8 Tips for New Grads in the ICU

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Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.

Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center.

What You’ll Learn

• Open Mind
• Typical Characteristics
• Initiative
• Advocating
• Orientation
• Organization
• Alarms
• Downtime

In this episode, we dive into 8 tips for new grads in the ICU! We discuss the characteristics of the intensive care nurse, normal expectations, critical thinking, advocacy, communication, and more. This episode is hosted by 3 CCRN nurses, which is a critical care specialty certification granted by the American Association of Critical-Care Nurses.

8 Tips for New Grads in the ICU

#1 Come in with an open and actively engaged mind

• Expect to be overwhelmed for awhile (at least 6 months)
• Fight the “I want to be perfect” mentality; while it’s admirable, it’s not possible – setting yourself for more stress and disappointment with that expectation
• Nursing is a practice – you’re never going to be at a point where you don’t make mistakes or be perfect. There is an art to this.  The skills in nursing school aren’t the only ones you’ll need.

#2 Be aware of typical ICU nurse characteristics

• Assertive, direct, business-like attitudes, detailed-oriented, anticipating things ahead of time, know protocols inside and out, intense, autonomous (very familiar with protocols, able to enact orders/protocols independently and then discuss with MD).
• You are still bringing something to the table, it’s just different than what the others who bring to the table who are already there.

#3 Show initiative

• You’ll have to be assertive yourself – go home to learn and understand more
• Invest time into making yourself better in the off time
• Round with MDs, seeking out learning opportunities
• Introduce yourself to others

#4 – Know yourself and be your own advocate

• Know your learning style and communicate this to your preceptor
• Know your limits / what you don’t know so you can fill in the gaps
  • Please don’t be the new grad know-it-all
  • Find the balance between not knowing anything and being so obvious about that people question your ability to be a safe care provider, and being the know it all who continually acts like they do not need to be educated
• Find a mentor!

# 5 – Own your orientation

• Orientation is truly an extension of nursing school without formal grading
• Ask for help when you need it – sometimes your preceptor cannot always pick up on times when things aren’t clicking
• Advocate for yourself!
• Work through the process of orientation; it’s a marathon and not a sprint

#6 – Keep an organized routine throughout your shift

• Have a systematic routine way of assessments, your day, meds, etc. otherwise you will miss somethings
  • This helps get through the shift and not miss things.
• Stop and get organized first before starting your shift so you start on a good note.
• Resource: Anatomy of a Super Nurse, The Ultimate Guide to Becoming Nursey, chapter 7

#7 – Learn your alarms and use them to your advantage

• Have a love/hate relationship with alarms.
• If there is always one going off, you’ll never know when it’s real…turn yours off if it’s non-actionable or adjusts threshold per policy.
• Use them to remind you so you don’t forget.
• If you change a pump, add volume, silence an alarm, or whatever for another nurse – let them know!
  • Do you hear what I hear? Combating alarm fatigue – American Nurse Today
  • Alarm Fatigue: A Patient Safety Concern – American Association of Critical Care Nurses CEU (free for members, $10 for non-members)
  • Alarm fatigue; a top patient safety hazard – NCBI

#8 – You need downtime

• Becoming a critical care nurse straight out of school tough and exhausting, take care of yourself
• Again, advocate for yourself
• Take time off for yourself, make time for yourself – no one will do this for you

Resources for newbies to critical care

• How to Manage Your Time In Critical Care
• Tips for New Grads in the ICU
• The FreshRN Podcast
• Nursing.com Podcast
• ICU Time Management Tips
• The Ultimate Guide to Creating an ICU Report Sheet (for new critical care nurses and nursing students)

Nursing.com also has quite a few great resources for nursing students and new nurses.  There are various courses on Nursing.com. You can even get a 3 day trial of the academy for only $1!

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