Organizational Tips for the ICU

Hey everyone! I’ve gotten a few requests for a post on how to plan out and organize your ICU shift for beginners. This post can definitely apply to experienced ICU nurses however, I wanted to tailor this post more towards the novice ICU nurse, still trying to figure out time management and the flow of the 12 hour shift. While every unit and nurse is different, I’m just going to go over my thought process to set myself up for success in the beginning of my shift.

So you sit down to get report. As I’m getting report I’m looking into the patient’s room and the environment. Are they vented, on drips, obvious line tracings on the monitor. Is there family in there? Make sure the offgoing nurse addresses everything you see. Don’t be afraid to ask questions to clarify any gaps in information.

If I have two patients, I always go into the sickest patient’s room first. Now I know some people are the type to glaze over orders first, over assessing first. I was always taught to assess first, so the second that person is your patient, you know every square inch of them right off the bat if anything were to happen at the beginning of your shift. People love to code at the change of shift sometimes I swear. However, I can see if you know doctors are about to round, especially dayshift, that you would want to look at your orders quickly to address any questions. Both options are appropriate depending on the type of patient. Always be thinking ahead regardless.

While I’m in the room doing my assessment, this is the time at the beginning of your shift to do your safety checks. Ambu bag in the room, side rails up, bed alarm on, call light within reach if applicable. If you didn’t do line reconciliation with the offgoing nurse, pull up your MAR and verify that the correct bag is programmed into the IV pump running at the correct ordered rate and dosing weight. Are the bags or lines expired. ALWAYS make sure you have one canister hooked up to suction – I don’t care how healthy some 25 year old Olympian patient looks, everyone in the ICU is there for a reason (unless they’re med-surg overflow lol but STILL) and that is that they’re critical. I always look for where the code pedal is since they vary on different beds. Where’s your IV access – if you need to emergently push a med? Check and flush those lines especially peripherals. People get lazy with maintaining those if you have a central line. Get in the habit of doing all of this at the beginning of your shift EVERY TIME. When you’re new, you’re still so moldable…you can set up your routine that will become second nature for years to come. So you want to make sure you start off with good safety habits at this time. Don’t get distracted by all of the tasks you have to do right away unless they’re emergent. Make sure you get to know your patient, your room environment, and that it’s safe.

So when I’m feeling pretty good about how my room looks I go and sit down at the computer and make a schedule for my night. I write out the next twelve hours on the back of my report sheet and go through the orders and the MAR – plugging in medication times and scheduled flushes, feeds, oral care, bath, etc. I’m someone that loves crossing things off a list. Makes me feel great. Sometimes there’s too many tasks in a shift and it’s easy to lose track of time or forget something. That’s why I love to write everything down if I can. Do this ESPECIALLY if you are new. There is no way to remember all of these tasks if you don’t write out a shift schedule for yourself. It will then become a habit and eventually you may not need to write things down. Notice my emphasis on forming all these great habits while you’re still fresh.

If you’re open for an admission, I like to prep my room the second I’m caught up on my other patient. Don’t be one of those people that doesn’t look in their other room until that new admit is assigned to you. You should be using that time to look up your new patient, not stock your room. If you’re on nightshift, bathe your first patient early in the evening, so that won’t be something you have to do later if you’re busy with the new patient. Dayshift won’t buy the excuse of you having an admission as a reason not to bathe your other patient.

Hm what else. Before the end of my shift I always have a 12 or 24 hour intake/output total, and specifically shift totals of anything we were concerned about (low urine output, high NG or chest tube output etc). If anything pops up throughout my shift that I have a question about I either write it on the whiteboard in the room or on my report sheet to cross off after it’s been addressed. Now obviously if there’s a major issue or question you’ll call the doctor right away. But for smaller questions/comments I write them down to pass on to dayshift or when the team rounds next. There is so much that happens in a shift that it’s so easy to forget a minor concern/question you had for the doctor.

Moral of the story is think ahead. Think in your head the 3 major issues your patient has at the beginning of your shift, and try to imagine any complications/emergencies that could potentially happen on your watch. Then think about what you would do in each scenario. If you plan ahead, you won’t be surprised/panicked if an emergency happens. And you’ll be calm and collected when it does. Any other questions for me write them below! Thanks for reading guys!