top ten things never to say your first year in ICU

Stripped of my nascent sense of adequate job performance since entering the hijinx, high-stakes Death Match Area of Critical Care, I find the one (admittedly petty) way I have to bolster my ego is making fun of others with even less experience than I do.

Yes, this means mocking new grads, and yes, it's completely immature and hypocritical of me, because I'm supposed to be a mentor to my peers and all that crap. (Which I am! I promise! I'll be really, really, nice to you, newbie grads, and maybe even bring you treats laced with anti-depressants to keep you from killing yourselves when you realize your career is going to be as financially successful and professionally rewarding as the DVD release of Paris Hilton's The Hottie and the Nottie (also starring Joe Moore and Christine Lakin!)

I'll be nice (or at least not spike your treats with horse laxatives) if you refrain from the following statements/faux pas:

1.) Never call a 3.2 second pause "sinus arrest." First of all, everyone will laugh at you. Maybe not to your face. But laugh, they will. Second, you may not ever recover fully functional hearing capacity if you call an attending at 2 a.m. for a patient you claim is "Going in and out of sinus arrest of 3.2 seconds." Because there will be a lot of yelling (and possibly swearing) coming from said attending. (If you work on a cardiac floor, I promise you that you would rather digitally disimpact everyone else's 88 year old, bowel obsessed patient than call a "pause" an "arrest.")

2) Never ask "Where do I put the EKG leads on a fat person?" Your patient may sit on your skinny little white punk ass if you do, and your nursing colleagues may claim "you called in sick" even if the nursing supervisor realizes you are missing at change at shift and inquires after your whereabouts.

3) "Push the code button?" is never the right answer when your preceptor asks you what to do in a code. Corollary: Neither should you answer, "Stop, drop and roll?" In general, it's a bad idea to make up an answer. If you really don't know, just say you don't know. Ironically, other nurses will take you more seriously and not be as afraid that you'll kill their patients as soon as you fess up to how little you really know.

4) "I think restraints should never be used on patients!" is a nice theory in the Happy Land of Fairies and Elves. In the world of patients suffering from dementia and ICU delirium, you are likely to wind up with a STAT psych consult, four point restraints and fed a Zyprexa and Haldol cocktail if you utter these words to more experienced staff nurses. (Oh yes, and did I mention? We will laugh at you. We like to laugh, you see. It makes our miserable lives briefly more tolerable. At least until we can get home and drink Draino to dull the pain and the homicidal voices in our heads).

5) "I saw a code, and it was sooooo cool." I shouldn't have to explain to any one why a patient with no pulse and no respirations is like, sooooooo the epitomy of "not cool."

6) "Does the heart really have four chambers? No really, does it?!" I'm not saying you have to be up on the latest electrophysiology buzz, but for the love of God people, I'm pretty sure a fourth grader with minimal anatomy and physiology knowledge would at least have the sense to keep their mouth shut if they didn't know the answer.

7) No one cares how many questions you answered before the NCLEX shut off. Really. I promise. No one.

8) "Don't help me! Seriously, DON'T HELP ME!" If you say this to another nurse who is, you know, trying to help your lame ass, which is quite obviously in a whole boatload of trouble, you quite obviously need help. Asserting you "don't need help" is, paradoxically, a cry for help. Same goes for asserting "Shut up! Let me think; I know this!"

9) "I don't understand why that nurse was freaking out. How was I supposed to know it was Torsades?" Hint: recognizing lethal cardiac arrhythmias is now your job.

10) "I love nursing!" No you don't. You just don't know that, yet.



N.B. These are real quotes from real new grad nurses. I weep and gnash my teeth, etc.