Surviving the ICU

There is no "regular day" in the ICU.  The day can go from boring to organized chaos in minutes. One minute you're talking about ordering pizza with your fellow coworkers and the next minute one of the nurses is yelling for help for an MI.  


While some nurses hate this type of unpredictable drama, others thrive on it.  It's the only thing they can imagine doing in life.  Welcome to life in the ICU, where nurses scrambling for crash carts is an every day occurrence.

ICU nurses are highly skilled and ready for any emergency.  It's packed with extremely fast paced and stomach churning activity.  You must constantly be on your toes and prepared for any critical emergency. 

The craziness of the ICU takes some getting used to, and this doesn't come overnight. For nurses that are new to this environment, it can make you want to run for the nearest exit and never come back.  But you have to learn, so you stick it out and hope it gets easier.  I promise you it does.  Here are some ICU survival tips to help you adapt:

1. Stay Organized

I know this sounds easy, but there are plenty of unorganized nurses that say they'll chart something later and later never comes.  Chart everything and chart as quickly as possible.  Remember, if you didn't chart it, it didn't happen.  The last thing you want is to postpone charting on one patient, only to have a code on another.  Believe me, once that code is over, you will forget what you meant to chart on a previous patient....Not good!

Get into a routine and always follow the same steps.  Here's an example of a great routine for the ICU:

Assess your patient, the monitor, and the vent. Check all your IV drips and make sure they are all correctly programmed with the right dose, rate, right drug and right time for that particular patient. Check and adjust alarm limits on monitors, if necessary and zero your lines.  Check all orders for medications and duties.  Gather your supplies.

2.Nights are Best

Night shifts are undoubtedly best for new nurses. I know nights are not for everyone, but when you're learning the ropes, it's best to work in a calmer environment and nights offer you that opportunity.  It's usually much quieter.  Management has usually gone home for the night, and there is much less drama. It's a great environment for a new nurse to perfect her skills. 

3.Ask for Help

Don't be afraid to ask for help.  It's much better than trying to muddle through and in the process making mistakes. Nurses often think they shouldn't ask for help because it makes them  look unorganized and unskilled. But, you can quickly sink from bad to worse if you don't ask for help and ask quickly. It's hard for nurses to accept the fact that you can't do everything.  Learn how to delegate. They taught you that in nurses school. So, choose some tasks to give to others, and relieve some of the stress on yourself. 

4. Know your patients

It is imperative in the ICU to have tunnel vision when it comes to your patients.  Concentrate on every single, minute detail about your them.  It's easy to get bogged down with tasks, but if you don't pay attention to your patients, it could be the difference between life and death.  

Watch everything!  Notice small deviations in blood pressure, heart rate, cardiac output, urine output, blood in drains. If you see a deviation in anything, do some detective work and figure out why it's happening.  These little deviations can add up quickly and before you know it your patient is crashing and you have no idea why. 

I've seen nurses that have transferred from another unit to the ICU, and they quickly begin to think ICU nursing is easy.  When they've been used to having 10 patients on a med-surg floor and now only have 2, they start to occupy their time with other things.  While they're looking up new recipes to make for dinner, their patient crashes and dies. Once this happens they never forgive themselves and can then become emotionally fried and hypersensitive to every little thing. They realize that they can't handle the pressure and responsibility of the ICU and then they quit. 


5. Lots of Authority

Some nurses tend to freak out about the responsibility involved with ICU nursing. The ICU operates on a lot of standing orders, and this constant authority and responsibility can prove to be too much for some nurses to deal with.

Often decisions must be made within minutes or seconds, and there are not always physicians around to make those calls.  You must always be on your toes, and you must develop excellent critical thinking skills to treat your patients effectively, safely and competently 


 6.Respect is Earned

If you're a newbie to the ICU, whatever you do, don't be a know-it-all.  You'll quickly be brought down to size by nurses who don't have time for this kind of arrogance.  Some ICU nurses are self-proclaimed superstars and don't mind flaunting it.  If they feel threatened by you at all, they will make it a point to embarrass you every chance they get.  

So try to stay humble and don't act like you know everything. Earn their trust by truly caring about your patients and staying positive.   Eventually, they will begin to respect you, and you will become part of the group until then you are the "outsider", and it's your job to prove yourself to them.

At the same time, don't allow other nurses to bully you.  If you give them any inclination that you are a push-over, they'll take it and run!


7. Help Others

One of the best ways to gain acceptance and trust as a good ICU nurse it to help others.  Jump in and assist when a surgery comes to the floor. Help answer the phone, suction patients, start IVs, place NG anything you can to grow your experience and learn.  Be a team player.  If you think  you're being watched you're right. These nurses are watching your every move to see if you're really cut out to be an ICU nurse. 


8. Giving Great Reports

When giving report it's important to stay organized.  Other nurses can tell how organized you are by the report you give, so stay focused during report. It's a good idea to memorize a good structure for your report and just fill in the blanks for each patient. Just as you do with patient assessment, start at the head and work down. This helps you avoid leaving important information out.  If your facility allows, bedside reports are great because they allow you to look at the patient while you're giving report, which helps you remember key points. 

9.Give it Time

ICU nursing isn't learned overnight; It takes time to improve your skills and adapt to your environment, Don't be too hard on yourself. You'll become a great ICU nurse if you persevere, and you're patient. 

10. Separate yourself

Dealing with life and death situations on a day-to-day basis can take its toll on you if you allow it to.  It's very easy to get caught up in the lives of others while caring for them, and this can become emotionally draining if you let it.  You must learn to separate yourself from your work as best you can when you leave your shift for the day.

You have to realize that this is a job and once it's over go home to your family and try to forget about it.  Take time for yourself. Pamper yourself, workout and do as much as you can to tackle any stress you have using healthy coping mechanisms. 

Do you have great advice for nurses who are new to the ICU? Comment below!