Inside Duke Medicine

Employee essay: New nurse in the ICU

Brian Hooker, RN, will soon mark his first year on the job as nurse in the pediatric intensive care unit at Duke University Hospital. In this essay, he reflects on what it was like to go from the classroom directly to intensive care nursing. Photo by Mark Schreiner

By Brian Hooker, RN

Exams and essays every week. Skits and hospital crisis situations to study. Drug dosages and their mechanisms of actions to memorize.

Nursing school was no joke; in fact, at the time I could have sworn it was the hardest thing I had ever attempted.

But textbooks don’t bleed. Skits aren’t real. Flashcards aren’t at the tips of my fingers anymore now. I’m a brand new nurse working in the intensive care unit.

It’s a circle. You work yourself from beyond the outside in, leaning on experienced preceptors and nurse managers. I received an overwhelming amount of support from former nurse manager Kristi Ryan and my preceptor and mentor Sue Parrish, an experienced PICU RN. Sue often tells me that the first year in the ICU is just like school; after work you must go home and study everything that was new to you that day.

First comes the responsibility of learning how to be safe, such as learning safety checks and what supplies and alarms need to be set up in the event of an emergency. Then come simple tasks, such as turning patients and monitoring their vital signs. More complex tasks – drawing frequent labs, understanding what lab values mean, and communicating with the health care team – soon follow.

The nurse is often the first health care provider to pick up on signs of poor organ function or poor body perfusion – I’ve learned how to voice these things to my team. One of the most intense experiences I experienced was coming back from a procedure.

My patient’s oxygen saturation monitor was quickly trending downward. By the time we reached the unit it was reading in the fifties. I remember immediately pulling the code bell and having the full support of my fellow nurses, charge nurse, clinical lead, respiratory therapists and physicians. I answered questions about what happened during the procedure and followed orders from physicians. Any order I did not fully understand was explained quickly to me in a thorough manner; the patient had a positive outcome due to successful communication and efficient teamwork.

Recognizing adverse events was sometimes the most difficult part for me. I had to learn that while turning Patient A is an important and necessary task, a hypotensive Patient B carries more weight. In the PICU/ PCICU, the words “I need clarity” are used to allow a new grad (or anyone) to stop whatever is going on and have someone clarify the situation.

The process of transitioning from classroom to real world can be summed up in one word: time. I found that Duke offered me excellent resources, tools, experienced co-workers willing to help me learn, and nurse managers ready to go “the extra mile” to help see me get through this transition.