Musings of a Nightshift Nurse

Being New in the ICU

Being New in the ICU

If you’ve just been hired into the intensive care unit, congrats! Or maybe you’re a few shifts in and you’re wondering “what the heck am I doing here??” Or, if you’re just considering ICU nursing, I hope this post brings you some comfort, motivation, and reality.

Being new in the ICU is not easy. You need to have the passion for critical care so much that you really don’t care how difficult it is. That passion is what gets you through the newbie stress. I was a new grad in the ICU, I started straight out of nursing school. I knew that’s where I belonged and I had wanted ICU all 4 years of school, with no hesitations. And even with that insane passion and devotion to the field of critical care, I went home in tears A LOT during orientation and lost 15 pounds. And I’m only 5’1.


A lot of people who work in critical care tend to be perfectionists. I’m one of them, and I think that’s why it was so hard to be new. I wanted to be good immediately, and boy was I humbled. It takes years to feel comfortable in the unit, no matter how smart you are. I work in a pretty unique ICU. We are a cardiac ICU, neuro/trauma ICU, and surgical ICU combined. We can take care of a fresh heart transplant one night and a traumatic brain injury the next night. It’s pretty awesome, but was a lot of information to learn being new since we’re not a specialized unit. And honestly, I’m still pretty new to the ICU! I’m coming up on 3 years and have learned so much in that time, but still have so much to learn. So my goal with this post is to teach you 8 of like, 1000 things I learned being new to intensive care, while giving you motivation to get through orientation and the years following.

ICU drips
Thanks Michelle for this pic πŸ™‚

1. Don’t get distracted by the technology. It’s overwhelming to walk into a room with 10 drips, a vent, CRRT, IABP, therapeutic hypothermia, whatever! It’s even harder when there’s family scattered in between each of those. Keep in mind, there’s actually a patient in the bed! A patient that has a family, that has a future, and YOU are the one in charge of managing that. Yes, that’s a lot of pressure. So when you’re feeling overwhelmed by all the technology that is new to you, don’t ever forget to look at your patient, assess that patient head to toe, touch that patient. Numbers can look good but how does the patient look? Are their extremities cold? Do they have delayed wound healing or a pressure ulcer? Are they getting good nutrition in the midst of all the machinery? All these things can lead to other complications that could possibly even lead to death! It seriously sucks when you’re managing such a sick patient well with all the technology but they die from something totally different from their initial diagnosis. It’s your job as a nurse to prevent that, and it’s not the technology that’s going to help you do that. Technology is your partner, utilize it, but combine it with your clinical knowledge and intuition for optimal care.

2. Learn outside of your shifts. Yes I know. The last thing you want to do after a 12 hour shift is to go home and continue more work. But I’m telling you this solidifies what you have learned during the day. If you don’t immediately look stuff up after your shift you’re going to forget a lot of the information the next day. When I was orienting, and even now, if there was a condition/medication/surgery I didn’t know, I wrote it down and looked it up when I got home if I didn’t have time at work. If you consistently don’t understand vent settings, or common ICU drips, you need to know those. So take the time to learn what you don’t know at home, cause those machines and medications aren’t going away any time soon.

3. Don’t be overconfident.Β You need to prepare to be a student of critical care…your entire career. New diseases will be discovered, new medications will be prescribed, and new technology will be introduced. No one likes the new nurse that walks into the unit acting like they know everything. Being cocky is dangerous. That nurse that doesn’t ask questions or ask for help when it’s needed can be deadly. I’ve walked into patient rooms to help after seeing bad vitals at the nurses station and my help has been declined when it was very much needed. I’ve been told, “Do you think I can’t handle this on my own?” Don’t take help offered as a jab to your ego! Take the help if it’s offered, always! Some patient assignments in the ICU wouldn’t be possible without the help of several nurses in a room so please, ask for help.

4. Be a team player. You are not in this alone. Physicians, technicians, therapists, housekeeping, transport, central supply, etc ALL contribute to the overall well-being of the patient. Collaborate with them, ask them questions, and give them your own suggestions. Again I reinforce what I said in #3, ask for help. And, help others around you. Nobody likes the nurse that stays in the patient’s room all night so they’re not bothered to help. Don’t be that nurse. If you have time, walk around to see if nurses are busy and need you.

5. Learn to take constructive criticism without it hurting your ego. You’reΒ going to get a lot of people telling you how to do things differently, their opinion on what they would do in a certain situation, and you’ll get tons of feedback when you have a preceptor. Don’t take these comments personally. Most of your coworkers genuinely want you to succeed, and they want to help get you there. So try to listen to their suggestions if they’re helpful to you, and incorporate them into your practice. When I started out, one of my first meetings on orientation started out with: “So I’ve heard you’re struggling.” OUCH. I remember walking out of that room in shock, never having “struggled” with anything in my life. School had always come easy to me, I’d ace tests without studying and stay out late before class. But after that meeting I went and cried with my preceptor in an empty room. After I let all my feelings out, the feedback motivated me to continue doing what I had a passion for, and that was critical care. Please don’t let any negative feedback turn you away from the ICU if you know you belong there. Turn it into something positive and let it drive you even more to prove them wrong.

Nurse smiling with stethoscope
6. Use your resources and support to help when you’re feeling stressed. I think it’s normal to say that your anxiety level when you start in the ICU is HIGH. You have someone’s life in your hands every shift and you’re not yet comfortable with any of the technology or drips you’re using. We’ve all been there. Understand that, and try your best to treat yourself well during this time. Stop the negative self talk and engage in self care outside of work. Talk to people on your unit about how they felt when they were new compared to how they feel now. It helps a lot to be able to relate to people who have gone through the same thing. You don’t have to act like you’re fine if you’re not! If you’re nervous to talk to coworkers (don’t be) then talk to your family and friends, vent about what’s hard. What I love about our unit is that we have a mentorship program for new hires to opt in on during their first year. All that was required was a 2 hour meeting every 2 months to just go out for a meal or do an activity together and talk about work. It helped you feel included and was nice to have that person to talk to. If you don’t have this on your unit I highly suggest starting a program like this!

7. Be compassionate. Your patients and their family are going through an avalanche of emotion and possibly the worst day of their lives. Try your best to put yourself in their place and think about how you would react in their situation. I learned this well when I was a trauma patient. There were some nurses I trusted with my life and some that scared me. Some I could tell genuinely cared about controlling my pain and others that were annoyed with how often I pushed the call light. It meant a lot to me that they allowed my family (and half of my SICU coworkers) to stay and be with me in my room. When you’re in that hospital bed, visitors mean everything to you. So yes, sometimes they ask a lot of questions or are in your way. Try to accommodate them the best you can while still being able to care for the patient. Every patient is going through something different with different needs, so please try and treat all of them with the same respect you would expect for yourself.


Scrubs up to 75% off!
 

8. Don’t be so hard on yourself! You will get there. If you have the motivation and passion for the field of ICU nursing, you will eventually be that nurse in the sickest patient’s room, running the show. Don’t give up, acknowledge that the journey is difficult but rewarding, and try your best to be social on the unit. It helps to have coworkers that support you and help you grow. When you’re finished with a tough shift, don’t go home and tell yourself that you’re dumb, or incapable of this job. Your brain feeds off that negative self-talk more than you know. Tell yourself one good thing you did that day, and be proud at how far you have come.

I wish you the best if you’re new to the ICU! It’s a crazy world but it is so awesome. Believe in yourself, your mind, and your skills. If you have any other tips or questions for me please leave them below, I would love to answer them!



35 thoughts on “Being New in the ICU”

  • Marrisa. This post is right on and a great advice to any new ICU nurse. Thanks for sharing your experience with others. Nurses need to learn from each other and, whether experienced or new, even nurse brings something new to the table. I commend you for your passion and compassion; two important traits for exceptional nurses.

  • Thank you for posting this. I am a new ICU nurse (about 7 months in) and I have had days that were bad and all I did was cry and vent to coworkers and fam. I honestly feel like I am being hit with all the hard assignments first compared to some other new nurses. I know working in an ICU isn’t meant to be easy but after days of not so great shifts, it makes one feel worthless. I do like learning a lot but also beat myself up a lot when I feel like I am behind. I enjoyed your blog and hope that this phase/feeling starts to ease some.

    • You are not alone. I felt exactly the way you do and I was constantly stressed at work and at home because I was thinking about work. It will get better. Know that and tell yourself that every day and one day you won’t need to keep telling yourself that anymore πŸ™‚

  • I’ve been an ICU nurse for thirty years. Let’s face it~ it’s really hard work. The take away is knowing that you helped in a small way. It’s not for everyone and most importantly , it takes a village. We , as nurses need to partner, not just with each other but everyone else who is involved in helping this really sick patient. Everyone has a place at the table.

  • Good tips! I started out on the acute Neuroscience floor, am still here even, but it was intimidating as a new nurse, and all of these tips are similar to advice I was given by a seasoned nurse – got me through! Thanks for sharing!

  • Thanks for this. I coordinate a course for nurses new to critical care from a consortium of hospitals and I will share this with all of them.

  • I am a 20+ year veteran nurse with mutiple years experience primariky in ICU & surgery. Over this past weekend I had the distinct honor of being my own ICU patient! Being an ICU nurse & a patient of the ICU is more mind boggling then managing even the toughest of cases as just the nurse! As the patient, my knowledge sometimes got in the way of my care. I knew so much… too many of the what if’s & what then’s… my critical mind was constantly trying to put all the pieces together & manage my care… yet I was SOO NOT IN CONTROL of any of it! I couldn’t just look at the chart & get test results when I wanted. I couldn’t page/text docs or even colleagues & collaborate thoughts. I didn’t know the knowledge base/professionalism/work standards of the nursing staff caring for me. I couldn’t choose my bedside nurse. Let’s just say I learned a new very real appreciation of a patient’s point of view duting my stay! I learned a new appreciation for the value of consistency of care! Every new face I met brought to the table another interpretation of what was really happening with me…. from THEIR point of view!

    • I know exactly how you feel! I was a trauma patient in June and still recovering. But being a nurse in the bed oh my word, I was a terrible patient. I kept telling them what meds were late and how to bolus meds from the pump! I couldn’t help it! I learned so much being a patient though, I definitely have so much empathy now. It’s not easy being a patient!

  • Such a well written article! I, like you, started as a new grad in ICU over 20yrs ago. It was so overwhelming and there was so much self doubt. It does take a village to get through every shift. No question is a dumb question. I was surprised at how drained I could feel after so many years in ICU from 1 shift. It is physically, mentally, emotionally, psychologically & spiritually draining. I truly believe the best of the best survive and thrive there. Keep up the words of encouragement and supporting each other. I preceptors new nurses in many different hospitals and I think it is important to never forget you were new once and that you are dealing with a human being. My motto was to treat the pt like a member of your family or someone you dearly loved. Compassion first!

  • I am currently in my last semester of nursing school and I just accepted my first job as a new graduate RN on an ICU. Like your ICU, this one is also very complex. It is a combination of neuro, trauma, medical, and surgical patients. I needed to read this article more than I can express. I have a mixed bag of emotions. I am so excited and honored to have been selected for the position but am constantly already asking myself, “Am I cut out for this?” I know my passion and heart is with ICU nursing and therefore after reading this I know I can do it. Thank you so, so much.

    -Rachel

  • The best thing I learned in the ICU was to bounce my thoughts off of another ICU nurse. I figured two brains were better than one. One nurse I worked with I called the other half of my brain. With some crazy sick patients I remember fondly the help I got from my coworkers. I was always available to help with another nurses patients. Those are some of my joys but I also remember a nurse sitting at the nurses station right in front of a patients room and her not even getting up to help as we coded the patient in there. A job that’s so difficult but that brings you so much love and satisfaction.

  • Don’t get lost in the hustle of everything and forget the family members. This is very easy to do in such a challenging environment. For new grads deciding to start in the ICU, remember, that for all they (family/friends) know you are a seasoned veteran in the ICU. They do not/can not fully understand the challenges you are facing with learning all the new information you have to learn or the time management skills you have to master so that you can get things done while still caring for their loved one. With that said, to be a truly effective ICU nurse, you can not simply be good at knowing the conditions you deal with, the medications you administer, assessments, documentation, etc. You have to also be good/great at remembering that that pt in the bed is a person who has family and friends that not only love them but are likely scared sh…less about what is going on. They often do not know if there will be a tomorrow for their loved one. It goes without saying that this can cause an immense amount of stress and anxiety and most people are not at their best in this state. They can come off as abrasive, mean, rude, needy OR they may just sink back into a corner and look terrified. It’s important to remember that they are also important. They often have to make difficult decisions and remember, they KNOW what the pt was like before ending up in the ICU. It’s important to find away to make some time to explain what your doing, why you’re hanging that drip, why your giving that med, placing that catheter/tube/moniter….whatever. Give status updates, provide necessary education. Also address their concerns. They don’t want to see their loved one sitting in a pool of stool for long periods of time and they don’t like seeing them all disheveled. They will seem nitpicky about such things when all you’re thinking is…REALLY??? I’m trying to keep him/her from dying and you’re worried about bit of blood on the gown?? BUT…they are scared, they know things are bad and these things are the only things they feel they have some control over. Acknowledge their concerns, let them know that you will be taking care of it, give an approximate timeframe and lean on your team to help out! This will ultimately make your life and their experience much better. The more unsure and the less knowledge they have….the more they are going to be seeking you out or calling often and this can really make for a bad day. Make them feel like a part of the team, as they truly are. Finally, don’t fall into the habit of allowing negative perceptions/opinions of family/pts shared by fellow RNs taint your attitude before even interacting with them. Go into each situation with a fresh perspective, give them a chance and show them that you respect them and care and you will often get it back multiplied.

    • Brandy,
      You are the epitome of a dream nurse! Your advice on treating the patient and interacting with family members by showing compassion, being kind, caring, and considerate, is golden! This speaks volumes on your character, ethics, professionalism, and integrity.
      You show such passion for your job, bundled with having exceptional interpersonal skills, actually listening to concerns of a patient or their family member, while being sympathetic, observant, warm and truly caring about the health and needs of others, is truly moving.
      Hopefully others (on both sides) will take heed- if only my husband (the patient) and I had encountered ICU nurses half as thoughtful and caring as you… that would have been magical-
      ~Rose R

  • I think it would do everyone in Critical Care Nursing some good to read this…. Having been a Critical Care Nurse some 30+ years {wow- has it been that long.} There isn’t a thing in your post about ‘Being New in the ICU” that doesn’t apply to me as well… One of the major reason I work in Critical Care in a Teaching Hospital is the constant challenge of keeping up with all the advances in Medicine… Plus I really like helping New ICU Nurses get there feet on the ground in our Unit (the Students and New Graduates constantly challenge me to bring my A game to work)

  • That patient in the bed, on the other end of all that technology is a person. They don’t belong to you, they belong to their loved ones and you need to be compassionate about the pain of the loved ones as you administer and monitor all that technology. You are a nurse. Be caring. Fake it if you must but be caring.

  • Extraordinarily honest and human and helpful perspectives from all. Thank you for the passion and compassion you bring to the ICU.

  • Such wise words for students, nurses on orientation or nurses who changed specialties as I did ( Med-surg X 14 years then ICU X8….it was terrifying to go from being so comfortable to being a beginner) I LOVED this article. and will share it with every new nurse I orient and have also shared it with my unit educator.

  • I love your article I can fully relate. ..Been an icu nurse for 3 years on my permanent job and I know I got my respect from my co-workers but now I decided to do travels and on my first assignment I feel like I’m back for being a newbie again…. 😣

  • Saw this in a recent issue of AACN’s BOLD and loved it! Shared it with my nurse manager and posted it in our pre-shift huddle room. As a preceptor, it’s difficult to convey how hard orienting to the ICU can be, even if you’re not a new nurse. Thank you for writing this so eloquently! And I’ve read a few other posts, thank you for sharing your journey both personal and professional. Lots of good tips on your blog <3

  • It’s good to know that when it comes to a nurse working in the ICU, that there are somethings that need to remember. I like how you pointed out that they need to be a team player when it comes to this job. As a potential patient, or the family of a potential patient; it would be nice to be in a care unit where the different doctors and nurses get a long and actually work together.

  • I love this post and the tips! So Im actually working in a NICU and have been there for over a year and a half! All of your tips apply there as well. Some days you walk out feeling like superwoman and some days its a struggle to hold your head up and hold in the tears until you get to the car. If you have anytips or no of anyone who has swithed from NICU to PICU or NICU to adult ICU I would love to hear what they have to say!

  • I am a new grad and new to ICU. I started six weeks ago, and I thought I was in over my head the first day I started orientation. It was so overwhelming and stressful. I often ask myself, am I smart enough for this? Should I continue? I do have a passion for ICU, and I love the idea that I will someday make a difference, however small it may be. Your words of encouragement are what I needed to see, and I thank you for sharing your views and giving, us “newbies,” advice.

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