First day in the numbers in critical care.

Yesterday I worked my first shift in the numbers in intensive care as a newly qualified nurse. After a slightly unorthodox supernumerary period including a seven-week long absence due to sickness, as well as starting in the midst of a global pandemic, I had, in total, around six or seven weeks clinical practice before being assessed by a very supportive senior nurse who deemed me capable of looking after critically unwell patients without supervision, which seems to be about average for a lot of ICUs.

Prior to going into the numbers, I had a lot of anxiety about all the things I just didn’t know. I know I can (and I do) ask a LOT of questions, but what about the bits I don’t know that I don’t know?! Will I miss something serious? What if my patient rapidly deteriorates and I freeze up? All of these questions were constantly whirring around my head. Nonetheless, I had to bite the bullet eventually, and I went into work for my first shift working ‘alone’.

Thankfully, I’m not really alone, the education team and senior nurses are incredibly supportive of new nurses into ICU where I work. I was placed working near to very experienced nurses who would be able to help me if I needed it. The patient I was allocated to was a bit of a mixed bag in terms of their nursing requirements with some elements I had previous experience of, and some not.

I set out planning my day which was easier said than done; this patient had a LOT of medications (all IV) and not many free lines, as well as various pumps and drains which needed regular maintenance, and not to mention a very pressing need for regular physical rehabilitation to help clear chest secretions. All in all, my time management was definitely going to be put to the test as I tried to scribble out some kind of rough plan that I was sceptical I would be able to keep anywhere near to.

The day went very fast, and lots of curveballs were thrown my way; a radiographer turned up for an ultrasound I wasn’t expecting, morning physio took much longer than I had anticipated (but was extremely beneficial), stitches popped on the patient’s central line which needed re-suturing. All of these meant I was continually reassessing the tasks that needed doing and rescheduling according to priority. Additionally, due to happenings in the areas surrounding me, I had a much-reduced level of support from colleagues for a lot of the afternoon (through no fault of their own) Needless to say, it felt a bit relentless all day.

At last, the end of the shift came, and I handed over to the nurse for the night shift. I looked back at my shift and weighed up how my first shift had gone. Had I managed to perform every task I had wanted to? No. But I had carried out the essential tasks and any non-essential ones I could manage and handed over the ones I hadn’t been able to do and, I might add, there was no judgement from the night nurse for handing over a couple of jobs.

So, did I manage to do a good job? At the time, it certainly felt like I wasn’t keeping it together, but I talked briefly with the nurse in charge at the end of the shift, and I expressed that I hadn’t done as well as I’d have wanted. However, she highlighted to me that I had managed to deliver all the patient’s essential medical care (including all those pesky IVs!); managed to help them get out of the bed for their longest stint yet with help from the physios; managed to wean down on their O2 support; managed to sort out getting the patient to speak with their family; managed to autonomously deal with issues as they popped up, and managed to ask for help when I wasn’t sure. I realise I said ‘manage’ quite a lot there, and that’s because the penny dropped for me, I had actually managed, not merely scraped through my first shift in the numbers.

Sure, I didn’t do things perfectly, but I left work leaving behind a patient who was a little better physically, mentally and socially at the end of my shift than when I went in at the start. All in all, I’d say that was a success. Bring on day two.

Michael (

Published by RCN Newly Qualified Nurses

The voice of newly qualified nurses within the Royal College of Nursing. Providing support from six months pre-registration throughout preceptorship.

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