ICU Tips for the
Future CRNA

Nobody tells you how heavy it feels the first day you are off orientation.

You have watched. You have shadowed. You have been the tech who knew the environment, recognized the sounds, understood what CRRT looked like and why a patient was intubated. You felt prepared. And then the day came where the patients were yours and the responsibility landed on you in a way that no amount of preparation fully anticipates.

That was me. And if that is you right now, I want you to know something before anything else. That feeling is not a sign that you are in the wrong place. It is a sign that you understand the weight of what you are doing.

Here is what helped me get through it and grow from it.

Ask everything. Look dumb. Do it anyway.

The nurses who grow the fastest in the ICU are not the ones who already know the most. They are the ones who ask the most questions without embarrassment. Your charge nurse, your resource nurse, your nurse educator — these people exist for a reason. Use them. If you are on orientation and struggling with a concept, tell your nurse educator directly. Most will be grateful you took the initiative. Say it clearly and professionally: I really want to feel confident with this before I get off orientation. In a healthy work environment that kind of self awareness is respected, not judged.

And if you speak up and nothing changes, keep going up the chain. Nurse manager. Director. Learn early that advocating for your own learning is not weakness. It is professionalism.

Write everything down.

There is so much in the ICU that nursing school simply does not cover. Vasopressors. Running a code. Getting comfortable with the Zoll. Managing septic shock. These things become second nature eventually but in the beginning your brain is absorbing more in a single shift than most people process in a week.

I carried a mini pocket notebook to work every single day. When something happened that I did not fully understand I wrote it down. A quick note, a few words, just enough to remember. Then when I got home I would open my laptop and type it up into a clean document. Something like: septic shock, get blood cultures first, then antibiotics, resuscitate with fluids, if still hypotensive start levophed as first line. Simple. Clear. Mine.

I went through almost an entire bulk pack of those notebooks during my new grad orientation. I used these exact notebooks and I loved them so much that I bought another pack when I switched jobs and I plan on buying more when I start clinicals in CRNA school. They were genuinely perfect for this and I still think about how much they helped me.

That habit of writing things down and then going home to understand them more deeply is one of the best things I did as a new grad. It kept me from relying purely on muscle memory before I had any and it built a personal reference that was actually useful.

Find the resources that teach the way you learn.

Beyond your own notes there are incredible tools out there for the ICU nurse who wants to go deeper. One YouTube channel that I kept coming back to was ICU Advantage by Eddy Watson. Clear, practical, and made for exactly where you are right now.

I also bought two books early in my ICU career that I want to recommend genuinely, that I constantly reached for when I needed to understand something better.

The first is The ICU Book by William Owens MD. It is the kind of reference that makes you feel grounded when everything around you feels uncertain. The second is Critical Care Nursing Made Incredibly Easy by David W. Woodruff. The title is not a joke. It takes complicated concepts and breaks them down in a way that actually sticks. Both are worth having within reach.

Show up wanting to learn more than the shift requires.

Here is something I genuinely believe. You can work the exact same shift as the nurse next to you and walk away having learned ten times more. Not because you were given more opportunity but because you wanted it more. You asked why. You looked things up. You connected what you saw to what you read the night before.

New nurses bring something that experienced nurses sometimes lose. Fresh eyes. Genuine curiosity. The willingness to question things that have always been done a certain way. Do not let the intimidation of the environment take that from you.

You are not alone in feeling overwhelmed. Every single ICU nurse you admire stood exactly where you are standing. The ones who became great did not get there by knowing more at the start. They got there by never stopping asking questions once they did.