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 4 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.
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. 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’re 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.
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.
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!