Starting in the ICU: Advice for New Grads | FreshRN Podcast

Starting your first ICU job can feel overwhelming. There’s unfamiliar equipment, a lot to learn, and experienced nurses who seem to anticipate things before they happen. Meanwhile, you’re still figuring out where everything is. In this episode of the FreshRN Podcast, Kati Kleber, Melissa Stafford, and Elizabeth Mills discuss what to expect when starting in critical care, from working with your preceptor to staying organized and making time for yourself.

Listen to the episode, then use these show notes to revisit the eight takeaways from our conversation.

Prefer a more detailed written walkthrough? Read our tips for new grads in the ICU.

Nervous about managing ICU drips? Start with this free class👇

Listen to the Episode

This podcast is available on Apple Podcasts, Stitcher, PlayerFM, iHeartRadio, Libsyn, Spotify, and Amazon Music.

Originally published May 8, 2018.

Who You’ll Hear

• Kati Kleber, MSN, RN: Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.
• Melissa Stafford: An experienced neurocritical care nurse who brings her bedside perspective to the conversation.
• Elizabeth Mills: An experienced neurocritical care nurse who shares practical advice for nurses getting started.

Episode Takeaways: Starting Your ICU Nursing Career

1. Come in with an open and actively engaged mind

Expect to feel overwhelmed for a while. You’re learning a new role, new routines, and how to apply what you learned in nursing school to critically ill patients. Getting comfortable takes time, and that timeline looks different for everyone.

• Fight the “I want to be perfect” mentality. Wanting to do well is admirable, but expecting perfection sets you up for more stress and disappointment.
• Nursing is a practice. You’ll continue learning throughout your career.
• Stay engaged. Ask questions, listen to feedback, and speak up when something isn’t clicking.

You don’t have to know everything on day one. You do need to recognize when you need help and ask for it.

2. Be aware of typical ICU nurse characteristics

ICU nurses can be assertive, direct, detail-oriented, and intense. They’re often anticipating what could happen next while keeping track of what’s happening right now.

That can be intimidating when you’re new.

• Direct communication can be important during urgent situations. It doesn’t make disrespect or bullying acceptable.
• Experienced nurses learn their protocols inside and out. Their ability to act independently still depends on applicable orders, approved protocols, demonstrated competency, and scope of practice.
• You don’t have to have the same personality as your preceptor to become a great ICU nurse.

You are bringing something to the table. It’s just different from what someone with years of experience brings.

3. Show initiative

Take an active role in your learning. Introduce yourself to others, participate in rounds with your preceptor, and look for opportunities to understand more about your patients’ care.

• Ask to observe unfamiliar procedures when appropriate and when your patient responsibilities are covered.
• Ask questions about the reasoning behind a decision, not just the steps involved.
• Choose a manageable topic to review between shifts instead of trying to learn everything at once.
• Balance studying with downtime. You need time to recover, too.

Need a place to start studying?

If terms like “pressors,” “levo,” and “titration” still feel unfamiliar, my free ICU Drips for Beginners email class is a practical next step. It covers foundational drip concepts, orders, administration considerations, and common medications, with an ICU drip chart to support your learning. Use it alongside your orientation and your unit’s policies.

4. Know yourself and be your own advocate

Think about what helps you understand something new, and communicate that to your preceptor. You might need to see a demonstration, talk through the reasoning, or practice with supervision.

• Know your limits and be honest about what you haven’t learned yet.
• Be open to feedback. Please don’t be the new grad who acts like they don’t need to be educated!
• At the same time, don’t hide uncertainty because you’re worried about looking inexperienced.
• Find a mentor—someone you trust who can help you process the experience of becoming an ICU nurse.

Try being specific: “I understand this part, but I’m unsure about the next step. Can we walk through it together?”

If you’re concerned about a patient, speak up promptly. You don’t need to have everything figured out before asking for help.

5. Own your orientation

Orientation is an extension of your education, with supervised practice and competency expectations. It’s a marathon, not a sprint.

Your preceptor won’t always be able to tell when something isn’t clicking. Let them know.

• Ask what you should be working toward during each stage of orientation.
• Check in about what’s going well and where you need more practice.
• Speak up about skills or situations you haven’t had an opportunity to experience.
• Involve your educator early if you need additional support or a clearer learning plan.

Advocate for yourself. Being actively involved in orientation includes being honest about what you need.

6. Keep an organized routine throughout your shift

A consistent routine can help you keep track of assessments, medications, and the many moving pieces of an ICU shift.

Work with your preceptor to develop a system you can use and adjust as your patients’ needs change.

• Use an organized approach to receiving report and identifying immediate priorities.
• Build a consistent assessment routine.
• Keep track of time-sensitive care and follow-up tasks.
• Reassess your plan when something changes.

When the situation allows, take a moment to get organized before jumping into your task list. Urgent patient needs come first—your routine should help you respond, not delay care.

You’ll refine your system as you gain experience. It doesn’t have to look exactly like everyone else’s.

7. Learn your alarms and respond to them appropriately

You may develop a love/hate relationship with alarms. They’re essential, but repeated alarms can contribute to alarm fatigue and make it easier to become desensitized.

Learn what the different alarms mean and how to respond with your preceptor.

• Assess the patient and investigate the cause. Don’t assume an alarm is false because it has gone off repeatedly.
• Don’t disable required alarms or widen limits simply to stop the noise.
• Learn the difference between temporarily silencing an alarm while responding and turning an alarm off.
• Check alarm settings at the start of your shift and with changes in patient condition or caregiver. Individualize settings according to hospital policy and any required orders.
• If you respond to another nurse’s alarm, tell them what happened and what you did. Equipment and infusion changes must stay within your competency, applicable orders, and policy.

The goal is to address the cause of unnecessary alarms while keeping meaningful alarms effective. AACN’s alarm-management recommendations provide additional guidance.

8. You need downtime

Becoming a critical care nurse straight out of school is tough and exhausting. Take care of yourself.

• Make time for sleep, meals, relationships, and things you enjoy outside of nursing.
• Give yourself permission to have time off that doesn’t involve studying.
• Ask for support when you need it.

Again, advocate for yourself. Make time for yourself. You don’t have to wait until you feel completely comfortable in the ICU to deserve a break.

Resources Mentioned and Next Steps

For more support as you get started:

• Tips for New Grads in the ICU: Our more detailed written guide to the topics discussed in this episode.
• ICU Drips for Beginners: A free mini-course with lessons and printable drip charts.
• Breakthrough ICU: Structured education on ICU equipment, patient priorities, common disease processes, report, and more to complement your bedside orientation.

You’re not going to learn it all in one shift. Stay curious, ask for help, and give yourself room to be new.