#future np

Hey good questions! First the ratio in PICU is 1:1 or 1:2 based on how sick the kiddos are. 

How to prepare yourself for an ICU shift:

1) Listen to report and write down the important details - no need to write down normals you can just write WNL or assume if it’s not on the sheet it’s not an issue

2) Ask questions if you are unclear about something that was said in report. Good questions to ask: a) Were any changes made during rounds today? b) When were they extubated/admitted/coded/intubated/etc c) Current access and do all the lines work d) What are the drips running at and what are our parameters 

3) I skim through my orders page and make sure that there are no orders that haven’t been covered in report

4) Sign off drips and high-alert medications with the offgoing nurse. Use a calculator and verify that your drips are running at the ordered rate and check the line from the bag (CHECK YOUR CONCENTRATION) down to where they are connected to the access.

5) Safety checks while you’re in the room. We require a mask and JP bag attached to oxygen flowing at >8 LPM, working suction, code sheet with correct patient weight. Also, check to make sure you have backup trach supplies if your patient is trached (same size trach, trach a size down, lube, scissors, empty syringe, extra ties, manual suction). Side rails up and call light in reach if that’s developmentally appropriate.

6) I let the day shift nurse leave at this point and I take a few minutes to write down my meds, when they are due, what volume they are, what dosage they are. I then fill in my hourly schedule with reminders like “Order new epi bag” or “Do foley care” depending on the patient’s needs. I also ALWAYS write their PRNs and the last time they received them on my paper. It’s for my knowledge and if someone is sitting for me for lunch they have the info right there so they can grab it fast. I also like to write my parameters and my titratable drugs on the paper so I can have this information readily available if I need to go up or down on any meds.

I wrote a post a while ago about fear in the ICU and how it can be a good thing and keep us sharp (see post here) but I wanted to expand on that in the light of current personal events. I am a type A personality (surprise surprise coming from an ICU nurse) but I have been feeling for a long time that I have a lot more anxiety than the average person. I remember my fiancé asking me what I was thinking about one time and I told him all of the things I was worrying about and planning for and he looked at me with a look of horror on his face. I realized then that not everybody has a constant stream of to-do lists, regrets, worries, and anxiety running through their head. 

I wrote it off as a personality quirk for a while and tested the waters with friends asking if they ever felt like I did. I got mixed replies and overall just wrote it off. In the past few months I was having a lot of anxiety to the point that I didn’t want to go out in big crowds, I was getting debilitating tension headaches, and I was starting to see the impact on my relationships. I decided to talk to my PCP about it and she diagnosed me with Generalized Anxiety Disorder. Strangely I felt relieved. I was relieved that I didn’t have to leave events early because of my neck pain and headaches. Relieved that this wasn’t just “my personality” and that it was something I could work through. Relieved when my doctor reminded me that I could be an amazing ICU nurse without my anxiety and that my skills and training were what made me good, not my disorder.