Disclaimer: This post is based on my personal experience transitioning into critical care nursing. Every nurse’s journey into the ICU is different, and this perspective may not reflect all experiences or how every nurse enters the field.
Starting out as a new graduate nurse in a Trauma Surgical ICU via a nurse residency program was, in a word, overwhelming. I had zero clue what I was walking into—but I knew I wanted to challenge myself. Neuro wasn’t my strong suit in school, and emotionally, I never thought I’d be able to handle trauma cases. After losing someone close to me in a tragic car accident at 19, the thought of managing trauma patients was something I never imagined I’d be strong enough to do.
But here I am—years later—still standing, still learning, and more confident than ever. The ICU stretched me in ways I wasn’t prepared for. It tested my critical thinking, my emotions, my teamwork, and my resilience.
So here are 10 things I wish I knew when I was just a baby ICU nurse. If you’re new to the unit, I hope this helps guide, ground, and grow you.
1. Orientation Expectations vs. Reality
When I chose a residency program, I fully expected structured classes that would go into detail about the conditions I’d be seeing. What I got instead? A mix of generic hospital orientation and trainings like PT basics, CPI (Crisis Prevention Institute), and fall prevention. Not bad information—but not what I needed to feel ICU-ready.
My preceptor trained me like a nurse who already had experience on the unit—not like a brand-new grad. I had to learn a LOT on the fly. So if you’re in the same boat, know you’re not alone. And yes, you can survive and thrive through the chaos.
2. Read the Room—Not Just the Monitor
Monitors are important, but they don’t tell the whole story.
You might glance up and see a stable-looking vitals screen… while your patient looks like absolute crap. Trust what you see and what your gut is telling you. Maybe the oxygen reading is 85%—but their nasal cannula is chilling on their forehead (it happens). Maybe the HR is “fine”—but the patient is pale, diaphoretic, and struggling.
Also, don’t forget about the family. They see and hear the same alarms we do, and it can be terrifying for them. A calm explanation and reassurance go a long way in keeping everyone grounded during tense moments.
3. It’s Okay to Ask Questions
What wasn’t okay? The nurses who didn’t want to help, didn’t listen to what I was actually asking, or brushed me off.
That taught me a valuable lesson about the kind of nurse I never want to be. We’re all always learning, no matter how many years in. Never feel embarrassed to ask for help or clarification—your questions matter, and they’re how you grow.
4. Prioritizing When Everything is “STAT”
Newsflash: everything in the ICU seems to be marked STAT. But you’ll quickly learn that not all STATs are created equal.
When you’re juggling orders, remember to fall back on your ABCs. If your patient is crashing and hypotensive, stabilize first—then get the head CT. If your stroke patient has a sudden neuro change, that CT? Definitely a priority over a STAT lab.
Take a deep breath, assess the whole situation, and triage accordingly.
5. Handling Traumatic Cases Emotionally
ICU cases are emotionally intense. It’s okay to feel it. I still remember the first time I had to intubate and code my own patient—alone, off orientation—and it wrecked me.
You’re allowed to cry. You’re allowed to step away to the breakroom and breathe. But eventually, you’ll need to pull yourself together and carry on. The patients need you. You need you.
If you’re struggling, talk to your charge nurse, a trusted coworker, or the chaplain. Remember, you’re human—and the best nurses are the ones who still feel.
6. Know Your Scope & Speak Up
If you’re asked to do something outside your scope, say so. You are allowed to say, “I don’t feel comfortable with that.” And you should. Because it’s your license on the line.
Don’t let providers—or anyone—intimidate you. Yes, they’re your colleagues, but they’re not your boss. Ask clarifying questions. Stand your ground. And always, always advocate for your patient and yourself.
7. Chart Like It’s Going to Court
Because someday… it might.
Charting protects your license. If you didn’t document it, it didn’t happen. I document everything—from changes in condition, to provider communications, to interventions performed.
Be specific. Include times, names, responses. Document who you paged, what you said, and what they replied. It may feel like overkill at the time, but future-you will be grateful.
8. The Value of Teamwork
There is nothing more powerful than a good team.
Nursing is a 24/7 job. It doesn’t matter what shift you’re on—care continues around the clock. Be honest with the next shift about what didn’t get done, but don’t leave tasks undone out of laziness.
Pitch in where you can. Reposition patients, help coworkers, answer call lights. And always, always respect every member of the care team. From EVS to respiratory therapy to pharmacy—we’re all in this together.
9 & 10. You Won’t Know It All Right Away… But Growth Happens FAST
In the beginning, I felt like I’d never know what the other nurses knew. But every shift, every mistake, every success… it all builds you up.
You will learn. You will grow. You’ll start noticing that you get it—without even realizing how far you’ve come. Stay curious. Keep asking questions. Don’t get stuck in the “we’ve always done it this way” mentality.
You’ll go from overwhelmed to confident faster than you think.
Final Thoughts for Baby ICU Nurses
To the brand-new ICU nurse reading this:
You are braver than you think. Smarter than you feel. Stronger than you know.
This journey will stretch you, test you, and transform you—and that’s exactly how it’s meant to be.
And if you need a helping hand to get started, I created a Free ICU Starter Toolkit just for you:
🩺 Download the ICU Starter Toolkit Here
📘 Or dive deeper with my ICU Crash Course for New Nurses
Loved this post? Follow along for more ICU tips, real nurse moments, and sanity-saving support:
📌 Pinterest | 📸 Instagram | 💻 Blog
You’ve got this, nurse. 💪
With love,
Jules 💙