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You’re a brand new ICU nurse or nursing student preparing to set foot in an intensive care unit for the very first time. (Talk about intimidating!) You’re nervous, but up for the challenge. You want to familiarize yourself with the ins and outs of an ICU and want to know all of the common meds, procedures, skills, and more that you’re going to experience. Well, great news! You’re in the right place.
Hi, I’m Kati Kleber, MSN RN. I’m a nurse educator who worked in neurocritical care and regularly floated to both regular ICU and CVICU. I love helping newbies acclimate into intimidating environments so they can lean into authentic learning STAT! Now, let’s dig into the most common meds, skills, procedures, and more that ICU nurses deal with.
(This post is very long, so if you’re interested in learning about a specific topic, simply click on the Table of Contents below to navigate through it faster.)
Table of Contents
Common ICU Medications
While there is some overlap, the meds given in the ICU are quite different than a med-surg nursing unit. The main variables include the level of urgency (faster), frequency (more often), and safety profile (big scary ones!). But, this doesn’t mean it’s impossible to give these meds! It can be scary at first, but once you familiarize yourself with them and get more comfortable, you’ll feel like a pro in no time.
ICU Nurse Pro-Tip ➡️ No matter how confident and comfortable you get with these meds, remember to never become complacent and lose your sense of vigilance. This is when deadly errors occur. The RaDonda Vaught case is a prime example. As a new ICU nurse, you now have an increased level of responsibility, so please do not lose sight of that.
Let’s go through a list of common ICU meds by drug class. Right now, just focus on familiarizing yourself with each drug and what they do and not dive into full memorization mode.
The term “vasoactive” means that the medication acts on the blood vessels. Simple enough, right? These medications may make the blood vessels constrict (tighten and get smaller) or contract (relax and get bigger), which naturally impacts a patient’s blood pressure and circulatory status. If you want to dig into more detail, I discuss this in my free mini-course, ICU Drips for Beginners. Below are the most frequently administered vasoactive meds.
- Norepinephrine (Levophed): Used to increase blood pressure in cases of shock or low blood pressure.
- Dopamine: Can be used for low blood pressure and certain cardiac conditions.
- Epinephrine (Adrenaline): Used in cardiac arrest and severe allergic reactions.
- Vasopressin: Sometimes used in combination with other vasoactive drugs to support blood pressure.
There are a few more that you may run across, but these are the medications you will likely see on a daily basis. They are all given through a central line, which you will be responsible for managing (more on that soon!) and are considered “drips”.
Sedatives and Analgesics
Often, patients in the ICU need to be sedated (and therefore receive a sedative) and/or need pain relief (analgesics). You will find that you will give these medication on a daily basis as well.
🔎 Under the ICU Nurse Microscope ➡️ A major issue with critically ill patients is something called delirium. Delirium is essentially a sudden onset of confusion, disorientation, and fluctuating levels of consciousness, often accompanied by agitation or lethargy. ICU delirium leads to many negative outcomes like increase mortality, prolonged ICU stay, cognitive impairments (that can be long-term!) and so many other awful things. This is one of those avoid at all costs / do whatever we can do prevent this kind of situations. Naturally, sedating someone and/or giving them copious amounts of pain meds can significantly increase the risk.
While given often, we should continually evaluate whether or not these are necessary and discontinue them as soon as they are no longer necessary.
- Propofol: A sedative used to induce and maintain anesthesia or sedation in critically ill patients.
- Midazolam (Versed): A sedative and anxiolytic commonly used in mechanically ventilated patients.
- Fentanyl: A potent opioid analgesic used for pain control in critically ill patients.
Of all of 🚧 high-alert 🚧 meds, neuromuscular blockers are the most serious. They induce paralysis, meaning the patient cannot move, breathe, or even blink when these are administered. Their bowels stop even stop! However, the patient will be completely awake (even though their eyes are closed because they cannot move their eye lids). Therefore, sedatives and analgesics are also given at the same time because being completely paralyzed is horrifically traumatizing.
Vecuronium and Rocuronium are the most common ones administered by an ICU nurse.
Conditions that would require these to be administered are extremely serious, like ARDS. (I actually go over ARDS in my crash course for new ICU nurses, and you can preview that module for free here.) Patients requiring treatment like this are always on a mechanical ventilator – otherwise they can’t breathe!
Serious infections can land patients into the intensive care unit. Patients are given something called “broad-spectrum antibiotics” like Vancomycin, Piperacillin/Tazobactam, or Meropenem until they can identify the specific pathogen 🦠 causing the issues. Then, they provide more targeted therapy.
As an ICU nurse, you’ll be responsible for administering these, ensuring they’re given on time, and safely. They’re IV medications, so you’ll be maintaining their IV site too.
Patients may come into the ICU because of blood clots, clotting disorders, and/or need active VTE prevention. Therefore, these medications prevent or reduce the formation of blood clots. Heparin and enoxaparin (Lovenox) are the most frequently administered ones, however there are many more available.
Patients in the ICU often have blood pressure issues. When it needs constant change and monitoring, the patient is on a drip (one of vasoactive meds earlier mentioned), but not everyone needs such powerful medications to manage their blood pressure.
Examples of medications to lower blood pressure that come in IV, oral (pill, capsule, tablet), or both, are listed below. Labetalol, Nicardipine (often administered as a drip in a serious hypertensive emergency), Esmolol, and Hydralazine are the most common ones you’ll see.
These medications are given to ICU patients for a few reasons. These include anti-inflammatory effects, allergic response and anaphylaxis, sepsis, adrenal insufficiency, post-op care, and even for brain swelling (cerebral edema). Hydrocortisone is the most commonly used, while methylprednisolone and dexamethasone are also given.
Other Common ICU Meds
Let’s go through some additional meds that you’ll likely encounter.
- Proton Pump Inhibitors (PPIs) or H2 Blockers
- Pantoprazole, Famotidine: Used to prevent stress ulcers in critically ill patients.
- Regular or rapid-acting insulin: This is used for glycemic control and can be given IV or subcutaneously.
- Electrolyte replacement
- ICU patients often have electrolyte imbalances that are important to address and proactively prevent.
- Potassium chloride and magnesium sulfate are the two electrolytes that need to be replaced most often, but you may also give chloride, calcium, sodium, and others.
- Furosemide (Lasix) is by far the most common. It is used to increase urine output in patients with fluid overload.
- This can be given IV, oral, or even an IV drip for severe needs.
- Amiodarone: Used to treat and prevent certain life-threatening arrhythmias.
- Inotropic agents
- Dobutamine: Used to improve heart contractility in certain cardiac conditions.
- Anti-epileptic drugs (AED’s, anti-seizure)
- Levetiracetam (Keppra), Phenytoin (Dilantin): Used for seizure management in critical care.
- Albuterol: Used to open airways in patients with respiratory distress.
- Often, these are given by respiratory therapists in critical care units.
Common ICU Drips
You may notice that various medications I mentioned are given as a drip. The most common drips in ICU are as follows:
During any given shift, it is highly likely that you will run at least one of those drips. For a deep dive into ICU drips, check out my free mini-course.
Common Skills for ICU Nurses
As an ICU nurse, you will be responsible for performing a variety of skills. Let’s go through a list!
- Patient Assessment: Regularly assessing patients’ vital signs, neurological status, and overall condition to monitor their health status and detect any changes or complications. In the ICU setting, this is often done at least every 4 hours, if not more often. (In the med-surg setting, this is done once per shift and with any significant clinical changes, so it’s much more frequent in ICU!)
- Medication Administration: Administering various medications, including IV drugs, vasoactive agents, analgesics, and sedatives, while closely monitoring their effects and potential side effects.
- Intravenous (IV) Therapy: Inserting and managing IV lines to deliver fluids, medications, and blood products to patients. Critically ill patients often have vessels that are difficult to access, therefore many ICU nurses become pretty amazing at starting IVs.
- Ventilator Management: Monitoring and adjusting mechanical ventilation settings for patients who require respiratory support. Because this gets quite complex, you will often work directly with respiratory therapists in managing these devices.
- Wound Care: Dressing and caring for wounds, surgical sites, and pressure ulcers to promote healing and prevent infections.
- Central Line Management: Inserting, maintaining, and troubleshooting central venous catheters for medication administration and hemodynamic monitoring (also called CVP monitoring, which is falling out of favor and becoming less popular/common).
- Feeding Tube Management: Inserting, maintaining, and providing enteral feedings to patients who are unable to eat orally. This is often due to needing ventilator support (when the breathing tube is going down the patient throat, making it so the patient cannot eat) but can also be due to compromised neuro status.
- Urinary Catheterization: Inserting and managing urinary catheters to monitor urine output and assess kidney function.
- Arterial Line Monitoring: Inserting and monitoring arterial catheters to continuously measure blood pressure and arterial blood gases.
- EKG Interpretation: Analyzing electrocardiogram (EKG) readings to assess cardiac rhythm and detect any abnormalities.
- Collaborative Communication: Communicating with physicians, other healthcare team members, and patients’ families to ensure coordinated and effective patient care.
- Mobility and Positioning: Assisting patients with positioning, turning, and mobility exercises to prevent complications like pressure ulcers and deep vein thrombosis. You will work closely with physical and occupational therapy to enable the patient to do as much as they can each shift. This is a huge aspect of delirium prevention!
- Pain Management: Assessing and managing patients’ pain levels through various pharmacological and non-pharmacological interventions.
- Emergency Response: Responding to medical emergencies and providing immediate life-saving interventions when needed.
- Family Support: Providing emotional support and education to patients’ families, involving them in care decisions whenever possible. ICU nurses often care for the actively dying patient. This means pivoting from a goal of cure and optimizing function to that of comfort. We discuss the important topic more here.
Common Equipment for ICU Nurses
While caring for critically ill patients, the nurse is responsible for managing some pretty advanced equipment. Here’s a master list of the most common ICU equipment you’ll encounter.
- Mechanical Ventilators: ICU nurses manage to support patients’ breathing by delivering oxygen and removing carbon dioxide from their lungs.
- Infusion Pumps: Nurses operate and manage to safely administer intravenous fluids, medications, and blood products at controlled rates.
- Cardiac Monitors: Nurses interpret and respond to, displaying patients’ heart rhythms and vital signs to detect abnormalities promptly.
- Central Venous Catheters: Nurses care for and maintain to facilitate medication administration, fluid resuscitation, and hemodynamic monitoring. However, they do not insert them. This is done by a physician or an advanced practice provider.
- Arterial Lines: Nurses manage to monitor real-time blood pressure and facilitate arterial blood gas sampling for critical patients. Again, nurses do not insert these lines either. They are responsible for care, monitoring, and removal.
- Urinary Catheters: Nurses insert and manage catheters to drain urine to accurately manage output (which is very important in critically ill patients) but also in situations in which the patient is unable to void independently.
- Nasogastric/Gastrostomy Tubes: Nurses safely insert, manage, and use NG and G-tubes to administer nutrition and/or medications to patients who cannot eat orally.
- Pulse Oximeters: Nurses utilize to continuously monitor patients’ oxygen saturation levels, which adds to the clinical picture and gives the nurses clues on if the patient is deteriorating.
- Blood Glucose Monitors: Nurses perform blood glucose monitoring to manage and maintain patients’ blood sugar levels. This can also be performed by a certified nursing assistant.
- Defibrillators: Trained nurses operate and use to administer defibrillatory shocks in cases of cardiac arrest or life-threatening arrhythmias. These are used in code situations, which includes cardiac and respiratory arrests.
- Continuous Renal Replacement Therapy (CRRT) Machines: Nurses manage to provide continuous renal replacement therapy for patients with acute kidney injury.
- Intra-Aortic Balloon Pump (IABP): Nurses manage and monitor to support the heart’s function and improve cardiac output in certain cardiac conditions. While some ICU nurses may use these devices, they are more commonly used in a cardiac ICU.
Myself and another highly experienced intensive care nurse (who is now a doctorate-prepared ICU NP) recorded two FreshRN Podcast 🎙️ episodes that go deeper into ICU devices.
To listen to episode one ➡️ click here.
To listen to episode two ➡️ click here.
Each episode has show notes with tips 😊
Common Procedures ICU Nurses Perform
You will soon discover that nurses in the ICU have quite a bit of autonomy. They are able to perform many procedures on their own. While this list might feel intimidating, keep your head up! This is 100% doable. You will be exposed to all of these during your orientation and be able to practice with the watchful eye of a preceptor before you’re expected to do these things solo.
- Tracheostomy Care: Routine cleaning and maintenance of tracheostomy sites to ensure proper airway hygiene and patency. Some hospitals have their respiratory therapists do this, while others have their nursing staff take responsibility for this.
- Central Line Dressing Changes: While nurses do not insert central lines, they must maintain them. This includes changing the dressing as needed. Regular dressing changes on central venous catheters are performed to reduce the risk of infection and maintain insertion site integrity. (But should NOT be done too often, because that also increases the risk for infection!)
- Central Line Removal: Safe removal of central venous catheters when no longer needed or due to complications. If this is done incorrectly, it can result in death.
- Feeding Tube Insertion and Maintenance: Insertion of nasogastric or gastrostomy tubes to provide enteral nutrition for patients unable to eat orally. Nurses then monitor the insertion site and the patient’s response (if they are tolerating enteral feedings).
- Urinary Catheter Insertion and Management: Safe insertion and management of urinary catheters to measure urine output and monitor kidney function. ICU patients often require urinary catheters and because they are a potential source for serious infection, it is imperative for nurses to insert and care for them properly.
- Wound Care: Assessment and dressing of wounds, surgical sites, and pressure ulcers to promote healing and prevent infection.
- Ventilator Management: Adjustment and management of mechanical ventilators to support respiratory needs and oxygenation. A physician or advanced practice provider (APP) will insert the breathing tube, but the nurse and respiratory therapist (RT) will be responsible for managing it. RT will likely take the reigns in adjusting settings, while nurses monitor the patient in between their visits.
- Continuous Renal Replacement Therapy (CRRT): Management of CRRT machines to provide continuous renal replacement therapy for patients with acute kidney injury.
- Note: This is an ADVANCED nursing skill. You must take additional classes and get specific training to do this correctly. This is not something a new ICU nurse will manage.
- Cardiopulmonary Resuscitation (CPR): Leading or participating in resuscitation efforts during emergency situations to restore cardiac and respiratory function.
- Intra-abdominal Pressure (IAP) Monitoring Device: Monitoring and measuring intra-abdominal pressure to assess for intra-abdominal hypertension and potential complications.
- Pulmonary Artery Catheter Care: Monitoring and use of pulmonary artery catheters to assess cardiac function and hemodynamics in critically ill patients. (You may see this more in the cardiac ICU.)
- Non-invasive Cardiac Output Monitoring: Using non-invasive techniques to monitor cardiac output, providing valuable information on heart function and circulatory status. This can be done in may different ways, like capnography, NICOM, CNAP, or TTB, depending on what technology your hospital uses.
Common ICU Patient Diagnoses
While the exact disease processes you’ll encounter really depend on your hospital’s case mix, regional patterns of illness, and prevailing health conditions, there are certain issues that you’ll see more often than others. Let’s go through the most common ICU patient diagnoses.
Sepsis is a life-threatening condition characterized by the body’s extreme response to an infection. The body’s immune system goes into overdrive, releasing inflammatory chemicals into the bloodstream, which can lead to widespread inflammation, tissue damage, and organ dysfunction. Sepsis requires immediate medical attention and intensive care management to provide antibiotics, fluid resuscitation, vasopressors, and other supportive therapies. There are strict sepsis protocols for nurses to follow when providing care to patients suffering from this condition. I strongly advise you to familiarize yourself with this protocol first!
For a great definition and conversation about sepsis between myself and two leading experts, check out this episode of the FreshRN Podcast.
Respiratory failure occurs when the lungs are unable to provide adequate oxygenation and remove carbon dioxide from the blood. It can result from various conditions, including pneumonia, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), or severe asthma exacerbations. Mechanical ventilation or non-invasive ventilation is often necessary to support breathing and manage respiratory failure.
Cardiac arrhythmias are irregular heart rhythms that can range from benign to life-threatening. Some arrhythmias can lead to poor blood flow, decreased cardiac output, and even cardiac arrest. Treatment may involve medications, electrical cardioversion, or other interventional procedures to restore a normal heart rhythm. A cardiac issue may not be your patient’s primary issue, but it may accompany their chief complaint and you will be responsible for monitoring and managing it. Patients in the CVICU are ones whose primary issue is heart-related.
We dig deep into all things cardiac in this comprehensive cardiac course.
Acute Respiratory Distress Syndrome (ARDS)
ARDS is a severe lung condition characterized by rapid onset of respiratory failure due to inflammation and increased permeability of the lung’s small air sacs (alveoli). It often develops as a complication of sepsis, pneumonia, or other critical illnesses, and patients with ARDS require mechanical ventilation and supportive care in the ICU.
Patients with severe traumatic injuries, such as those from accidents, falls, or assaults, may require intensive care management to stabilize and treat life-threatening conditions, including head injuries, chest trauma, abdominal injuries, and fractures. As you can imagine, the care of these patients quickly becomes exceedingly complex. If you work at a larger hospital, these patients may go to a Trauma ICU.
Following major surgeries, patients may experience complications such as bleeding, infections, respiratory issues, or cardiovascular instability, necessitating close monitoring and management in the ICU. Many ICU patients head down to the operating room for various procedures and surgeries, so post-op care is a necessary skill for ICU nurses.
Acute Coronary Syndrome (ACS)
ACS encompasses a spectrum of heart conditions, including unstable angina and myocardial infarction (heart attack). Patients with ACS require immediate intervention, such as angioplasty, stent placement, or clot-dissolving medications, to restore blood flow to the heart and prevent further damage.
In larger hospital, these patients will likely be in a cardiac intensive care unit (CVICU) and receiving cardiac nursing care. However, if you are working in a smaller hospital or if the CVICU is full, you may care for patients suffering from these issues. You may also have a patient suffering from ACS and other issues concurrently.
Patients with intracranial hemorrhage (bleeding in the brain) or stroke may present with neurological deficits and require ICU care for close monitoring of intracranial pressure, interventions to manage bleeding, and neurological support.
Similar to ACS, patients who present with neurological complications to larger hospital systems may be cared for in a dedicated neurocritical care unit. However, your ICU patient may have a history of stroke or develop one while in your unit.
If you find yourself regularly floating to a neuro ICU, check out this comprehensive prep course.
Acute Kidney Injury (AKI)
AKI is a sudden loss of kidney function, which may be due to various causes, such as sepsis, decreased blood flow to the kidneys, or kidney injury. Patients with AKI may require renal replacement therapy (dialysis) and close hemodynamic monitoring in the ICU. This is a very common occurrence.
There are also many patients who also suffer from chronic kidney disease, which compounds the impact of kidney impairment should the patient suffer from another disease process (like sepsis).
Gastrointestinal Bleeding (GI Bleed)
Severe gastrointestinal bleeding, such as upper gastrointestinal bleeding from peptic ulcers or variceal bleeding, can lead to significant blood loss and hemodynamic instability. ICU care involves stabilizing the patient, managing bleeding sources, and providing blood products when needed.
We provide a pathophysiology brush-up to these issues in our course for new ICU nurses, Breakthrough ICU.
Common ICU Diagnostics
Your ICU patients will undergo many diagnostics around the clock. Let’s chat about the ones you will facilitate or complete yourself every single shift!
Arterial Blood Gas (ABG)
An ABG analysis measures the levels of oxygen, carbon dioxide, and acid-base balance in the blood, providing crucial information about a patient’s respiratory and metabolic status. In many hospitals, respiratory therapists collect these blood draws.
Complete Blood Count (CBC)
A CBC assesses the number of red and white blood cells, hemoglobin, platelets, and other blood components, helping to diagnose anemia, infections, and other hematological conditions. This is a simple blood draw.
An ECG records the heart’s electrical activity and is used to diagnose cardiac arrhythmias, ischemia, and other cardiac abnormalities. For a small brush up, we discuss EKG’s more here. For a comprehensive prep course, click here.
Chest X-ray (CXR)
A CXR provides a detailed image of the chest, aiding in the diagnosis of conditions such as pneumonia, pleural effusion, and pneumothorax. Radiology technicians often come to the patient’s bedside to perform this test, but the patient can also get these completed in the Radiology Department.
Computed Tomography (CT) Scan
CT scans use X-rays and computer technology to create detailed cross-sectional images of body structures, helping diagnose various conditions, including head trauma, pulmonary embolism, and abdominal issues. These are done quickly and can be done with or without contrast.
Magnetic Resonance Imaging (MRI)
MRI uses magnetic fields and radio waves to create detailed images of internal body structures, useful for evaluating neurological conditions, spinal issues, and soft tissue injuries. These are much more detailed than CT scans and therefore take much longer. Critical care physicians must consider if the patient will be stable enough to endure a longer scan like an MRI before ordering it.
Ultrasound imaging uses sound waves to visualize organs and blood flow, assisting in the assessment of cardiac function, vascular access, and abdominal conditions. These are done at the bedside.
Ventilation/Perfusion (V/Q) Scan
V/Q scans assess lung ventilation and blood flow, assisting in the diagnosis of pulmonary embolism and other lung disorders. These are bit less common than the other diagnostics.
Blood cultures help identify bacteria, fungi, or other microorganisms in the bloodstream, aiding in the diagnosis of sepsis and guiding appropriate antibiotic therapy. These can be drawn from a central line or from a regular phlebotomy stick.
Coagulation Profile (PT/PTT/INR)
The coagulation profile assesses clotting factors and platelet function, providing crucial information for patients at risk of bleeding or clotting disorders. This is a simple blood draw.
Blood tests measuring electrolyte levels, such as sodium, potassium, and calcium, help monitor and manage imbalances that can affect cardiac and neurological function. ICU patients often have their electrolytes checked at least once per day, if not more often.
A lactate level test assesses the amount of lactic acid in the blood, aiding in the diagnosis and monitoring of sepsis, shock, and tissue hypoxia.
Brain Natriuretic Peptide (BNP) Test
The BNP test helps assess heart failure severity and guide treatment decisions in patients with heart-related issues. It is from a regular blood draw.
D-Dimer is a blood test used to detect the presence of blood clots, helping diagnose conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE). This test does not 100% confirm a DVT or PE, rather it helps complete the clinical picture.
The troponin test measures cardiac troponin levels, aiding in the diagnosis of acute myocardial infarction (heart attack) and other cardiac conditions. These are often drawn in the emergency room and if elevated, they are then drawn on a schedule and basis for a specific amount of time.
These diagnostic tests provide critical information to guide patient management and treatment in the intensive care unit. As an ICU nurse, understanding these diagnostics and their implications is essential for delivering high-quality care to your patients.
Common ICU Nurse Abbreviations
You may hear a lot of terms thrown around the intensive care unit. Let’s go through the most popular ones.
- ABG: Arterial Blood Gas
- ARDS: Acute Respiratory Distress Syndrome
- BP: Blood Pressure
- SBP: Systolic Blood Pressure
- DBP: Diastolic Blood Pressure
- CABG: Coronary Artery Bypass Graft
- COPD: Chronic Obstructive Pulmonary Disease
- CT: Computed Tomography
- CVP: Central Venous Pressure
- DIC: Disseminated Intravascular Coagulation
- DNR: Do Not Resuscitate
- ECG/EKG: Electrocardiogram
- ED: Emergency Department
- ETT: Endotracheal Tube
- FiO2: Fraction of Inspired Oxygen
- GCS: Glasgow Coma Scale
- HR: Heart Rate
- HOB: Head of Bed
- ICP: Intracranial Pressure
- ICU: Intensive Care Unit
- IV: Intravenous
- MAP: Mean Arterial Pressure
- MRI: Magnetic Resonance Imaging
- NPO: Nothing by Mouth (from Latin: “Nil per Os”)
- NSTEMI: Non-ST-Segment Elevation Myocardial Infarction
- STEMI: ST-Segment Elevated Myocardial Infarction
- PICC: Peripherally Inserted Central Catheter
- PO: By Mouth (from Latin: “Per Os”)
- PRN: As Needed (from Latin: “Pro Re Nata”)
- PT/PTT: Prothrombin Time/Partial Thromboplastin Time
- RASS: Richmond Agitation-Sedation Scale
- RR: Respiratory Rate
- SaO2: Arterial Oxygen Saturation
- SIRS: Systemic Inflammatory Response Syndrome
- SOB: Shortness of Breath
- SVC: Superior Vena Cava
- TID: Three Times a Day (from Latin: “Ter in Die”)
- TLC: Total Lung Capacity
- TPN: Total Parenteral Nutrition
- TPRI: Transpulmonary Thermodilution Pulse Contour Cardiac Output
- VAD: Ventricular Assist Device
- VAP: Ventilator-Associated Pneumonia
- VTE: Venous Thromboembolism
Please note that while some abbreviations are more commonly used in the ICU setting, it’s important to exercise caution when using abbreviations in patient documentation and follow your facility’s guidelines for accurate and clear communication.
How to Avoid Common ICU Nurse Mistakes
Contrary to popular belief, nurses are not super human. We make mistakes. As a nurse who is new to a fast-paced and complex environment, how do you avoid making them? Let’s go through some tips.
Avoiding ICU Medication Mistakes
- Don’t make chit-chat in the med room; focus on what you’re doing
- Possible talking point 🗣️ “Hey let me pause this convo for just one sec while I pull out some meds…”
- Possible talking point 🗣️ “One sec, lemme get this med out real quick so I don’t mess it up…”
- Double-check meds that are continuously infusing after you take over for another nurse
- Don’t trust the previous nurse! Double-check ✅ ✅ to confirm that what they told you matches the chart and what the pump says
- These actually happened ➡️ The off-going nurse said the patient was nopeepinephrine, but the pump was program for neosynephrine … another patient was on a morphine PCA but it was programmed as Dilaudid and it went through three nurses before someone caught it … 😳
- Don’t trust the previous nurse! Double-check ✅ ✅ to confirm that what they told you matches the chart and what the pump says
- Trace and label your IV lines
- With so many IV lines, it’s easy to get mixed up. Trace the tubing from the patient to the bag to ensure it’s the right med at the right rate.
- Label them! I think it’s best to label near the port where it attaches to the patient so at quick glance you can see all of the lines.
Communication and Report
- Don’t continually interrupt during report; this can make the off-going nurse’s thinking more fractured and they might miss something important. Save most of your questions until the end, if possible.
- Get good at report
- Go through it the same way every single time – like a golf swing
- I have a mini-course to help med-surg nurses get better at report, but many of the principles are similar for ICU
- If you’re not sure about what someone said, ask for clarification
- “Hey, I just want to make sure we’re on the same page. So, what I’m hearing you say is that you want _____________. Is that correct?”
- Off-load important information to a reliable place: The chart! Document what you’ve done as soon as you can so you don’t have to struggle to remember it later (let’s make it cognitively easier to get through the shift!).
- Write down questions you may have or clarification you need to obtain on your report sheet. (You won’t remember later – I promise!)
- Clean your stethoscope in between each patient
- Wash 👏 Your 👏 Hands 👏
- Double-glove in serious code brown situations
- Central lines and urinary catheters are major sources of possible hospital-acquired infections that can be fatal for some patients. It is imperative to not only insert correctly but care for them well.
- Wash your hands BEFORE and after you go to the bathroom
Monitoring and Assessment
- Double check your alarms when you start your shift
- For example, if your orders tell you to treat systolic blood pressures that go above 160, ensure your alarm will go off to notify you
- Don’t trust that the previous nurse had it set up correctly
- During report, if the off-going nurse mentions any neuro deficits, confirm them in the moment
These tips are just a few from my personal experience (and some that I learned the hard way) – there are many more to consider to lower the likelihood of making a mistake. Even very diligent people mess up. In my professional opinion, it’s about mistake management rather than elimination. Humans make mistakes, so if perfection is your goal, you’re actually increasing stress and pressure because it is unattainable.
Do what you can to reduce the likelihood of a mistake (5 med rights, checking alarms, and so forth).
Be unapologetic, objective, and business-like when monitoring for lapses in judgement and preventing mistakes. This means that if you see someone giving a med without scanning it, that means saying something in a neutral tone (“I thought we were supposed to scan everything before we give it.”) or using those previously mentioned talking points in the med room.
Finally, how you handle the mistake yourself is just as important as preventing it from happening in the first place. This means ensuring everything that needs to be done clinically is done (patient is stable), appropriate documentation is done, and you mentally and emotionally process the mistake. Get the most out of it that you can. This means that you don’t brush it off and try to move on STAT. Rather, you take some time to consider what went wrong, why that was an issue, and extract as much value from that one mistake as possible so that you genuinely don’t do it again – and are now in a place to educate others from making a similar mistake!
Manage Your Own Stress
This is an intense job – intense is literally in the name! You must proactively work to manage the trauma and stress of working in the ICU. If you can harness your own stress response, you can really lean into authentic learning.
How can we do this? First, familiarize yourself as much as possible beforehand. Then, situations won’t be as scary because you’ll know what to expect and you can breathe through it. You can do this by reading more FreshRN blog posts and listening our FreshRN Podcast (especially the ICU episodes!).
Next, we need to remove the shame that comes with freezing in an emergency. We dig into that a bit more here.
Finally, remember that you are human. Just because you signed up to be an ICU nurse and work in an incredibly intense environment doesn’t mean you are immune to the mental and emotional toll of high stakes, difficult emotions, and death. The way to cope is not to simply grin and bare it until you break. That’s like waiting until your patient’s heart stops to intervene. Don’t call a code on yourself!
(I go through a systematic way to harness your stress response in Breakthrough ICU’s coaching package.)
How to Prepare For Your First Day as a New ICU Nurse
As you can imagine, there is a lot that goes into becoming a successful bedside nurse. I remember how tough my transition from cardiac med-surg/stepdown nurse to neurocritical care nurse back in 2012. It was like I was a new graduate again!
During that challenging time, I desperately wanted something I would work on while I was at home so that when I clocked-in I felt more confident and less nervous. Fast forward over a decade later and I’ve created the ultimate resource for new ICU nurses!
Trying to build your confidence as a new ICU nurse?
Breakthrough ICU from FreshRN is a 6-week, online course specifically crafted for brand new ICU nurses who want to get ahead of the game. So that instead of merely surviving orientation, they’re confidently thriving all the way through. With Breakthrough ICU, it’s like we took all of the highlighted info from the nursing textbooks, mixed in our own experience, wisdom, and expertise, and packaged it in a way that it’s tangible, easy to digest and understand, and can be applied to your very next shift. You can start your ICU journey with your head held high (but not too high!) and your heart calm.