In honor of my 100th post I figured I'd write 10 important things I've learned these past two years of ICU nursing. 10 things I would tell myself as a new-grad... if only I knew then what I know now. I think it'll be fun to do this and see how it might change over the years.
10. When in doubt gown up!
Self explanatory really but if you're interested... Read this post and you'll see just what I mean. Also, since we are on the subject... it never hurts to have an extra pair of scrubs in your locker and this can be applicable to any hospital health care worker.
9. It's all in the details...
Even if its the smallest change or just barely off vital sign, lab value etc... sometimes its the subtleties that add up to a very important diagnosis. Example: A nurse once sent home a pediatric patient with a temperature that was slightly below normal. 96.9 f (normal is 98.6 f) The child ended up back in the hospital the next day with full blown sepsis and ended up later passing away. The below normal temp. was a sign that the patient was in the "cold" phase of septic shock.
8. Some things just take time.
No matter how much you study or how many classes you attend...some things just come from experience.... and that just takes time. Don't stress about trying to get the "difficult" assignments... they will inevitably come to you and when they do... trust me... you'll miss the days of getting the patient up to the commode 10 times in one shift.
If there is one thing I've realized about myself and people in general while working in the ICU is that a lot of the time when people are cocky or defensive it is because they have some major insecurities they are trying to compensate for. Consciously having humility will always get you so much further than being domineering or prideful towards others... especially when you are working in a team setting.
6. Never, ever say things like, "I'm bored." "Man, it's slow." or "It sure is quiet around here these days!"
Phrases like that are certifiably going to buy you at least one nasty code blue or a few gnarly admissions in the middle of the night... if it's quiet just enjoy it while it lasts!
5. If you are unsure about something STOP and double check before you proceed.
Probably one of the hardest lessons I have learned since becoming an ICU nurse. Even if it is in the middle of a code... even if people are rushing you or yelling at you... even if you are afraid of looking dumb... if you feel unsure about a drug you are giving or a procedure or a protocol... stop and ask! Trust me... it is always worth taking the extra minute or so to double check or to ask for help. It takes only a few seconds to make a fatal mistake and only a few seconds more to prevent one from happening. It's always worth the extra time and people will trust you and respect you more if you know when to ask for help.
4. A good report sheet and a checklist can keep you sane.
The thing that I love most about ICU work is the detail of it all. As ICU nurses we care for our patients from head to toe. Most of the time our patients rely on us for everything large and small... from oral care to breathing. No task is insignificant and sometimes remembering it all... even if you have only 1 or 2 patients... can be daunting. Having a thorough report sheet and a checklist of things to be done can be a complete lifesaver when things get crazy.
3. Choose to be happy.
The ICU is often times a really difficult place to work and if you aren't intentional about being happy in the midst of that... sometimes it can really bring you down. I think sometimes we have to make a conscious effort to smile, laugh and be happy because usually... the people around us are really sick and scared and are often times in the worst physical state they have ever been in their entire lives... it never hurts to try and bring some joy into the ICU.
2. Leave work at work.
When I first started I used to always bring work, home with me. I think its only natural to do this to a certain extent but it has to be in moderation. It's a good thing to maybe re-hash your day on the drive home a bit... maybe there is something you forgot that you need to communicate to the nurse who followed you.... or maybe something went wrong and it's good to think about how to do it better next time. But seriously... learn to just let it go. Take a deep breathe, go for a run, read a book, take a hot bath... do something to re-center your mind or the stress of working in the ICU will have you on the burn out list before you can say "help!"
1. Follow your intuition!
Because most of the time you are completely right on and it may be that the "hunch" you have can be the clue that can save a person's life. I can guarantee that you will never regret bringing up the small things to the physician even if they seem silly... however if you ignore what your intuition is trying to tell you, and it means you miss something huge later on... well that will be something you will definitely regret.