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This is a guest post.

The purpose of this post is to offer tips and advice to new graduate RNs starting in an ICU.

All opinions in this post are that of the guest author and not those of their employer.

This three part series gives helpful tips for an ICU nurse. As a new graduate, the ICU can seem overwhelming, these tips will help you find your way.

Tips for an ICU Nurse

Advice #3: Show initiative

It develops rapport. Every single interaction with every single patient, family, nurse, doctor and other health care partner will be a learning opportunity. Seeking out learning opportunities shows your co-workers that you are engaged. There’s a patient getting a bedside trach or ICP bolt? Ask to be in the room and tell them you’ve never seen it before. Ask questions. Most doctors appreciate the new nurse who demonstrates the desire to learn.

RT can teach you about blood gases or lung sounds, or modes of the ventilator. PT can teach you the best way(s) to mobilize patients (a huge AACN initiative). OT can show you adaptive maneuvers to help the patient learn new ways for ADLs (like feeding themselves after a stroke). ST is not just about safe swallowing (though important)… they can teach you about other cognitive deficits and how to recognize them and help patients adapt. BE A SPONGE and soak up the opportunities. That being said, be careful not to over-extend yourself in any given shift.

Advice #4: Know yourself and be your own advocate. An important point in many ways.

  • Learning style vs. teaching style If I’m going to teach you how to knit me a scarf, how do you learn best? Can I just talk you through it? Do you want me to give you an article to read? Do you want to watch me do it? Or, do you need to hold the needles and do the stitches? Or… do you learn best with a combination of those things? Your learning style and my teaching style may be very different, so we should talk about that at the beginning. Or, best way you learn knitting may not be the best way to learn figure skating. Talk to your preceptor about things that are or are not working, that’s how you’ll learn to adapt to each other.
  • Know your limitations. Recognize what you don’t know. Nothing will kill your credibility quite like being the ‘know-it-all’. As a new grad, it will make you look dangerous. I would recommend you have regular conversations with your preceptor.
    • Example: Your post-op patient is becoming increasingly tachycardic.
    • You: “My patient is tachycardic. I’m concerned they might have internal bleeding”.
    • Preceptor: “Why do you think that? The patient has a fever.”
      • This would be your opportunity to show your critical thinking skills by reviewing the patient’s other vital signs (say a low BP), or your preceptor may direct you to check the patient’s lab work, or most recent dose of pain medication.
      • It takes time for your preceptor to validate your knowledge and technical skills. By allowing this natural progression, you will only improve your credibility among your peers, which will help demonstrate your independence.
  • Ask for help. This coincides with knowing your limitations. Asking for help is not always a weakness. Sometimes it can be a key strength in safe patient care. If you aren’t sure how to titrate your vasoactive drips on the new IV pump, or, if you need a refresher on how to perform trach care, ask. Your preceptor may want you to demonstrate what you do know, but this will help identify learning opportunities.
  • Find a mentor. This will likely NOT be your preceptor during orientation (but they will often become one after you are on your own). This person does not have to be the most experienced person. But, it should be someone who has experience in the unit who can offer a sounding board after a rough day, suggestions for your performance, or how to interact with your preceptor. This would be someone who is not grading your knowledge/technical skills, but someone focused more on personal and interpersonal development.
  • Own your orientation. Orientation is an extension of nursing school, without the formal grading. Use resources like textbooks, professional nursing organization references, or reputable internet sites to look up unfamiliar things (like disease processes) on your own time. Your preceptor and manager will appreciate your self-motivation to learn! Bonus: These notes will give you something to go back to when it comes back up again in the distant future.

You will more than likely come across many chances to use these tips; some will be easier to master than others. The ICU can be very intimidating, but remember that you are not any less valuable to the team. Everyone has something to bring to the table, and that includes you!

This is part two in a 3 part series. You can read part one, New Grads in the ICU, Nurse Characteristics and part 3, Be Your Own Advocate.

Melissa will also be our featured guest nurse in Season 2 of the FreshRN Podcasts.

Tips for New Grads in the ICUMelissa Stafford, BSN RN CCRN SCRN graduated from nursing school in 2000, and after a short time on a medical surgical floor transitioned to neuro critical care. During her career, she has precepted multiple nurses, taught classes ranging from neurological/neurosurgical specific subjects to general critical care medicine, been involved in shared governance and resides as chair for nursing peer review. She has received various recognition’s, including the Great 100 Nurses of North Carolina and DAISY Award. Melissa enjoys spending time with family, painting, watching sports, visiting the beach whenever possible, and vacationing at Disney World

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