Are you ready to move into critical care?
Pens, scissors, stethoscope and thermometer – check! The nurses version of heads, shoulders, knees and toes. I was ready for my first shift in ICU. Well my first shift in NICU, so the tiniest humans you can imagine, just to add more anxiety to the experience, was terrifying. Alarms were constant, patients frequently having spontaneous hypoxic bradycardias. Up. Down. Up Down. I was like a jack-in-the-box on speed and felt more confused than a chameleon in a bag of skittles.
My buddy nurse had many years of experience in NICU and sweetly told me to “relax” – that I didn’t have to attend every alarm – just observe. See the slightest movement was enough to set the alarms off and while they are tiny they definitely do not lie still! Her reassurance was greatly appreciated and while I remained overwhelmed for most of the shift, it was manageable – just. Amazing how clearly I remember that conversation and it was over 21 years ago. Don’t ever underestimate how a supportive word can make the world of difference to someone new. Senior nurses want to see you succeed but personality differences mean that their intentions don’t always come across as positive.
Take the humble approach
There’s nothing more loathsome than a know-it-all brand new recruit who refuses to listen and argues with every correction or redirection. Your preceptors and educators want to see you succeed and the right attitude on your part will make the process immensely easier. Every preceptor is different and will require a slightly altered version of their routine. Go with it. Learn as much as you can; imbibe it all like a little sponge without complaining. Even if you had previous nursing experience, let them teach you without contradicting or fighting their advice. They know the unit much better than you do and they are trying to impart their sage wisdom to you. Stick with humility, learning as much as you can, and don’t be afraid to ask questions.
Recognize what you don’t know
The more senior nurses understand that you are fresh out of school with no actual skills, and they also don’t want you to kill anyone under their supervision. Ask the question before you make a mistake, even if you’re unsure. Far better you ask about the route or dosage of a medication then have to fill out the paperwork for a medication error. Inquire about resources from your preceptors on topics you will see often and want to familiarise yourself with beforehand. Get comfortable with unit policies and procedures. Observe all that you can.
See one, do one, teach one
Everything moves fast in the ICU and despite your best efforts at taking a lame patient, you may end up with a disaster before the night is over. Your stable GI bleed patient may code and die. You may get a septic patient from the ED who requires central lines and vasopressors. You could get stuck with the uncontrollable patient who, despite your best cajoling, requires maximum restraints and a frequent dose of Haloperidol. Some procedures aren’t done too often so you may only get one chance to observe before it’s your patient the next time. Take a deep breath, rely on your resources (you’re never alone) and step up to the challenge. You just never know, so you have to adjust quickly, relying on your preceptor for help. Flexibility is key in these situations, and also not letting fear impede your ability to perform your job.
It’s going to be a fun experience, full of vomit and chest compressions and upset family members. But remember at the end of the day- you are making a difference in the lives of your patients and their family members. It’s all worth it.
By Tracy Niesler RN
Pens, scissors, stethoscope and thermometer Ð check! The nurses version of heads, shoulders, knees and toes. I was ready for my first shift in ICU. Well my first shift in NICU, so the tiniest humans you can imagine, just to add more anxiety to the experience, was terrifying.