Re: Open heart ICU

Perhaps I am too old school, I do not believe that any new grad should ever begin in any ICU like setting. As a new nurse, you need to learn the proper ways to triage, and assess your patients. Please begin in a Med-Surg unit, this does loads for your self-esteem, as well as your ability to assess critical patients. I work in an ICU, and there are some very good GN's yet, there are many that are awful, and those of us that are experienced carry the load, for those that aren't as competant.

Re: Open heart ICU

Sorry you don't like that. It is true. If you are understaffed and working with new nurses, some (not all) just don't get it. This makes your day that much harder. Unfortunately, the nursing shortage has made what were once jobs requiring several years experience open to ALL. If you have had to clean up someone's mess despite giving positive feedback as well as 4-5 months orientation, and this person continues to have issues with patient care, perhaps your oppinion would change.

Re: Open heart ICU

Lorilou22RN,

How many years of MED/SURG have you had before you became an ICU nurse? How has this experience helped you better prepare for your ICU exp, besides build confidence because I believe anytime you step out of your comfort zone, confidence dwindles. How do you personally treat the new grads that aren't picking up their slack? What does it mean to clean up someone else's mess? What types of patient care issues is the nsg having? Also, do these new grads that are having problems, are their problems only evident during days that the unit is understaffed? I believe that 4-5 months of orientation isn't enough...especially in an ICU. I am not attacking you, so please don't think that. I am only trying to fully understand you POV and others that believe the same. Also, I will be starting in an ICU on Monday so any advice does help! Thank You

Originally Posted by lorilou22RN

Sorry you don't like that. It is true. If you are understaffed and working with new nurses, some (not all) just don't get it. This makes your day that much harder. Unfortunately, the nursing shortage has made what were once jobs requiring several years experience open to ALL. If you have had to clean up someone's mess despite giving positive feedback as well as 4-5 months orientation, and this person continues to have issues with patient care, perhaps your oppinion would change.

Re: Open heart ICU

Originally Posted by lorilou22RN

Sorry you don't like that. It is true. If you are understaffed and working with new nurses, some (not all) just don't get it. This makes your day that much harder. Unfortunately, the nursing shortage has made what were once jobs requiring several years experience open to ALL. If you have had to clean up someone's mess despite giving positive feedback as well as 4-5 months orientation, and this person continues to have issues with patient care, perhaps your oppinion would change.

Lorilou, I highly recommend that you read the book, From Novice to Expert, by Patricia Benner. It would save you (and the novice nurses you have to "clean up after") a world of headaches.

I consider myself a mentor to our newer nurses, and some of them have been practicing for close to a year. I don't expect them to know everything by the time they're off orientation, nor over the course of a year, because a large part of becoming an expert at nursing entails experience.

Experience has the unfortunate disadvantage of a time factor. It simply does not mean that in X months, this new nurse should have Y skills and knowledge. A lot depends on how well the nurse was nurtured by the more experienced nurses, such as yourself.

Maybe next time when you are "cleaning up after" someone, you can change it from annoyance "dang, have to clean up after So-and-So again" to "Gee, apparently So-and-So is weak in this area and I'll be happy to take her aside and teach her about it."

Not only should the new nurse learn how to develop skills on whatever unit she works, but the more experienced nurse needs to develop her teaching skills and use teachable moments in order to retain those new nurses. Retaining newbies saves the unit money and also benefits the unit in that they do not have to un-learn what was learned on another unit.

Just hoping that another POV will help you understand that sharing your knowledge and nurturing new nurses, will only benefit the patient, the unit, and in the end, yourself, Lori.

Re: Open heart ICU

Originally Posted by lorilou22RN

Sorry you don't like that. It is true. If you are understaffed and working with new nurses, some (not all) just don't get it. This makes your day that much harder. Unfortunately, the nursing shortage has made what were once jobs requiring several years experience open to ALL. If you have had to clean up someone's mess despite giving positive feedback as well as 4-5 months orientation, and this person continues to have issues with patient care, perhaps your oppinion would change.

I don't think you can pigeonhole all new grads. I started my first job in nursing on an open heart unit 4 months ago and I am doing fine. Sure, some aren't cut out for it, but telling someone they need several years of experience before going into critical care is just ridiculous.

Re: Open heart ICU

Originally Posted by Angie O'Plasty, RN

Lorilou, I highly recommend that you read the book, From Novice to Expert, by Patricia Benner. It would save you (and the novice nurses you have to "clean up after") a world of headaches.

I consider myself a mentor to our newer nurses, and some of them have been practicing for close to a year. I don't expect them to know everything by the time they're off orientation, nor over the course of a year, because a large part of becoming an expert at nursing entails experience.

Experience has the unfortunate disadvantage of a time factor. It simply does not mean that in X months, this new nurse should have Y skills and knowledge. A lot depends on how well the nurse was nurtured by the more experienced nurses, such as yourself.

Maybe next time when you are "cleaning up after" someone, you can change it from annoyance "dang, have to clean up after So-and-So again" to "Gee, apparently So-and-So is weak in this area and I'll be happy to take her aside and teach her about it."

Not only should the new nurse learn how to develop skills on whatever unit she works, but the more experienced nurse needs to develop her teaching skills and use teachable moments in order to retain those new nurses. Retaining newbies saves the unit money and also benefits the unit in that they do not have to un-learn what was learned on another unit.

Just hoping that another POV will help you understand that sharing your knowledge and nurturing new nurses, will only benefit the patient, the unit, and in the end, yourself, Lori.

Excellent points here. It's too bad that some of the "experienced" nurses would rather complain than teach. Sometimes I wonder if these nurses even remember what it was like to be a new nurse.

Lori, weather you like it or not, new nurses are going to be working in the ICU and it's up to you weather you are known as someone who is open to teaching or not.

Re: Open heart ICU

Please, let's keep inflammatory remarks out of this thread. Serves no useful purpose and only derails and/or mires the thread.

Thank you.

Re: Open heart ICU

Look it is like this. When you get out of nursing school, you have alot of book smarts yet little experience with practical application. Yes this does come with time (hopefully). Until then you are relying on your peers (as resource), and your ability to tackle critical situations in a timely fashion. As I stated before I have worked with many competent GN's, some so good it blows me away, these people tho were techs beforehand. The newest nurses that have come to us just aren't the sharpest tools in the shed, and could really benefit from Nursing 101, Prioritization.Now I have been an RN for 11 years in May, and certainly don't believe I am an expert, yet I am a mentor for new nurses, as well as a resource for others. I know that I would not be the nurse I am today if not for a good strong background in Med-Surg (4 yrs), Tele (4 yrs), and now my niche ICU. I think back to the nurse I was and the nurse I am and the chasm is huge. I see the big picture, I know what is most important, and I know what to do in many situations. As for what some new nurses have done that I refer to as "cleaning up the mess", you determine: BP's in the toilet and not knowing how to mix up Levophed, infusing an 18 hour bag of amiodarone in 6 hours, irrigating a foley thru the balloon port, and my own personal fave dumping in an insulin gtt in 1 hour etc. Yes these have happened, and despite receiving reprimands, and other guidance etc some of these nurses are still there. I have seen some new grads that are a bit weak, yet I know they are gonna get it, completely have their confidence shot by taking on a situation they were not ready for. So do we allow potential harm to patients occur? Do we allow the newbie, become scared to death to trust her/his own instincts due to too much too soon? Or do we encourage med-surg, or better yet telemetry first to get your feet wet?

Re: Open heart ICU

I think the way you did it seems to be the way that's right...I started in ICU as a new grad so that's how you should do it. Or, I did some time in med-surg first, so that's the correct route. Who's right? You both are.

I personally started in the ICU as a new grad. I've worked with RNs who started there as well who just weren't cut out for it and some who were. For me it was easier to know EVERYTHING about 2 patients than JUST THE FACTS MA'AM about 6. I think being a good med-surg nurse is an incredible juggling act and I have a lot of respect for those guys.

If you want to go straight into ICU, make sure you will get a good orientation and will work with RNs who will nurture (not torture) you. Look at the unit turnover, and the mix of veterans vs. newbies. If it's all 20+ year staff and new grads, run, because they may "eat their young," to borrow an overused term.

Read as much as you can, learn as much as you can from the experienced RNs you work with, and don't be afraid to ask questions. There's nothing scarier to a seasoned nurse than a newbie next door who hasn't asked a question ALL day! Subscribe to medscape journal watch for your specialty area, join AACN, read nursing journals, bounce things off allnurses.com. Eventually you'll start to feel like you know what you're doing. One day you'll realize you know cardiac index and SVR and all those meds like the back of your hand, and you'll automatically titrate those drips without giving it too much thought. You'll move from novice to expert and you'll pass on your vast knowledge to newbies coming behind you.

Good luck!

Re: Open heart ICU

Originally Posted by lorilou22RN

Look it is like this. When you get out of nursing school, you have alot of book smarts yet little experience with practical application. Yes this does come with time (hopefully). Until then you are relying on your peers (as resource), and your ability to tackle critical situations in a timely fashion. As I stated before I have worked with many competent GN's, some so good it blows me away, these people tho were techs beforehand. The newest nurses that have come to us just aren't the sharpest tools in the shed, and could really benefit from Nursing 101, Prioritization.Now I have been an RN for 11 years in May, and certainly don't believe I am an expert, yet I am a mentor for new nurses, as well as a resource for others. I know that I would not be the nurse I am today if not for a good strong background in Med-Surg (4 yrs), Tele (4 yrs), and now my niche ICU. I think back to the nurse I was and the nurse I am and the chasm is huge. I see the big picture, I know what is most important, and I know what to do in many situations. As for what some new nurses have done that I refer to as "cleaning up the mess", you determine: BP's in the toilet and not knowing how to mix up Levophed, infusing an 18 hour bag of amiodarone in 6 hours, irrigating a foley thru the balloon port, and my own personal fave dumping in an insulin gtt in 1 hour etc. Yes these have happened, and despite receiving reprimands, and other guidance etc some of these nurses are still there. I have seen some new grads that are a bit weak, yet I know they are gonna get it, completely have their confidence shot by taking on a situation they were not ready for. So do we allow potential harm to patients occur? Do we allow the newbie, become scared to death to trust her/his own instincts due to too much too soon? Or do we encourage med-surg, or better yet telemetry first to get your feet wet?

Wow, you'd really hate me because I've done clinicals in a cardiac ICU for a total of 62 hours as part of my senior practicum (yes, I'm still in school) and I've already participated in a code, titrated drips, done head to toes on fresh CABGs, ran the CCRT, called docs for meds, taken wedge pressures and CO/CI, weaned pts off the vent, and I do ALL the charting. I'm in the accelerated program, which is a BSN in 1.5 years and I taught English before that, so I have no tech or medical experience. Do I know it all; not by a long shot. I have a great preceptor who gives me enough rope, but not enough to hang myself. My medsurg rotations were miserable and I found many of the nurses lacking; most were afraid of the doctors and some were just lazy. To the person who started this thread, if you have the ability to grasp information coupled with the desire to put theory into practice, I think you should go into open heart ICU. Unlike Lorilou22rn would have you believe, it doesn't take 8 (EIGHT!) years of floor nursing to be a good ICU nurse. My wife went directly into the ICU after graduating and she's a wonderful nurse (soon to be pharmacist).

Sorry if I ranted, just got done with clinical.