A Nursing Student on Reddit recently asked the r/nursing sub reddit for advice on how to manage an ICU placement as a third year student. They were understandably scared, and uncertain as to what they could achieve that would be useful for them in their future career.

I have helped guide nursing students through placements throughout a large, tertiary referral hospital in the role of Clinical Facilitator. Most of these wards have some kind of specialisation (ie, not a “surgical ward” but an “organ-system surgical ward”). Even our rehabilitation units are specialised.

This was the perspective I tried to give the nursing student on the ICU prac, but it could be helpful for anyone undertaking a specialist placement and who is finding it challenging to see the point…

 

 

 

 

You need to take these concerns to your facilitator/preceptor for context specific advice on what you should do regarding your fears for this placement. With so many different nursing systems and cultures on r/nursing it will be hard for answerers to assist you in a meaningful way.

 

On the other hand, as an undergraduate nursing student remember you aren’t there to learn How To Be An ICU Nurse 101. (This is the first point I started my undergraduate students in ICU on every time. Gives permission for a big relaxing breath).

 

You say the nurses are used to having students – they really aren’t expecting you to be an ICU nurse at the end either. Maybe to have an interest and want to come back, but that’s about it.

 

 

‘So what am I there for?’

 

To learn to be a NURSE. And in ICU you have a unique and peerless opportunity to take advantage of.

 

 

‘Why?’

 

Let’s start with What Does the ICU do…

 

It looks after really sick people. Medications, ventilators etc. the scary stuff.

 

From a healthcare system viewpoint it does a few things.

 

It supports them through critical illness and multiple organ failure or serious injury. It generally doesn’t admit patients on its own – all the patients will be under a treating team. (Usually the speciality of the patient’s primary issue: this might not be the same on discharge from ICU as it was at admission).

 

It also acts as a safety net for the whole hospital.

 

The ICU primarily coordinates care between the specialities that need to communicate and work together for the benefit of the patient. That means the ICU staff (nursing and medical) have to know at least a bit about EVERYTHING.

 

Aside from admitting to other higher level ICU’s it doesn’t generally have it’s own safety net.

 

All this make it the perfect place to see/hear/experience all the patients you could hope for as a student.

 

 

‘So how do I make the most of this opportunity then? I don’t know even a bit about everything?‘

 

Easy. Ask yourself what you CAN learn that you can use WHEREVER you end up. If you don’t yet really know where that is (even if you liked medical ward nursing, that’s no guarantee of a career there) then look globally.

 

Despite the monitoring, observations don’t record themselves. What happens if the power goes out? Practice taking all the BPs, pulses (ALL the pulses), looking at pupils, describing colours, warm or cool, and listen to chests.

 

 

‘All the pulses?’

 

ALL the pulses. And ALL the chests. Find out as much as you can. Listen before a suction. Listen after a suction. Listen before and after Physio. Listen before and after turns. Listen to bowel sounds, and maybe listen to heart sounds. Get a library of remembered sounds going. Look at wounds. Do dressings. Take ECG’s. Ask for help.

Ask for descriptors.

 

Make descriptors up yourself. Practice writing them in notes.

 

Get comfortable with how to do a manual blood pressure (yes, even in ICU). Not simply a non-invasive BP, but one where you listen. Learn why the automatic BP cuffs are a silly waste of money (and why at 3am the doctor wants you to do a manual one before they get out of bed to see your patient). And when you get the stethoscope out for the BP, Listen to the patients chest again.

 

 

‘Er, I did obs in first year…?’

 

Ask your buddy nurse to relate all that to the disease or injuries of the patient. Then when you get the idea, practice relating all the obs to the buddy nurse. Anyone can take obs. It’s knowing what they mean that’s the hard part.

 

 

‘And then?’

 

Do the same thing with medications, even the IV. Doesn’t matter if you can’t give them. You’ll have to know them. Most of the ones in ICU are used in medical wards anyways. (Ok, there are obvious exceptions to that). But this will help your future practice by increasing your knowledge of pharmacology and physiology.

 

Oh, and do the obs again after medications have been given or titrated.

 

See? The drug works!

 

 

‘And you said I’m not studying ICU 101?’

 

But you are learning how to be a nurse. These skills, all this knowledge is transferable. Remember the ICU as safety net bit? If you call for help as an RN, how much more helpful, how much earlier are you going to notice changes, how much more comfortable will you be.

 

Instead of ‘Er, um, can you come see Mr So-and-so, I’ve got a feeling…’ you will be able to say ‘he sounds like a bowl of Rice Bubbles on his lower right lung, and his sats drop when he’s laying on that side, … … …etc”

 

Much more helpful. And much more confident.

 

Enjoy the rest of the prac.