Take it from someone who has been there and done that. You won’t find these tips and advice anywhere else, only from this experienced nurse. Working as a new grad is hard. Working as a New Grad in the ICU is even harder. Let’s look at some tips and advice from an experienced nurse.
Do you prefer to watch videos? All the advice and wisdom in this post are in my recent video.
The Best Advice From An Experienced Nurse
From the super practical to the more emotional, as an experienced nurse, I know there are things that will help you enjoy your job. These are things I’ve learned firsthand on the job that has helped me, and I bet they will help you too.
#1 Don’t Take Assertive People Personally
There are a lot of type-A personalities in the ICU. This is because a lot of the duties in the ICU require confidence, attention to detail, and a love of patterns and checklists. Nurses with these traits might be seen as rude or unkind to newbies.
But don’t take it personally. I know, that’s easier said than done. When you miss a step in a checklist the nurses around you might remind you in a very short manner. But you have to look beyond how they say it and understand what is going on in their head.
If your preceptor is being short with you, they might be thinking of 100 things at once and trying to concentrate. Sometimes, there just isn’t time to explain or think about how they are coming across.
And take it from me. If you are not confident and assertive, you need to learn to be. Working in the ICU requires it.
#2 Read the Room
Yes, you know how to read monitors, but I’m talking about the importance of reading the emotional climate.
If people are moving really fast and trying to get things accomplished ASAP, this isn’t the best time for you to ask a bunch of questions.
The same thing goes for emotions in the room. Take a second and look for clues. If you are picking up high stress, don’t ask “why” just do what’s asked. When things calm down you can go back and ask for more information.
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#3 Don’t Mess With Someone Else’s Pumps
This next tip is super important. If another nurse sets up and is monitoring a pump, don’t make any changes to it. Every nurse has their own way of handling the pumps and if you do something to it, it could confuse them and cause them time away from the patient to fix it.
However, if you are asked, go ahead and change the titrate drips. But never pause pumps unless you are told to. And don’t “add volume” without going to tell the nurse right away. I understand that it’s ok to do this in Med Surge but it’s not acceptable in ICU.
#4 If the Code is Full, Check On Your Colleague’s Patients
If all of your duties are complete, then don’t wait to be asked to help out. The ICU is a place where we all help each other out, without having to ask or be asked.
So if your code is full, check on your colleague’s patients. Of course, you don’t want to mess with the pumps or make any changes without telling them, but you can do the minor checks. This will save everyone time and energy.
#5 Don’t Make Chit-Chat While Pulling Or Giving Meds
The ICU is a very delicate place. You need to give all of your concentration, especially when pulling or giving meds. Even the tiniest of mistakes could have huge ramifications here.
Other nurses won’t be wanting to chat, so don’t try to make small talk at this time either.
Tip From An Experienced Nurse – It Just Takes Time
There you have it! As an experienced nurse, these are honestly some of my best tips I can give you. Don’t be intimidated. Use these first few months as a learning experience. Allow yourself to grow and change.
Thank you so much for this! Just getting my feet wet 6 weeks in and really second guessing myself but every single tip is 100% accurate
Allie Chan says
I hear icu nurses aren’t as alarmed by low BP as medsurg nurses are. What’s an alarming or limit on low BP that you would usually look for in the ICU?
Kati Kleber, MSN RN says
This is correct, but likely the reason is that ICU nurses are a bit more versed at quickly addressing hypotension than med-surg nurses and have fewer patients to care for so it’s not as cumbersome. In the ICU, I find that we tend to look at MAP more than systolic blood pressure. The golden rule is to keep the MAP above 65 to ensure adequate end organ perfusion. In the ICU, they also have other meds at their quick disposal to be able to increase blood pressure (like norepinephrine, neosynephrine drips) that they are very comfortable running. When you see a systolic blood pressure in the 80’s, you’ll be paying close attention, but if the MAP is greater than 65, it might not yet be ordered to intervene. Your nursing orders will tell you when to notify the physician, who may order a bolus first and then possibly vasoactive drips to maintain the BP if the bolus is either ineffective or only temporarily works.