New grads shouldn't work in ICU?

[Kayla2013]

I graduated in May and was hired in a small town four bed ICU/IMC unit. I previously have experience in a 20 bed neurological ICU unit as a nurse extern, so I have some experience in critical care. I recently have heard from many I work with that I should not have been hired in the ICU as a new grad and that there is no way I'll be ready to work by myself since I need nursing experience before I gain critical thinking skills. This is extremely frustrating to me since I know I would be a capable and safe nurse in this unit working by myself, and my manager agrees. Any suggestions on how I can handle this negative feedback or has anyone experienced the same thing?

[sunflrz321]

Many years ago I started out in peds ICU, and I LOVED it and it worked out great.

It is, certainly, trial by fire. You have to commit to studying on your off days, and bringing your absolute A-game to every.single.shift. You have to basically become an expert in each category of pediatric complications- you have to know the worst of what can happen and what to do about it for neuro, cardiac, respiratory, metabolic, endocrine, etc problems. BUT- you will become an INCREDIBLY good nurse in the course of your first year. You will learn to calculate and titrate drips like nobody's business, you will develop incredibly fine-tuned assessment skills, and you will learn the art of one of the most in-depth forms of nursing. If you meet up with your fellow graduates one year from now, you will probably have stronger clinical skills than most of your peers. When your classmates hired onto med-surg or ortho call a rapid response or any other type of alert, they will be calling for your team and your ability to respond quickly on your feet and your critical thinking skills.

Your first year as a nurse is like the real final year of your schooling in many ways, because there is SO much learning that happens in that year. You will be taught by some of the most nit-picking nurses in the field, and they will challenge you every day, but they will teach you a TON. They are like the hardest teacher you ever had in nursing school- the one who taught you more than you ever wanted to know but whom you can only dream of knowing that much one day too. That will be most if not all of your coworkers and preceptors.

Just remember ICU experience is HIGHLY sought after, so if you can learn to swim in the ICU over the next year, you can survive anything in your career. Starting as a new grad in ICU is not for the faint of heart, and it also isn't for the nurse with a ton of other distracting family and personal commitments that can get in the way. But if you really put your all into it, you will be the better for it.

[Do-over, ASN, RN]

I think one of the biggest issues will be when you are floated out of the unit...

[Scooby-Dooby-Doo]

Hi, I came upon your thread when I was looking for opinions about new grads in ICU. I'm 23 yrs old and am a graduating BSN student next month, and tonight I had just finished my senior preceptorship in an MSICU at a teaching facility. I learned SO much that every time my shift was over, I would go home and research new concepts that I wrote down on a mini notepad that I carried in my scrub pocket.

Anyhow, I had my final evaluation from my preceptor and clinical instructor. My preceptor told me that she believes that if you're prepared as a new grad in ICU, then go for it as she herself did so when she did her preceptorship in the ICU. I got off the phone from my instructor and she advised me not to start in the ICU as a new grad as well as other RNs who insist I take a med-surg job or step-down position, whereas special instructors told me to not start in med-surg and go straight to critical care, keeping that passion and drive burning before it goes out as time passes.

As a student, I feel that if you have the motivation, perseverance, and devotion for passion in ICU, you will thrive. I feel the same way since I never come into the unit unhappy but excited to learn what's new and ask questions like a sponge takes in wáter for answers.

Try asking to care for "unique" patients. I remember I had times where I learned about CVVH/CRRT and learned about Intra-aortic Balloon pumps and how it works. Learn to use your resources such as other workers besides RNs in your unit. For example, I even had to ask the respiratory therapists on the unit about concepts that RT was good at such as ventilator management and some skills that I never had experience on like setting up aerosol treatments or RT medications. RT will become your best friend as I learned, even in code situations haha! Also, one thing that helped me in my preceptorship as a student RN was learning what my weaknesses were and seeking help for it from experienced RNs. For example, I had difficulty with knowing a WIDE range of critical care pharmacology and their effects, considerations, precautions, and side effects... OMG, that was overwhelming since my preceptor would quiz me on them. But once you learn them and begin to apply the reason behind why they are prescribed, it all makes sense, then my mind goes "oh yea, duh! silly me!" haha!

Try asking if an RN can be a mentor maybe? I know I asked some RNs on the unit some questions about how I felt such as "is it normal for a new RN to always feel like I'm missing something?" I know sometimes when I give report and then drive home, I remembered that I forgot to let the oncoming RN know that I stopped a gtt. or needed the art-line dressing or IV tubing changed lol, it's those Little mistakes. The RNs thankfully were nice and understanding that I was a student, so maybe perhaps talking to fellow co-workers who are understanding may help?

In any case, I wish you the best out there! I understand it can be overwhelming and dealing with negativity is totally stressful, but hang in there and prove 'em that you can do it! Go in there and show them, good luck!

[babyNP., APRN]

I started out as a new grad in a large level IV NICU together with ECMO, HFOV, vasopressors, nitric oxide, dialysis, post-ops (no such thing as a PACU for the NICU!), bedside surgery, etc etc. It was very hard but it was completely worth it. And our unit has much better luck with new grads than non-NICU experienced nurses, especially those with adult experience.

[calivianya, BSN, RN]

I get tired of all this stuff about new grads not doing well in ICU. I think you have to have the personality for ICU to do well, period, and it doesn't matter if you're a new grad or you have 20 years of med/surg experience - both types of people will fail if they are not cut out for ICU. In my hiring group, there were a couple of experienced med/surg nurses. Both required an extended orientation because they were just not getting comfortable. None of the new grads needed extra time. I don't hear anyone talking about how med/surg nurses are a poor fit for ICU, though - based on my experience, maybe they should.

[msn10]

Being a successful nurse in an ICU is not an independent adventure. Your success in an ICU is almost completely dependent on the support you have. You could be a rockstar student, but by virtue of the environment, an ICU will be one of the toughest places to work. Know what your resources are, know who your allies are, and know when you are getting in trouble and ASK for help if you need it. Do not be a "know-it-all" as that is the worst kind of preceptee. Critical thinking skills are developed, yes some people have better CT skills than others, but a good preceptor will help you develop those (Based on Tanner's model) and so, you should not do this alone. It can be disheartening to hear negativity, but I am hoping that you will find colleagues who share your passion and want you to succeed as much as you do. Connect with them...it may the difference between failure and success.

[PacoUSA, BSN, RN]

I started out in a specialty unit ((LDRP). I graduated with honors sigma theta tau, took extra clinical courses through an additional collage, took a beginning midwifery course separate from my nursing courses, and became a certified doula during nursing school. There are your average students and your above average students. Some new grads do great in specialty units while others do better starting in med/surg. To make a blanket statement that new grads should not start out in specialty units is saying all new grads are equal; (I don't know how to say this without being rude) but that simply is not true.[/quote']

Top student does not necessarily equate to top clinician. This assumption is simply not true.

[manusko]

I was a new grad in the CCU and had an admit that was suffering from low blood pressure and placed on a norepinephrine drip. It was end of shift and my last day for two days. I suggested the night nurse pass on to the day nurse to inquire about a PICC line if the pt was still requiring drips to maintain pressure.

I came back two days later and the pt was still there and on her norepinephrine drip with the same peripheral IV. I inquired about a PICC line for the pt and also reviewed their chart. The same night nurse and day nurse was with this pt for two days. The resident wrote to continue the PTs home BP meds. The nurses never questioned this order and continued to give the pt medicine to treat her high BP which she obviously was not having trouble with at this time.

Personally I thought this was common sense. I had a few months experience and questioned it but the two nurses I worked with probable had 30+ yrs each. It doesn't matter your age or experience if you are going to blindly follow orders without ever critically thinking for yourself.

[Jmpwells]

I love reading this because I too will be a graduate nurse in Dec 2014. I've already picked up on many acute changes so far with my med-surg patients and I feel as though my home should be in critical care. I've been a Medical Assistant since late '06 and worked specialty. Thanks for everyone not labeling new grads as the same.

[monkey2008]

I agree with so many statements here. I was/am (less than 1 yr working) a new grad in MSICU . It's scary, challenging, heartbreaking, exhilarating, frustrating, fun, sad, happy and a whole bunch of other things all at once. The most important things are to know when you're in over your head so you can ask for help, and always think about WHY you are doing something, WHY doctors ordered something, and if you aren't sure the reason, ask. If the answer doesn't sit right with you, ask someone else. Never, never, never assume that the doctors or residents are always right. therefore, never blindly follow orders. soak up every single experience you can...I can often be found in the sickest patient's room, picking the nurses brain and lending a hand. There is so much to learn, never stop learning, never stop questioning, and always, always help out your neighbors...the day will come when you get a crazy assignment and need the extra hands to help you .