Welcome to the ICU. We're happy to have you here, and we know you want to be a great ICU nurse. That's going to take a long time, but you can be a great colleague in the mean time.
When you encounter someone new -- or anyone, really -- smile, say hello and introduce yourself.
Do this as many times as it takes. Some of your new colleagues will remember you the first time. Others aren't so blessed with name/face memory. Some will remember your name or face but not what you're doing in the ICU. Introduce yourself to the secretary, the tech, the housekeeper, the pharmacists, the providers and the consulting services. Those who are shy or find it difficult to introduce themselves will be grateful to you for making the first move.
Be up front with what you know and what you don't.
If you're transferring in from Med/Surg, you already know how to put in an IV, NG and Foley but may not know how to set up the monitor. If you're transferring from the SICU across town, you already know how to take care of a patient but may not know how to document in this hospital's clunky computerized chart. If you're brand new, you may not know anything, and that's OK too. What isn't OK, is for you to pretend you know something you don't, or not to know something you do know and could help out a colleague by doing.
Watch the monitors.
If someone else's patient has a systolic blood pressure of 42 or a heart rate approaching 300, DO something. Grab the nurse, alert your preceptor, tell the provider. Don't just hope that someone else will notice so you won't have to.
If someone else's patient is coding, help out.
Even if you're new, you can run specimens to the lab, pick up blood from the blood bank, corral the visitors in the area, answer call lights for the nurses in the room, jump on the chest to do CPR (the best place to be to see everything!) or watch the monitors on the rest of the unit. In fact, a study done when I was a brand new ICU nurse concluded that other patients in the unit are at risk of dying or complications while their nurses are helping out in the code. So you can help out by just watching the other patients. (IF it's your patient, remember Samuel Shem's rules from "House of God": The first pulse to take in a code is your own.)
If a patient is being admitted, help out.
Even if the only thing you can do is plug in the bed and the IV pumps, take a set of vitals and I & O on the admitting nurse's other patient or update the visitors.
Manage your alarms.
No one likes to listen to someone's patient alarm over and over because they're in A Fib with RVR and the upper ECG limit has been set at 80. If your patient's heart rate is usually 120, set your limit 20% higher. (Or whatever your unit protocol may be.) If his systolic blood pressure typically runs around 80, set the lower limit accordingly. Silence your art line alarms BEFORE you draw blood. Change the ECG patches, leads, cables -- whatever you need to do to get a clear picture and no extraneous alarms.
Manage your pumps.
Learning how to titrate drips is a skill. But most ICU patients have multiple IV pumps, and managing them is a different skill. They can all fit on one pole rather than having three poles at the bedside. Label your channels and your tubing in the unit-appropriate manner. Set your volume to be infused to a reasonable amount -- you don't want the IV to run dry, but you don't want the pumps alarming constantly either. Before you go on break or sign out to another nurse, make sure there's plenty of fluid in your bags. Order the new bags in plenty of time. Make sure your pumps are plugged in -- a battery that dies takes up to 24 hours to recharge, and some of the pumps cannot be silenced except by Biomed. (If that happens to you, get the pump off the unit or bury it under blankets and pillows until it's inaudible from more than 20 feet or so. Then call Biomed.)
Manage your own visitors.
Don't let them wander up and down the hall peering into other patient's rooms. When you ask them to step out, direct them to the family waiting area and tell them how approximately how long it will be until they can come back. Don't just leave them standing in the hall even though it's only going to be "a minute". It's far too easy for them to see or hear something that is HIPAA protected if they're just standing there. Visitors standing in the hall create obstacles to be negotiated and can get themselves into trouble. I once watched (from my patient's bedside, where I was holding pressure on an arterial squirter) a group of visitors pull the tops off every lab tube on the supply cart and switch them around. Another group discovered an unlocked computer at a charting station and were navigating through a patient chart when I happened upon them. And one group amused themselves by staring at other patients in the unit. So don't let them hang out in the hall, the nurses charting stations or near another patient's bed.
Ensure that visitors know and follow the rules.
Most ICUs have some sort of rules for visitors -- things like only 2 at a time, no eating or drinking in the room, no cell phone use -- whatever. They're written down somewhere (and if they aren't that would be a great project!). Know what they are and follow them. When you don't manage your visitors and ensure that they follow the rules, you're setting up a bad situation for the next nurse. If you've let the visitors do whatever they want and the next nurse wants them to follow the rules, you've made her a bad nurse in the family's eyes. Yes, it's easier to get through your shift if you don't insist upon follow the rules, but it's going to make your colleague's shift worse. Don't do it. You don't have to LIKE or AGREE with the rules; just follow them.
Follow the rules for nurses.
Follow the dress code, even if you don't like it. Be on time. If you're not supposed to carry your own private cell phone, don't. If you're only supposed to eat in the break room, don't eat at the nurse's station. Hide your beverage. Whatever the rules are, follow them. That especially goes for self scheduling if you're allowed the privilege. A new employee who tries to slide an extra weekend off past the scheduling committee or slough off on their night shift requirement may not get counseled the first or second time it happens, but someone has noticed and is not impressed. That person may be quicker to jump on other minor offenses, and is less willing to like you or give you a break when you need one.
Be accountable.
If you say you'll watch someone's patient while they go on break, watch that patient. If you say you'll clean the balloon pump that has just been removed, clean it. If you're supposed to be hand washing monitor, be hand washing monitor. Pay attention to your skills checklist and be alert for opportunities to learn new skills or practice older ones.
Fit into the unit culture.
Talk to people. ICUs are stressful environments, and ICU nurses are often possessed of a very dark sense of humor. There may be a list in the break room of 47 ways to say "the patient is about to die". Circling the drain, waiting for the Jesus Bus, high Vulture index -- and many, many more. You're not going to make friends by being offended, even if you ARE offended. Add your favorite saying to the bottom of the list, and be prepared to think of a dozen new ways to say your patient lost consciousness. Or threw up. We joke about things that aren't really funny because often times things are so serious that if you don't laugh, you'll cry. Understatement is the hallmark of a true ICU nurse. The patient that just ripped off all his ECG leads, pulled out his central line and is running down the hall naked and screaming for the police may be described as "a tad lively" and the one with a blood pressure south of 60 and a heart rate north of 160 may be described as "a touch unstable." Sinus rhythm with PACs, PJCs and PVCs is "cardiac salad" and a loud murmer may be called "the Maytag sound."
I am sure I've forgotten dozens of things, and hopefully someone will remind me.
When you encounter someone new -- or anyone, really -- smile, say hello and introduce yourself.
Do this as many times as it takes. Some of your new colleagues will remember you the first time. Others aren't so blessed with name/face memory. Some will remember your name or face but not what you're doing in the ICU. Introduce yourself to the secretary, the tech, the housekeeper, the pharmacists, the providers and the consulting services. Those who are shy or find it difficult to introduce themselves will be grateful to you for making the first move.
Be up front with what you know and what you don't.
If you're transferring in from Med/Surg, you already know how to put in an IV, NG and Foley but may not know how to set up the monitor. If you're transferring from the SICU across town, you already know how to take care of a patient but may not know how to document in this hospital's clunky computerized chart. If you're brand new, you may not know anything, and that's OK too. What isn't OK, is for you to pretend you know something you don't, or not to know something you do know and could help out a colleague by doing.
Watch the monitors.
If someone else's patient has a systolic blood pressure of 42 or a heart rate approaching 300, DO something. Grab the nurse, alert your preceptor, tell the provider. Don't just hope that someone else will notice so you won't have to.
If someone else's patient is coding, help out.
Even if you're new, you can run specimens to the lab, pick up blood from the blood bank, corral the visitors in the area, answer call lights for the nurses in the room, jump on the chest to do CPR (the best place to be to see everything!) or watch the monitors on the rest of the unit. In fact, a study done when I was a brand new ICU nurse concluded that other patients in the unit are at risk of dying or complications while their nurses are helping out in the code. So you can help out by just watching the other patients. (IF it's your patient, remember Samuel Shem's rules from "House of God": The first pulse to take in a code is your own.)
If a patient is being admitted, help out.
Even if the only thing you can do is plug in the bed and the IV pumps, take a set of vitals and I & O on the admitting nurse's other patient or update the visitors.
Manage your alarms.
No one likes to listen to someone's patient alarm over and over because they're in A Fib with RVR and the upper ECG limit has been set at 80. If your patient's heart rate is usually 120, set your limit 20% higher. (Or whatever your unit protocol may be.) If his systolic blood pressure typically runs around 80, set the lower limit accordingly. Silence your art line alarms BEFORE you draw blood. Change the ECG patches, leads, cables -- whatever you need to do to get a clear picture and no extraneous alarms.
Manage your pumps.
Learning how to titrate drips is a skill. But most ICU patients have multiple IV pumps, and managing them is a different skill. They can all fit on one pole rather than having three poles at the bedside. Label your channels and your tubing in the unit-appropriate manner. Set your volume to be infused to a reasonable amount -- you don't want the IV to run dry, but you don't want the pumps alarming constantly either. Before you go on break or sign out to another nurse, make sure there's plenty of fluid in your bags. Order the new bags in plenty of time. Make sure your pumps are plugged in -- a battery that dies takes up to 24 hours to recharge, and some of the pumps cannot be silenced except by Biomed. (If that happens to you, get the pump off the unit or bury it under blankets and pillows until it's inaudible from more than 20 feet or so. Then call Biomed.)
Manage your own visitors.
Don't let them wander up and down the hall peering into other patient's rooms. When you ask them to step out, direct them to the family waiting area and tell them how approximately how long it will be until they can come back. Don't just leave them standing in the hall even though it's only going to be "a minute". It's far too easy for them to see or hear something that is HIPAA protected if they're just standing there. Visitors standing in the hall create obstacles to be negotiated and can get themselves into trouble. I once watched (from my patient's bedside, where I was holding pressure on an arterial squirter) a group of visitors pull the tops off every lab tube on the supply cart and switch them around. Another group discovered an unlocked computer at a charting station and were navigating through a patient chart when I happened upon them. And one group amused themselves by staring at other patients in the unit. So don't let them hang out in the hall, the nurses charting stations or near another patient's bed.
Ensure that visitors know and follow the rules.
Most ICUs have some sort of rules for visitors -- things like only 2 at a time, no eating or drinking in the room, no cell phone use -- whatever. They're written down somewhere (and if they aren't that would be a great project!). Know what they are and follow them. When you don't manage your visitors and ensure that they follow the rules, you're setting up a bad situation for the next nurse. If you've let the visitors do whatever they want and the next nurse wants them to follow the rules, you've made her a bad nurse in the family's eyes. Yes, it's easier to get through your shift if you don't insist upon follow the rules, but it's going to make your colleague's shift worse. Don't do it. You don't have to LIKE or AGREE with the rules; just follow them.
Follow the rules for nurses.
Follow the dress code, even if you don't like it. Be on time. If you're not supposed to carry your own private cell phone, don't. If you're only supposed to eat in the break room, don't eat at the nurse's station. Hide your beverage. Whatever the rules are, follow them. That especially goes for self scheduling if you're allowed the privilege. A new employee who tries to slide an extra weekend off past the scheduling committee or slough off on their night shift requirement may not get counseled the first or second time it happens, but someone has noticed and is not impressed. That person may be quicker to jump on other minor offenses, and is less willing to like you or give you a break when you need one.
Be accountable.
If you say you'll watch someone's patient while they go on break, watch that patient. If you say you'll clean the balloon pump that has just been removed, clean it. If you're supposed to be hand washing monitor, be hand washing monitor. Pay attention to your skills checklist and be alert for opportunities to learn new skills or practice older ones.
Fit into the unit culture.
Talk to people. ICUs are stressful environments, and ICU nurses are often possessed of a very dark sense of humor. There may be a list in the break room of 47 ways to say "the patient is about to die". Circling the drain, waiting for the Jesus Bus, high Vulture index -- and many, many more. You're not going to make friends by being offended, even if you ARE offended. Add your favorite saying to the bottom of the list, and be prepared to think of a dozen new ways to say your patient lost consciousness. Or threw up. We joke about things that aren't really funny because often times things are so serious that if you don't laugh, you'll cry. Understatement is the hallmark of a true ICU nurse. The patient that just ripped off all his ECG leads, pulled out his central line and is running down the hall naked and screaming for the police may be described as "a tad lively" and the one with a blood pressure south of 60 and a heart rate north of 160 may be described as "a touch unstable." Sinus rhythm with PACs, PJCs and PVCs is "cardiac salad" and a loud murmer may be called "the Maytag sound."
I am sure I've forgotten dozens of things, and hopefully someone will remind me.
Comments
Post a Comment