” and especially if you are new.
  • Set alarm parameters on your patient’s monitors each time you work to monitor vitals within the ranges you’re comfortable maintaining.
  • Call NPs, PAs, and residents before the MD unless specifically stated otherwise.
  • Learn how to give and get good change of shift report. My advice is to go head-to-toe by body system and keep your report routine as consistent as possible so it becomes a habit where crucial details don’t get missed.
  • Learn about common medications used in critical care areas:
    • Vasopressors like Levophed, Neosynephrine, Vasopressin, Epinephrine
    • Inotropes like Dopamine and Dobutamine
    • Sedatives like Precedex, Propofol, Versed
    • Pain medications like Fentanyl, Ketamine, Morphine
    • Rapid sequence intubation medications and paralytics like Etomidate, Succinylcholine, Rocuronium, and Nimbex
    • Cardiovascular medications for BP regulation and prevention of arrhythmias/clots like Cardene, Esmolol, Labetalol, Nitroprusside, Nitroglycerin, Cardizem, Amiodarone, Heparin

Congratulations on pursuing a career in critical care! I sincerely hope these bullets of information help you excel in all things ICU related! If you are a critical care nurse already and can think of some helpful info to share, drop it in a comment below! If you want to keep reading for more ICU tips & tricks, check out this article: https://thestudynurse.com/2020/09/30/icu-tips-tricks/ or this one about how to set up your room for an admission: https://thestudynurse.com/2020/10/17/setting-up-an-icu-room-for-an-admission/

XOXO,

Andra Alyse

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