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Updated: September 2026
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.)
- How to Use This Guide
- What to Learn First as a New ICU Nurse
- Common Skills for ICU Nurses
- Common Equipment for ICU Nurses
- Common Procedures ICU Nurses Perform or Assist With
- Common ICU Medications
- Common ICU Patient Diagnoses
- Common ICU Diagnostics
- Common ICU Nurse Abbreviations
- How to Avoid Common ICU Nurse Mistakes
- How to Prepare for Your First Day as a New ICU Nurse
How to Use This Guide
Think of this guide as a reference you can return to throughout ICU orientation. You do not need to memorize everything here before your first shift. You’ll build understanding as you care for patients, ask questions, and practice with your preceptor.
Bookmark this page and review topics as you encounter them. If your patient is receiving an unfamiliar medication or using equipment you haven’t seen before, start with the relevant section and bring your questions to your preceptor. Ask how it connects to your patient’s condition and what you’ll need to monitor together.
Use this guide alongside your unit’s policies, approved clinical resources, and hands-on training. Give yourself permission to learn a little at a time; that’s how these unfamiliar terms start becoming familiar parts of your day.
What to Learn First as a New ICU Nurse
There’s a lot to learn in the ICU, and figuring out where to start can feel like a challenge in itself. During your first shifts, focus on these three priorities with your preceptor:
Understand Your Assigned Patients
Start with why each patient is in the ICU, what the team is treating, and what needs close monitoring. Ask your preceptor to help you connect the diagnosis to the assessment findings, medications, and bedside equipment. You’ll remember more when you understand why something matters to the person you’re caring for.
Learn Your Unit’s Routines and Safety Processes
Get familiar with how your unit handles report, assessments, rounds, medication checks, and emergencies. Have your preceptor show you where to find policies, supplies, and emergency equipment. You don’t need to know where everything is immediately, but you do need to know how to find help.
Know When and How to Ask for Help
At the beginning of each shift, discuss which patient changes you should report immediately and who to contact if your preceptor is unavailable. If something seems wrong or you’re unsure how to proceed, speak up promptly. You do not need to figure everything out before asking for help. Recognizing your limits and involving the right people are essential ICU nursing skills.
Common Skills for ICU Nurses
ICU nursing involves gathering information, recognizing changes, and responding with your team. These are skills you’ll develop throughout orientation with your preceptor’s guidance.
- Patient assessment: Establish your patient’s baseline, perform scheduled and focused assessments, and recognize changes that need prompt attention. Assessment frequency depends on the patient’s condition, orders, and unit policy.
- Medication and drip management: Understand why each medication is ordered, verify your infusions and IV lines, and monitor the patient’s response. Follow orders and unit protocols for titration.
- Respiratory assessment: Assess breathing, oxygenation, and how the patient is tolerating respiratory support. Work closely with your respiratory therapist and preceptor when responding to alarms or changes.
- Cardiac and hemodynamic monitoring: Connect heart rhythms, blood pressure trends, and other assessment findings to the patient’s overall condition.
- Line, tube, and drain care: Assess insertion sites, maintain secure connections and appropriate dressings, monitor output when applicable, and recognize potential complications.
- Pain, sedation, and delirium assessment: Use your unit’s approved tools to assess patients (including those who cannot speak) and help the team evaluate comfort and sedation goals.
- Mobility, positioning, and skin care: Work with your team to support safe activity, protect skin, and determine what movement the patient can tolerate.
- Communication and teamwork: Give organized report, contribute to rounds, communicate changes promptly, and ask for clarification when the plan is unclear.
- Patient and family support: Explain care in understandable terms, listen to concerns, and support patients and families through uncertainty and end-of-life care.
Ask your preceptor: “For these patients today, which assessment findings and changes should I pay the closest attention to?”
Common Equipment for ICU Nurses
You’ll encounter different equipment depending on your ICU’s specialty and patient population. Start by understanding what each device does and why your patient needs it. Your preceptor will guide you through its operation, alarms, and required safety checks.
| Equipment | What it does |
|---|---|
| Mechanical ventilator | Supports breathing through an artificial airway. |
| Infusion pump | Delivers IV fluids and medications at controlled rates. |
| Cardiac monitor | Displays heart rhythm and other monitored information, such as blood pressure and oxygen saturation. |
| Central venous catheter | Provides access to a large vein for prescribed therapies and, in some cases, monitoring. |
| Arterial line | Provides continuous blood pressure measurements and access for arterial blood sampling. |
| Urinary catheter | Drains the bladder and allows urine output measurement when indicated. |
| Feeding tube | Provides a route for nutrition and certain medications when oral intake is not appropriate. Some tubes are also used for decompression. |
| Pulse oximeter | Estimates blood oxygen saturation. |
| Blood glucose meter | Measures glucose using a blood sample. |
| Defibrillator | Delivers electrical therapy for specific abnormal heart rhythms. Some models also provide pacing capabilities. |
| Continuous renal replacement therapy (CRRT) machine | Provides ongoing blood filtration and fluid removal for selected critically ill patients. |
| Specialized cardiac support devices | Devices such as an intra-aortic balloon pump support circulation in selected patients. They are more common in certain specialty ICUs and require additional training. |
You won’t necessarily use every device during orientation. Focus first on the equipment supporting your assigned patients.
Ask your preceptor: “What is this device doing for our patient, and which alarms or changes require an immediate response?”
Common Procedures ICU Nurses Perform or Assist With
Your role in a procedure depends on your training, demonstrated competency, facility policy, and applicable scope of practice. Some activities become part of your regular routine; others require additional education or a specialized team.
During orientation, you may learn to perform or assist with:
- Peripheral IV insertion and blood collection
- Urinary catheter insertion and removal
- Nasogastric or orogastric tube placement
- Central line dressing changes and removal of designated lines
- Wound care and dressing changes
- Tracheostomy care and airway suctioning
- Arterial blood sampling through an existing arterial line
- Resuscitation and emergency response
You may also help prepare patients and assist the team during procedures such as intubation, central or arterial line placement, bronchoscopy, or chest tube insertion. Your responsibilities may include gathering supplies, monitoring the patient, administering ordered medications, and providing care afterward.
Specialized therapies and monitoring (such as CRRT, pulmonary artery catheter monitoring, or intra-abdominal pressure measurement) depend on your unit and may require separate training.
Before an unfamiliar procedure, review your role with your preceptor. Understand what preparation is needed, what to monitor, and when to call for help.
Ask your preceptor: “What am I responsible for before, during, and after this procedure?”
Common ICU Medications
While there is some overlap, the meds given in the ICU are quite different from those on 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 it does, without trying to memorize everything
Vasoactive Medications
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 dilate (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.
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 medications 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 increased mortality, prolonged ICU stay, cognitive impairments (that can be long-term!), and so many other awful things. Preventing delirium is an important part of ICU care.. 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.
Neuromuscular Blockers
Neuromuscular blockers, also called paralytics, are high-alert medications that temporarily prevent skeletal muscles from moving—including the muscles needed to breathe. Here’s the critical distinction: paralysis does not provide sedation, pain relief, or amnesia. A patient who cannot move may still be aware and experiencing pain if they are not adequately sedated. Appropriate sedation and pain management must be established before paralysis and maintained throughout its use, along with assisted ventilation and close monitoring. As a new ICU nurse, administer these medications with your preceptor’s guidance and follow your unit’s protocols. Never assume that a motionless patient is comfortable or asleep.
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!
Antibiotics
Serious infections can land patients in 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.
Anticoagulants
Patients may come into the ICU because of blood clots, clotting disorders, and/or need active VTE prevention. These medications prevent or reduce blood clot formation. Heparin and enoxaparin (Lovenox) are the most commonly administered; however, many others are available.
Antihypertensives
Patients in the ICU often have blood pressure issues. When it needs constant change and monitoring, the patient is on a drip (one of the vasoactive meds mentioned earlier), 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.
Steroids
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
- Insulin
- Electrolyte replacement
- Diuretics
- Antiarrhythymics
- Inotropic agents
- Anti-epileptic drugs (AED’s, anti-seizure): Levetiracetam (Keppra), Phenytoin (Dilantin): Used for seizure management in critical care.
- Bronchodilators
Connect the Medication to Your Patient
When you encounter an unfamiliar medication, start with why this patient is receiving it. Review its intended effect, required monitoring, and important precautions with your preceptor using your unit’s approved medication resources.
Ask your preceptor: “How will we know this medication is working, and which changes should I report right away?”
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
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
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
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.
I go through the patho more specifically in this free preview of the ARDS module of my comprehensive ICU prep course.
Trauma
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.
Post-Operative Complications
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 a 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.
Intracranial Hemorrhage/Stroke
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 many patients who 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.
Connect the Diagnosis to Your Assessment
Two patients with the same diagnosis can have very different needs. Review why your patient requires ICU care today and how their other conditions affect the plan.
Ask your preceptor: “What are our biggest concerns for this patient during this shift, and which findings would tell us they’re improving or getting worse?”
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.
Electrocardiogram (ECG/EKG)
An ECG records the heart’s electrical activity and is used to diagnose cardiac arrhythmias, ischemia, and other cardiac abnormalities.
➡️ For a quick refresher, review our guide to EKG interpretation 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 (US)
Ultrasound imaging uses sound waves to visualize organs and blood flow, helping assess 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, helping diagnose pulmonary embolism and other lung disorders. These are a bit less common than the other diagnostics.
Blood Cultures
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.
Serum Electrolytes
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.
Lactate Level
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 Test
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.
Troponin Test
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, repeated at ordered intervals.
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 to delivering high-quality care.
Understand Why a Test Was Ordered
Learning what a test measures is a starting point. Next, connect it to the question the team is trying to answer about your patient. Review results with your preceptor in the context of previous results, the bedside assessment, and the treatment plan.
Ask your preceptor: “What are we trying to learn from this test, and how might the result change our care?”
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
- 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
- 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 superhuman. We make mistakes. As a nurse new to a fast-paced, 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
- Double-check meds that are continuously infusing after you take over for another nurse
- Trace and label your IV 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 you get better at report!
- If you’re not sure about what someone said, ask for clarification
- 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!)
Infection Control
- 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
- During report, if the off-going nurse mentions any neuro deficits, confirm them in the moment. For example, if they say the patient has a right facial droop, ask the patient to smile at that time to confirm it has not changed. If the patient is unconscious and unable to follow commands, then quickly go through an unconscious neuro check
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 judgment 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 to 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 bear 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
Your first day isn’t a test of everything you know about critical care. Your goal is to get oriented, connect with your preceptor, and start learning how your unit works.
A little preparation can make that first shift feel more manageable:
- Confirm the logistics. Know when and where to arrive, who to ask for, what to wear, and which materials your educator wants you to bring.
- Review what your unit has provided. Start with assigned orientation materials. You don’t need to spend the night before your first shift trying to teach yourself critical care.
- Have a place for learning questions. Use a notebook or another unit-approved method to record topics you want to revisit, without including patient identifiers.
- Discuss your starting point with your preceptor. Share your previous experience, what feels unfamiliar, and any concerns. Ask what you’ll be expected to observe or practice that day.
- Choose one manageable learning goal together. That might be understanding the flow of report or connecting one medication to your patient’s plan of care.
- Make room for rest. Give yourself time to eat, sleep, and arrive without rushing. Preparation includes taking care of yourself.
Before you leave, ask your preceptor what went well and what to focus on next. Let that conversation guide your studying so it stays relevant and manageable. I remember how challenging my transition from cardiac med-surg/stepdown to neurocritical care felt. Even with nursing experience, I had so much to learn. Give yourself time to build those connections, and keep asking questions. You’ve got this!
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Thank you Katie!! You are truly a blessing!! I ABSOLUTELY LUV nurses like yourself!! PLEASE CONTINUE TO INSPIRE AND HELP OTHERS!! GOD BLESS!!💯💯❤️❤️