Episode 65

Episode 65: How To Hit The Ground Running As An ICU Nurse With ICU Nurse AJ

May 18, 2022

CRNA 65 | ICU Nurse

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Looking for tips on how to start strong as a NEW ICU NURSE? Well, here is the podcast episode you need. Join us as we talk about AJ’s ICU journey- he is a current CCRN and travel ICU nurse. From being a podcast listener, we will bring him to the hot seat today to discuss how he navigated changing roles and ICU units. He’ll also share the knowledge and experiences he gained that allowed him to gain acceptance and achieve his goals as a CRNA student.

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04:15 – Things that really helped get the ICU position as a new grad and getting the exposure that you need in the ICU

08:15 – Being part of two different residency programs and finding a scholarship opportunity

13:49 – About ICU interview and the grueling part of CRNA interviews (always staying on your toes and being prepared for different situations!)

19:01 – The factors that can ultimately help in landing your next ICU role

21:28 – How extensive the residency program can get and the biggest challenge as a new ICU nurse

26:46 – The knowledge and skills that you will possess working in the ICU (which you feel you didn’t have when you first started)

31:41 – What you can enjoy and dislike about ICU nursing

41:46 – About not getting med surg experience (will you miss out a lot?)

45:49 – Advice to those considering going straight to the ICU as a new grad

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How To Hit The Ground Running As An ICU Nurse With ICU Nurse AJ

In this episode, we have a guest, AJ, who is an ICU nurse. We are going to talk about how to hit the ground running as a new ICU nurse. Welcome, AJ. I am so excited to have you here.

Thank you so much, Jenny, for having me. It’s such a pleasure. I have been reading your blog for a while. Now that I’m on the show, I’m so excited and happy to talk about what we are going to chat about.

Me too. It’s funny. Some backstory, I did stumble upon AJ on Instagram because he shouted me out when he got his shadow experience. He was a reader, and one of the episodes had helped him utilize his time and shadow experience. Thank you so much for that shout-out. I appreciate that. AJ has been an ICU nurse for a few years in a medical-surgical ICU, mostly MICU. He made a move to California, and we are going to talk a little bit about how he navigated changing roles and changing ICUs as well. Let’s start with maybe giving people a little more background as far as how did you decide to go into ICU nursing? Did you always know nursing was your field of choice?

Since I was a kid, I have been surrounded by nurses. Coming from a Filipino family, there are many Filipino nurses. I want to say more than half of my family is in healthcare. Maybe half of them are nurses or nurse practitioners themselves like PTs, OTs, and doctors in my family. It’s primed from the beginning. I knew that nursing was more of a financially stable career. I’m very flexible with hours, 3 days a week, 3 shifts a week.

With that in the back of my mind, science was something that I liked too, and being able to put that together into nursing was something I wanted in my future as a career. It wasn’t like a certain moment that happened in my life where I decided, “This is a moment I want to go into nursing.” It was more something that I had to suss out for myself in high school.

I love how you started that early in high school, though, and you always knew that science was a big draw. A lot of us can relate to that. I know that is how my interests started, where I was watching discovery health obsessively when I was little like surgery shows. I used to think I wanted to be a surgeon, either way, I knew I loved science. That’s cool. I love that and the fact that you have a family. That’s interesting that you have a lot of nurses and medical professionals in your family but you did choose nursing. Not only that but you chose ICU nursing. That’s unique. Let’s get into when you made the choice to go to the ICU as a new grad. How did you go about navigating that? What are some things that you think helped you get that ICU position?

My background is a little different than what most people go through. All the way back in college, when I was an undergrad, I went to a four-year BSN program. I had the opportunity to apply for a scholarship that would pay for almost half to a third of what my tuition was for my junior and senior years. As a result, I was bound contract-wise to work at a hospital.

I was already able to work in a hospital. It was more so what specialty? How would I approach these units? I was able to have my clinical rotation at the hospital that I was going to end up working at. I ended up applying for ICU for my clinical, like my senior clinical. From there, the clinical was my interview. It spoke for myself like the skills.

That’s something I tell all the nursing students who I chat with on Instagram. The advice I got from nursing students in my program was that clinical is an interview. That’s how you should approach it because you never know whenever you are going to meet someone from that unit. You might end up interviewing for that unit again. You want people to remember you for how you presented yourself.

How did I end up in the ICU? I feel like that’s something that has always been in the back of my mind since I started nursing school. I liked the autonomy, and being able to have the provider on the unit was a big draw to the ICU. Being able to experience that as a student solidified it for me that critical care was where I wanted to end up.

A big takeaway for me from what you shared was the fact that you did this. First, AJ requested to get his rotation as a senior nursing student in the ICU. That is key and vital when it comes to, again, the exposure to even know if it’s something you want to do. As he mentioned, the job interview aspect of it: it’s a long-term job interview, which I tell current nurse anesthesia residents as well because every day, the way you show up, your attitude, and essentially how much effort you put into your learning goes a long way and shows your future coworkers “I want to work with AJ. He seems like a good team player. His attitude is always upbeat and bubbly. I enjoy having him around.”

Having a foundational relationship with the staff gets a good word out there. Click To Tweet

This is, one hundred percent, the best way to essentially have people vouch for you when it comes to getting that job after school. If you are a senior in nursing school, try to get into the ICU as your senior clinical rotation. I also love the fact that he stressed that is what solidified his desire even to pursue ICU. The ICU has its own realm. I’ve shared on the show before that I was not crazy about the ICU but it had nothing to do with the actual ICU concepts.

It had more to do with the death and suffering that I tended to have a much harder time with but I loved the environment. I love the fast-paced, critical thinking, the complex disease process, and pharmacology that was right up my alley. I thrived. I felt on fire and alive when I was constantly thinking about those things. I knew the ICU would be hard because emotionally, I have a hard time.

I am the person who wears my heart on my sleeve. I’m a “crawl on the fire to get you out” person. When I saw my patients suffering, it hurt me not to be able to do more but that’s something you have to work on. I encourage you to get this experience because it’s going to allow you to see whether you are going to enjoy the day-in and day-out of being in ICU. That’s how you land the position. You mentioned the residency program. You applied for a residency. How long was that residency program?

ICU Residency Program

My residency was also different than a traditional residency because, essentially, I was a part of two different residency programs, one for my hospital itself and one for the hospital system. Like talking about the residency in my hospital, it was a three-month stint. I was already hired onto the ICU but as part of that three months residency in my hospital, I had to deal with rotating through different units to get a grasp of what it’s like on the telemetry unit, for example, which is where we would float if we were needed from the ICU to telemetry.

I was able to stay in the ICU for 2 out of the 3 months that we had the rotations and also integrated into that were shadowing opportunities in different practices throughout the hospital to hone a good global interdisciplinary understanding of how the hospital works as a system. That means phlebotomy, lab, and pharmacy. The residents would shadow and talk about it afterward in a debrief every Thursday, which we call Thirst for Knowledge Thursdays and what the program director called it.

That was for 3 months and then the 12-month hospital system residency. Those were seminars every other week, where we would go to Philadelphia, which is every new grad was in a residency. All the hospitals in the system went to Philadelphia for the seminars, SIM labs, debriefs, and an evidence-based project at the end of the year that we would work on for around half a year. I would say my new grad experience was very well integrated. I was able to get a good global understanding of how the hospital works and networking between hospitals as well.

AJ has explained that his situation is a little unique but let’s back up a smidge. How did you find the scholarship opportunity that got your foot in the door that way? Was that something that you actively sought out? Did you know about it from friends or family?

It was back in nursing school. It was the nursing school that partnered with the hospital, and it was offered internally to undergrads, so I applied. I interviewed for it then I was able to get the decision sophomore year.

That’s something that if you folks are thinking about those things, start seeking out opportunities like that early on in nursing school because that’s a cool opportunity. It’s funny to share my own experience. I was telling AJ that mine was back in 2009, so I felt old. There are similar aspects but things have changed. Back when I graduated from nurse residency, programs were a relatively new thing. I remember it being a big deal that my hospital suddenly now had a residency program. Prior to 2009, they were direct-hiring nurse aids out of the ICU and all on-the-job training. It wasn’t anything else to it, which worked well but they started making a lot of changes.

They also started saying they only took BSN-prepared nurses in the ICU. There are a lot of things to start considering when it comes to that but a residency is always a great way to get into the ICU as a new grad. I will say, as AJ mentioned, one of them was three months. That was my experience. It was only three months, and we did rotate. I went to the surgical ICU, medical ICU, and a step-down unit as my rotation.

Clearly, since I had worked as a nurse’s aide in the medical ICU, those nurses were like, “You are not going to leave us, are you? You are going to come work here, aren’t you?” I’m like, “Yes, of course. I’m not going to leave you.” Essentially, I knew I had a job in the medical ICU. They loved me. They want to keep me. To me, it was a no-brainer that I would go back to the unit where I knew I would be supported emotionally and physically by the nurses, who essentially I call like work moms and work dads.

A nurse with a clipboard in their hand talking with another nurse

ICU Nurse: You should approach the clinical as an interview because you never know when you will meet someone from that unit. You might end up interviewing for that unit again. You want people to remember you for how you presented yourself.

There were dads there, too. They were looking after me. They knew me so well that I felt supported. That’s why I went to that environment. Even though I would be quite honest with you, I was way more intrigued with the surgical ICU population. I went to the medical ICU because that was where my work family was.

Different experiences in the twelve-month residency program that you went to afterward, too. It sounds like it was a lot of education with seminars and reflection, simulation, and shadowing, which, holy moly, that’s amazing. That’s an incredible opportunity and a good experience. A great way to get into the operating room to see the transfer of care from OR to ICU, an evidence-based project.

I will say, though, that in my three-month residency program, we did do a residency-based project. Even though that three-month stint was relatively short. We worked on it longer than three months but essentially, after three months, we then started our unit hire orientation, which was probably, another month or two, at the most, where you were paired up with someone.

Another great thing about residency programs is the evidence-based project that you will more than likely have to work on because that’s great for applications. I love all this information. It’s so great. You mentioned the interview for the scholarship but let’s talk about the ICU interview. Did you have to interview for the ICU you eventually got hired on? What was that like?

The ICU Interview

I still did have to interview for the ICU. From what I remember, it was the assistant nurse managers who showed up and my nurse managers. Maybe around 5 or 6 people were there, as for me, at the head of the table. I was nervous. I was a new grad nurse. All I remember was maybe a lot of situational and personality-based questions. I was able to do well in the interview because I already had ICU experience because of my clinical.

Already having a foundational relationship with the staff gets a good word out there. That’s a good tip for going back to what I said about getting your foot in the door in an ICU. Even if that’s not the ICU that you are going to work in or how you plan on applying to having that background, especially when they ask questions like, “Tell me about a time when you went above and beyond for a patient.” Situational questions like that when you manage conflict. Pulling that from clinical experiences is how I was able to stand out.

I also can tell from our conversation that you have a very calm demeanor, which is great; you have a good way of keeping your composure. I love the fact that you also reiterated that you established relationships. It becomes more of a casual conversation versus this high intense pressure environment. That’s key.

I also love how you pointed out they ask situational-type questions as well as a personality but the ICU experience prior to your residency program helped you have a good understanding of what the ICU nurse’s role is. They understood that you knew what you were getting yourself into. They probably didn’t have to drill you as hard as someone they didn’t know has that experience. As for me, my interview was so incredible. It makes me chuckle because it wasn’t an interview.

It was like, “Cool, Jenny. You are coming to work for us. Bye.” I don’t remember even getting asked hardly anything. It was maybe, what are your long-term career goals and some situational type questions but for the most part, it was like, “We are excited to have you. Here’s the paperwork. Sign here” thing. That being said, I also want to stress to you, folks, especially those who are reading, that you are our future CRNAs. You may not have a real grueling interview process in your ICU time if this is your situation.

I see a lot of my students struggle with this because going into the CRNA school interview is the first experience they might have. It’s a truly grueling experience with people they don’t know at all, and it can rattle them a little bit because again, they’ve never experienced the high-pressure environment. They will ask a lot of questions, and they are difficult questions. I want to make sure those who are reading put those two things together if you ease your way to the ICU with a residency program.

When you talk about the grueling part of CRNA interviews, you mentioned in your show before that you always prepare for your CRNA interviews, even before you submit your application. All these reiterate that. Even when I was interviewing for the job that I’m going to take now, that was one of the more grueling interviews pharmacologically and pathophysiologically, and I was already being prepared or preparing from an ICU background for that. They were asking about sepsis or ventilator settings. I was like, “This is probably one of the most difficult interviews that I have had compared to being a new grad.” Having that in mind rings that bell. You always have to stand on your toes and be prepared for situations like that.

You always have to stand on your toes and be prepared for any situation. Click To Tweet

Also, the fact that they didn’t know you. Outsiders coming to the ICU are going to probably drill them a little bit harder than someone coming straight out of the residency program. I love the fact that you listened to me. Thank you. I always wonder how much my talking and teachings get through because I see that all the time where people are like, “I thought I wasn’t going to get an interview.” I’m like, “You applied. If you applied, that means you are going to get an interview.” You should treat it as such. It’s almost like you are kicking yourself before you even get a chance. You’ve taken the opportunity to apply. That means you are taking the chance you are going to get an interview, which means giving yourself the best chance possible and preparing.

I love that you are doing that. It helped you the fact that you are already preparing for the ICU knowledge you need to know going into interviews in the future. It helps you land this next ICU position, which I would love to maybe touch on. I know we didn’t have it on our schedule to talk about but you mentioned where you moved. We are not going to mention hospital names or anything like that but the area and the environment are more competitive to gain a good contract. What do you think so far? It’s relatively new and fresh but what do you think you have done that has helped ultimately land your next ICU position?

I’m not going to go into the nitty-gritty details about applying for contracts. That could be an episode on its own but I want to say once I was able to get an interview for a hospital, for a unit, I was already primed with the knowledge that I had in the past. I was doing some studying in the background, knowing that because this is such a highly competitive area, I have to know everything from a granular level, from molecular level almost to ICU level care.

Being able to prepare for that helped me shine because, first of all, they cold-called me. I was at the gym. I was like, “I need to answer this phone call because I don’t know when the next person is going to call me.” That’s where I left the gym. I took the interview. It was 45 minutes. They were like, “When can you start?”

That’s an impressive cold call. No preparation. That’s good to know. Interesting. It goes back to honing in on your ICU knowledge because that’s what these units want to see, and the little bit of ICU tips I can give you from the students I’ve talked to is that they do want to understand if you understand the ventilators, different types of disease processes.

Meaning if you are applying to CVICU, you should have a good understanding of those types of patients from the disease processes around what you would be doing. Medical ICU is the same thing as sepsis, and respiratory failure understands those disease processes. I don’t know what else they would add. That was pretty extensive but did you feel the residency program truly prepared you in the ICU or was there anything that may be caught you off guard when you started in your own ICU?

I will say that the residency itself was more so to help me transition as a baseline, as a nurse to be familiar with how to be a nurse like bedside skills, and be able to talk to other people who are going through the same thing, which is probably one of the best advantages of going through a residency because it was just me who was orienting on the ICU.

Being able to have other new grads in my cohort to talk to about the Imposter syndrome that we all go through, the struggles of multitasking or how to prioritize was how the residency helped me. I would say it was my coworkers who finished the process of that orientation and being familiar with the ICU that got me to be comfortable in that environment. Less of the residency. More of my coworkers and the relationships that I had in the ICU.

That’s your support system and very similar. I’m always doing these comparisons but the same thing applies to CRNA school. Your classmates are your biggest support system by far, and don’t get me wrong, I’m sure your spouse and kids love you but it’s something about someone else going through the very unique, similar process and experience that you can relate to that can keep you up when you are down. You are both going to have a rollercoaster ride.

You are both going to feel stressed for different reasons. Sometimes, it’s hard for someone on the outside who doesn’t understand, who’s not in it, to truly feel that empathy. It’s hard to relate to. They just stare at you like, “Are you okay?” I want to stress that while we are having it on-topic but what would you say would be the biggest challenge? You mentioned time management and prioritization but would you say that is your biggest challenge as a new ICU nurse?

New Grad ICU Nurse

Being a new grad ICU nurse is like two extreme challenges at once because not only are you getting used to bedside skills, bedside manners, and time management like I talked about. It’s also trying to master the ICU knowledge that’s on top of that. When you layer both of them together, it’s like, “This is so overwhelming,” and that’s how I felt. I’m sure everyone has been in those sheets before like, “I can’t do this. My preceptor is cool and awesome. How can I end up being like that?” Those two challenges tackling together at the same time was my biggest challenge.

A nurse holding a stethoscope in their hand and looking at a patient who is laying in a hospital bed

ICU Nurse: Being a new grad ICU nurse is like two extreme challenges at once. Not only are you getting used to bedside skills and manners or time management, but you’re also trying to master the ICU knowledge on top of that.

I feel like the way that I was able to get over that was to see my preceptor and my preceptors as people to trust. I had good relationships with them to talk through the process of what I was thinking so that I could get their input. At the end of the day, the preceptor is there not only to teach but to bounce ideas off of too, which by the end of my orientation, that’s how I treated my relationship with my preceptors became because that’s where my critical thinking was. I was able to get a good grasp on it by the end of that orientation by having that relationship with my preceptors.

I love the fact that you’ve had that open communication piece and are able to ask questions. That is so vital. One of the things a lot of students who enter CRNA School struggle with is it does make it extremely hard as you are with different people all the time. You are not building that trust, that relationship because you are bouncing around from CRNA to CRNA, and you haven’t built that trust yet. It takes time.

Sometimes, students can feel intimidated or scared, or they are going to think that they are stupid or not good enough, so they don’t ask. Something that shouldn’t happen happens or they don’t do something they should have done. It’s one of those things where it’s like, “If you would have asked.” I preach this all the time.

The same thing goes for adjusting to ICU. Ask questions to the residents, the fellows, the attendings, your coworkers, and anyone who will listen. I’m not saying don’t look it up yourself and take the initiative. You want to take the initiative but if you are in the moment and you have to know something or alter the decision you are going to make, ask. If it’s something that you can look up later because it’s not pertinent to what you’re currently doing. Cool, look it up. If you need to know it at the moment, then 100%, you folks need to be asking questions. As AJ said, find that buddy system. Find someone you feel comfortable with who is going to treat you like an equal human being and not talk down to you.

You will be able to find them. Don’t get me wrong. I don’t agree with it but sometimes you will have people who are not those people. You will quickly be able to know who those people are, and you avoid them, and you ask the right people. Phone a friend if you have to. That’s great advice. What knowledge or skill set do you possess now that you feel like you didn’t have when you first started?

New Skill Sets

I could need anything, and that would be a good skill but everything. Generally speaking, critical thinking and time management have been a Godsend. Being able to integrate that into my practice adds to the confidence that I have in the care that I provide. Also, having that ICU knowledge and knowing the surgeries or the disease processes helps me talk with families.

Putting that all together is the skill that I possess now. When I think of more specific skills, I got good at ultrasound-guided IVs. That was an initiative that they started in my unit. Maybe halfway through or a year after I started. Being able to put in those IVs and be the go-to IV guy has been cool. Also, knowing devices like CRT and TTM and being assigned to those sick patients was a big confidence booster. Having those patients, honing my ICU skills, and being familiar with the machinery devices like that on a more specific level are the skills that I was able to get.

The big picture, obviously, is the confidence, being able to manage your time and prioritize and critically think enough so that you could educate the family and feel confident to do so. You’ve always gone back to knowing your critical care knowledge. I love that because it serves you in many ways. That’s why I mentioned it. I’m equally guilty and in the anesthesia realm as long as you get very comfortable in what you do.

You walk into work, do your thing and go home. Sometimes, you don’t think about what it is you are doing. You become like this machine, this robot. You just do. You don’t always put the thought process behind it. You just know it works. What I love about teaching and working with students in the operating room is it helps me to slow down and explain my thought process because otherwise, I may not think about it. I love that aspect of teaching, and it keeps me able to be cognizant of my own growth and so I don’t get complacent.

The same thing can be true for the ICU always to be aware of, “Are you thinking about the cause-and-effect relationship, the disease process, how this drug works, and why they pick this over that.” If you can always have that inquisitive mind, you will flourish in a way that is so rewarding and causes so much career satisfaction. I love that you pointed that out. As far as skills go, you’re going to take sicker patients now, learning advanced life support mechanisms and IV-guided ultrasound. You are going to be a wizard when you get your original rotation.

It’s funny because I have a lot of students who tell me about the IV-guided ultrasound and how that’s a skill. That’s great. I also want to challenge you, folks. That’s amazing. I often have students say that’s great but I’m being honest, in the operating room, we don’t have ultrasounds. Typically, if you are doing A-lines or IVs, you are not going to the ultrasound first thing, so definitely make a point, especially in your anesthesia training to seek out regular IVs. I have had students who go spend a whole day in pre-op, which is a great way to get IV experience. I love starting a fourteen gauge. It’s probably my favorite thing. I also now have the challenges are in a 24 gauge on a plump little baby. You go by landmarks to that point.

You learn a lot by asking why. It helps you understand the fine details of why things are being done. Click To Tweet

What’s cool about a plump little baby versus an adult? Those IVs can take all kinds of pokes. You can poke and poke them, and they are fine. You can still get a good IV despite being poked a hundred times because they are so buoyant and bouncy. They dart the needle. Whereas an adult is less forgiving. If you puncture that, it’s blown like, “New spot.” There are some differences between babies and adults starting IVs. The techniques are different so getting that experience, whether that’s in ICU or not, is important.

One of the things I used to do, was around 2:00 AM, I worked in the NICU as you did, and we would have central line holidays. Good IV access was crucial. Every 3 days, 72 hours, and 48 hours, you would have to restart a peripheral IV. I would do my assessments early, have a buddy watch my patient next door, and I would walk around the unit and start IVs for everyone.

Some of these patients would have three-plus pitting edema. You are like, “I’ve got to find a vein in that arm the size of an elephant trunk.” That was challenging but seeking out these opportunities is only going to help you in the long run. All those are great takeaways. What do you say you enjoy the most about ICU nursing?

What I Love About ICU Nursing

What I like the most, generally speaking, is autonomy and collaboration. When you are in the ICU, from my experience, I had the providers right there. I worked with MPs, MDs, DOs, and they’re right there in the unit. You walk down the hallway, and they are right there if you need anything. When it comes to the autonomy part, taking care of the sick patients on multiple drips, so that would be like nurse-driven heparin or insulin protocols, or even the vasoactive medications.

You, as a nurse, have the autonomy to make the clinical judgment and titrate these medications. Autonomy can be on the side of patient care too. I’m always going back to the ICU knowledge, and when I talk about my background, I liked Science in high school. Being able to put that all together in the ICU and answer the question, “Why,” every time is what draws me and keeps me excited in ICU. I feel that being a preceptor has been helpful. As you were saying, it helps you understand the fine details of why we do these things. As a student, as a new grad asking why has gotten me through a lot, and I’ve learned a lot by asking why.

It goes back to like, “That’s how toddlers learn.” For two straight years of a toddler’s life, every question is why. “Why is the sky blue? Why?” “I don’t even know.” As an adult, the same thing. We forget that but asking why is an integral way of how we learn. Also, what’s interesting about asking why is, if you can look it up yourself in a book, cool. I encourage you to do so.

When you ask someone else their why, you will gain a perspective that you won’t have. Everyone understands knowledge differently. Everyone has a way of understanding knowledge differently, and they can share that with you, which is powerful. It allows you to essentially add to your own knowledge in a way that maybe you never would’ve grasped before.

One thing I want to slow down and back up to touch on again, because I want our audience to think about this, especially when you are applying to CRNA school and they ask, “Why do you want to be a CRNA?” People just say autonomy but then they stop. You said autonomy, and there’s nothing wrong with autonomy. That’s great but you backed it up with your “why”.

You gave good reasons but you also mentioned collaboration. That’s important because being a CRNA, you have a lot of autonomy but you collaborate. It is a team effort. If that’s not something in your wheelhouse, you will struggle, and it’s frankly not even safe. In general, as a patient care model, it’s all about collaboration. You make decisions, which is the autonomy piece of it.

As you said, you have protocols you follow and allow you the knowledge base to say, “I know how to safely titrate this drip. I’m following a protocol but I’m also learning and understanding how this medication works and how to fine-tune it based on this patient’s disease process.” That goes back to your ICU knowledge and understanding of what’s going on with the patient. Understanding their disease process allows you to understand how these drugs will affect them. I love that part.

It’s okay to say autonomy. You just have to make sure you are backing up with, “How is that? How do you see yourself in that role as a CRNA provider when you speak of wanting autonomy? What does that mean to you?” This was a beautiful answer to that, especially even as an ICU nurse. This is why I did a whole episode about CRNA being different than ICU nursing but there are so many similarities, and this is one of them. Reread this and put it in your notebook. What would you say you dislike about ICU nursing?

An alarm clock with a nurse sitting at a computer in the background

ICU Nurse: Being able to integrate critical thinking and time management into your practice adds to the confidence you have in the care that you provide.

With ICU nursing, there’s a lot of charting. You can go from Q1 every minute or every 3 minutes, 15 minutes or 1 hour, and you are continuously charting, which is a good and a bad thing. It’s a push and pull. The main thing that I dislike about the ICU, especially getting off of orientation in March of 2020, is death. Facing that every day and trying to keep in tune with my own humanity and patient dignity throughout it all has been one of the most difficult parts of being an ICU nurse.

As much as I dislike seeing all the death, I’ve come into myself reflecting on who I am, bringing back the humanity of the patients and the family members. It has been such an eye-opening experience, especially getting through all of these peaks and waves of the pandemic. Especially when nurses are like, “I have never seen nursing like this before or I’ve never bagged and tagged so many bodies before.” That’s the only experience that I know. Being able to take care of myself, and having healthy coping mechanisms, of course, have taken me a long way in coping with the things that I dislike in the ICU.

Coping With The Difficulties Of The ICU

AJ, you gave me goosebumps. First, thank you for everything you’ve done. I cannot even imagine. I will share with you a little background. I mentioned 2009. Probably you don’t remember this because it’s insignificant compared to everything else that has gone on over the last few years. Back when I first started in the ICU, it was the H1N1.

That was a very scary thing that occurred. A lot of pregnant girls and girls my age, in their twenties, were dying from it. It was scary to walk into an ICU room with someone who has the same birthdate as you, and they are dying. All because they have a contagious virus that you are like, “This is scary. I don’t want to get it.” We saw a lot of people lose their babies and people delivered in ICU. It was a very intense time, I thought.

I can’t imagine like, that on fire times million is what this pandemic has done. I want to hone in on that fact and I had to deal with this too. I mentioned at the beginning how I had a hard time coping health with death and suffering. What it did, and I saw this happen time and time again, is sometimes these nurses who were in it for a long time would put up their armor and lose what I would call empathy or compassion.

Bringing it back to its human experience and thinking about the families, the patient, and what they are going through is hard to do without also suffering yourself. As a human being, you naturally want to love, care for, and help someone. It’s so emotionally draining, and it tests you. It’s like being in a war zone. It’s not good for your soul. I don’t know how nurses do it for their entire lifespan. Some people are angels in disguise.

I truly believe that but I also had seen it have the effect of becoming someone who separates it and so much so that it affected their ability to have a soft shell, a soft heart, which is upsetting. I remember thinking, “I don’t want that to happen to me. I like my softness. I want to remain soft.” That stems from what you said, the coping mechanisms that you have, and self-care and understanding who you are.

One of the things that took me a very long time and I thought a lot about was death. I thought about how I felt about death. “What if I die tomorrow? What if my mom dies? My sister dies?” Many times, I have a patient who reminds me of my family. I would feel like I was walking in my room with my dying father in front of me or you would relate and make a relationship with a family member, then you have to watch them sob. It was so emotionally draining.

That, by far, for me, was the hardest part about being in ICU. When I started coming to terms with how I felt about death and not thinking about it in such a negative way and realized that it is a cycle of life, that’s a part of what we live and the thing that these patients want it all done. They want to be there. They want to fight. We are there to help them fight. Even though sometimes it feels like you are doing the opposite like you are torturing them. They have a choice. Their choice is to be there and fight. They know when to give up. Your bodies will know when to give up.

Obviously, as an ICU nurse, you watch it unfold before your eyes but seek out help. A lot of hospitals, especially now, have therapy that’s free for ICU nurses. Don’t be afraid to get help, to have someone, a resource to talk to. Sometimes, as I’ve mentioned, it shouldn’t be your significant other because they are not going to understand how to help.

They want to but you need a professional. Someone who can understand how to help you cope, have a mindset around what you are experiencing, and also recognize that it’s okay to be mad, angry, fearful, scared, and feel like you are grieving because you are. You are grieving someone else’s life. That is a human experience that you need to hold on to because that is part of who you are as a human being.

Real-life nursing is nothing like nursing school. Be a sponge and learn from the people who are teaching you. Click To Tweet

Being okay with that and not making you feel shameful, disappointed, that you are weak or that you are this. The fact that you were in there, doing it day-in, day-out, you are strong. You are there. You are showing up and giving yourself a lot of credit for that. That’s enough of my soapbox. I got passionate about that one but thank you for sharing that, AJ. I thought that was great. Do you think you missed out on anything by skipping med surg? On a lighter note. You did mention how you transferred to tele during your rotation but do you think you missed out on anything by not getting the true med surg experience?

I think I did. A lot of people I follow on social media and Instagram talk about med surg as med surg is its own specialty. ICU is its own specialty. People get certified as med surg nurses. There are people who love med surg. I feel what I missed out on was the sheer multitasking and extreme organization that is needed in that setting. Sometimes, I was floated to tele one time or a few times in my previous hospital. I’ve had to take care of six patients at one point, which one is maybe not the safest but secondly, daily, people would take care of 5 to 6 patients at night on that unit.

That’s something that I’m not used to because I’m used to my 1 to 2, 1 to 1, and 1 to 3 sometimes, and that’s something that I could never get used to unless I worked on a med surg tele unit. It’s the efficiency that the nurses have over there that we, as ICU nurses, probably can’t switch on or off if we were to float there for our lives. That’s where I have a lot of admiration for med surge nurses and med surg tele nurses because they know how to run around, get to their patients, get their assessments, and chart on time times six. We have to worry about our 1 to 2, which is probably one of the curse parts of being in the ICU.

You are right. It’s a different specialty, and it’s a completely different mindset, a different strategy that goes behind it, as you said, the efficiency, the organization, and the multitasking aspect of it. I guarantee if you were to put in a med surg nurse in the ICU, they would also feel like a fish out of water for the complexity and how probably scary I would think it would seem to have a patient who is now on death’s door. They have to know somehow when they need to speak up and say something when something is going wrong but it’s different. I want to hone in on if you have med surg, bring it and own that strength and be proud of that. Don’t be shameful.

Bring your med surg experience to the ICU but don’t think you need to start there because it is its own specialty. As long as you are sure, like AJ said, if you were to get this foundation in the ICU, then choose med surg nursing after the fact. Don’t get me wrong. I know you can do it. Anyone can do it. If you can go both ways, you can go both ways but it’s going to be a big adjustment.

Maybe that’s something you even like. I encourage you, and that’s another aspect I get to is some med surg nurses who want to become a CRNA were like, “I don’t know if I’m going to like the ICU.” You are right. You won’t know that but you are not going to know until you try, so shadow if you can. Find a residency program.

I don’t know how many residency programs take experienced nurses but they have to be out there. Seek those opportunities out. That way, if you get halfway through and decide, “This isn’t for me,” then you know it’s not for you but the only way to CRNA is ICU. The Cath Lab, PACU, operating room, and pre-op that doesn’t work, unfortunately. Don’t get me wrong. If you are like, “I know someone, Jenny.” I’m sure you might know somebody but that’s not the more common.

That is the outlier, and chances are, they have prior something that gave them the cutting edge they needed to apply. I might not know that part. Most of the time, it’s usually a previous skillset ICU experience that allowed them to get in with Cath Lab experience. Anyhow, that’s great. I love how you separated that. What advice would you give to those considering going straight into the ICU as a new grad? Did that sound off?

Going To The ICU As A New Grad

You got to do your homework. You’ve got to put in the work because if you are a new grad in the ICU, you are already overwhelmed with all the new things that are coming at you on top of being a new nurse. You don’t know how to nurse, and that’s something that you are learning at the same time. Do your homework outside of work or in your downtime, looking up why we are doing this and the types of diagnoses that you are working with.

Maybe even getting a CCRN book or resource to feed off of. I found that the CCRN books condense it well. They get the essentials out of it. Say you are working with sepsis and a patient in septic shock. You flip to the chapter about septic shock and you are like, “That’s why we are giving this. That’s why we are doing that.” That’s my biggest advice.

On top of being inquisitive, be a sponge when you are with your preceptor. Maybe not everything that your preceptor does is kosher or along with the textbook. Real-life nursing is nothing like nursing school, let’s be honest. Being a sponge and learning from the people who are teaching you, writing down notes, maybe even journaling, sometimes. Journaling was something that I did maybe for six months as a new grad. Funny enough, I looked back at my first entries. I was like, “I’ve grown as a nurse.” Being able to see that progress because you are working every week, and progress is seen in tiny increments but when you reflect back, you see the huge jump that you’ve made. That helped with my confidence moving forward.

A person sitting at a computer reviewing information in a notebook

ICU Nurse: Do your homework. You’ve got to put in the work because if you’re a new grad in the ICU, you’re already overwhelmed with all the new things coming at you on top of being a new nurse.

The last point is that you have to know that the people that you are working with have been in your shoes. Everyone that’s on your unit has been in your shoes and is uncomfortable. Coming to terms with that, from my experience, has been helpful to overcome these imposter feelings, Imposter syndrome, because you are going to end up in that higher position. You are going to become a senior nurse on your unit eventually with new hires and whatnot. You are going to be the resource for people in the hospital. Maybe even become a preceptor or a charge nurse. Being humble is the lesson that I got out of that.

Those are such great takeaways. I love the fact that it’s relatable because everyone has to start somewhere. You are always a learner, and as long as you are humble and essentially help others see that, you may think that you could never do this but the reality is you will, over time. Journaling to see your progress that’s a great way to feel gratitude toward how far you’ve come. I know I’ve spoken about gratitude before in the show but that’s one of the most powerful human emotions you can ever experience other than love.

That is so powerful because it keeps you going. It keeps you fueled up and satisfied in your career. I love the fact that you brought it back to that. AJ, this has been so amazing. This is by far one of my favorite episodes I have ever done. Thank you so much for being a part of that. Where can people find you and connect with you on social media?

You can find me, @AJTheNurse, both on Instagram and TikTok. I turned on my life and talked about anything that came up. I initially used to be more of an ICU nurse informational type of Instagram but I’ve transformed it into more personal. Every now and then, we will get into nursing and whatnot. That’s my branding.

Thank you so much. I’m about to find you on TikTok because I’m on TikTok. I’m trying to learn. I’m trying to be humble about it.

Thank you so much, Jenny, for having me.

Thank you so very much.

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