Monday, January 24, 2011

10 things I've learned being an ICU nurse

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.

7. A little lot of humility goes a long way.
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.


  1. I've been reading your blog for a while but I don't think I've commented before. I love this list! For a while I've been toying with the idea of going to nursing school and I've recently decided that it is what I definitely want to do and have a meeting at a school on Friday so this came at a great time!

  2. @bunny Hi! Thanks for the comment. How exciting you are thinking of becoming a nurse. It will undoubtedly be the most difficult and yet most rewarding thing you will ever do! Feel free to email me if you ever wanna talk nurse stuff!

  3. Andy, seriously love your list. *thumbs up* I especially agree on #'s: 1 (huge!), 2 (I even do a little motion with my hands when I walk into the parking structure to symbolize that my night is BEHIND me), 4,7 & 8 (ok, most of your list!).

  4. ahh- so wise! and applicable to most medical jobs! i tell the residents about #5 all the time. and about attending to the details!
    thanks for sharing!

  5. I just wanted to say thank you. I just started work in an ICU from a tele's been five weeks..and everyday I struggle and want to cry. Reading your points really helped a ton!!

  6. Hi came across your blog while searching the web for tips on Icu. I'm a new nurse I worked 4 weeks on a tele floor impressed some people and got placed in the ICU. I always wanted to do ICU just thought it be years away. Now i'm dealing with pressure of learning it and living up to these expectations. So far I love it but extremly overwhelming. I am lucky cause my preceptor is amazing and they are paying for me to take a class. My thing is all the nurses have like 20 years in nursing and could do it with their eyes closed and i'm still trying to figure out what half the acronyms mean. Lol I love your list especially the detail one. ICU nurses are OCD and for good reason:)

  7. Hi NewNurse! Glad you came across the post... people like you are exactly why I wrote it. Hang in there. Ive been working in the ICU for two years now and I think its only been in the past 6 months that I felt like I was comfortable with everything on the floor. I still have to ask for help from the elders who have been nursing for years beyond me. Trust me... ask a ton of questions. They know you don't know everything and its obvious they have a ton of faith in you so don't worry about that. Good luck with everything!

  8. Hi I am a new nurse on a PCU. I have been working to find the perfect worksheet and came to the conclusion that the best thing would be to make on of my own. Do you have any examples of what you've used or recommendations for me?

  9. Hi.
    I'm a Spanish nursing student, who is making her final degree project about Therapeutic Hypotermia post-PCR.
    I have recived some spanish protocols or clinical guidelines, but I would like to compare and improve it with other countries protocols or clinical guidelines.
    I would be very gratefull if you could send me your hospital protocol or if it's not any contact that you know it could help me.
    my email is:

    Thanks a lot.

  10. I am looking at creating a ICU nurse ad campaign for a hospital and would love some thoughts from all of you.

    What are the top 5 things that would make you consider leaving your current employer?
    What are the top 5 things you look for in an employer if different from above?
    What are the top 5 things that you love about being an ICU nurse.


  11. Does me missing the icu as a patient make sense?.

  12. I would love to pick your brain. I am currently a nursing student and I am having to do a project on a Communication Challenge. The setting is the ICU, and the challenge is a situation where I feel another team members actions are unsafe. I would love to be able to hear first hand from an ICU nurse.
    My email is

  13. Your blog has given me that thing which I never expect to get from all over the websites. Nice post guys!

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