Starting in ICU

  1. I know this has been covered NUMEROUS times before, but I'm going to ask anyway.

    For the nurses who started as a new grad in the ICU, how did it go? Do you wish you had prior experience in another unit before the ICU? Did you feel well-supported as a new grad in the ICU?

    Pros/cons of starting in the ICU? Go.
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  2. 19 Comments

  3. by   Ruby Vee
    Quote from Tacomaboy3
    I know this has been covered NUMEROUS times before, but I'm going to ask anyway.

    For the nurses who started as a new grad in the ICU, how did it go? Do you wish you had prior experience in another unit before the ICU? Did you feel well-supported as a new grad in the ICU?

    Pros/cons of starting in the ICU? Go.
    I started in Med/Surg, and that worked for me. I had already learned the basic nursing skills plus how to talk to patients, families, physicians, pharmacists, etc. I had organizational skills and a solid knowledge base. I had already developed my critical thinking skills. All I had to do was add in the ICU specialty skills, so it was a relatively smooth transition.

    Speaking as an experienced preceptor, some new grads will thrive in the ICU, some will fail and some aren't interested in ICU at all other than as a stepping stone to "bigger and better" things. I'd advise anyone to get some Med/Surg experience first. I realize that's an unpopular opinion these days, and many new grads who started in the ICU feel that they're doing just great without the med/surg experience. Some of them actually ARE doing just great. Many of them are more confident than they are competent, which is a problem. MOST of them would have benefitted from either CNA experience or Med/Surg experience.

    The pros of starting in the ICU -- avoiding Med/Surg, which seems to be unreasonably hated and disrespected.

    The cons -- learning all the basics at the same time you're learning the specialty. It's difficult. Never getting the opportunity to see the wide variety of patients seen in Med/Surg which may challenge your idea of what you really find interesting. And nurses who start in the ICU seem to lack career longevity. They burn out faster. I used to think that was a function of having started in the ICU; now I'm wondering if the kind of people who skip the basics aren't just the same kind of people who burn out faster and lack career longevity anyway. It would be an interesting area to study.
  4. by   Tacomaboy3
    Quote from Ruby Vee
    I started in Med/Surg, and that worked for me. I had already learned the basic nursing skills plus how to talk to patients, families, physicians, pharmacists, etc. I had organizational skills and a solid knowledge base. I had already developed my critical thinking skills. All I had to do was add in the ICU specialty skills, so it was a relatively smooth transition.

    Speaking as an experienced preceptor, some new grads will thrive in the ICU, some will fail and some aren't interested in ICU at all other than as a stepping stone to "bigger and better" things. I'd advise anyone to get some Med/Surg experience first. I realize that's an unpopular opinion these days, and many new grads who started in the ICU feel that they're doing just great without the med/surg experience. Some of them actually ARE doing just great. Many of them are more confident than they are competent, which is a problem. MOST of them would have benefitted from either CNA experience or Med/Surg experience.

    The pros of starting in the ICU -- avoiding Med/Surg, which seems to be unreasonably hated and disrespected.

    The cons -- learning all the basics at the same time you're learning the specialty. It's difficult. Never getting the opportunity to see the wide variety of patients seen in Med/Surg which may challenge your idea of what you really find interesting. And nurses who start in the ICU seem to lack career longevity. They burn out faster. I used to think that was a function of having started in the ICU; now I'm wondering if the kind of people who skip the basics aren't just the same kind of people who burn out faster and lack career longevity anyway. It would be an interesting area to study.
    Wow, thanks! I get that line of thinking: having that med/surg/other foundational experience to build upon rather than the foundational AND specialty skills earned at the same time.

    Personally, I don't mind working med/surg, or an ICU step-down (which is my inclination at the moment) first. However, I don't like the idea of using another unit as a stepping stone towards something else. I like to think of myself as a loyal employee -- I wouldn't want to burn a med/surg unit after a year or two to move on to a "better" thing if I could just start in my preferred unit to begin with.

    It's interesting you think new grads in the ICU seem to burn out more quickly. By burn out, do you mean transferring to another unit (if this is the case, I'd think med/surg new grads burn out quicker) or leaving the profession of nursing altogether?
  5. by   Catticus11
    You're right. This HAS been asked NUMEROUS times before.
  6. by   Ruby Vee
    Quote from Tacomaboy3
    Wow, thanks! I get that line of thinking: having that med/surg/other foundational experience to build upon rather than the foundational AND specialty skills earned at the same time.

    Personally, I don't mind working med/surg, or an ICU step-down (which is my inclination at the moment) first. However, I don't like the idea of using another unit as a stepping stone towards something else. I like to think of myself as a loyal employee -- I wouldn't want to burn a med/surg unit after a year or two to move on to a "better" thing if I could just start in my preferred unit to begin with.

    It's interesting you think new grads in the ICU seem to burn out more quickly. By burn out, do you mean transferring to another unit (if this is the case, I'd think med/surg new grads burn out quicker) or leaving the profession of nursing altogether?
    First, if you spend the two years in Med/Surg (the time it takes to completely make the transition from student to nurse and to become competent in the role), you may find that you LOVE Med/Surg and wish to stay. Or you may find that you have an affinity for end of life care and wish to transfer to hospice. Or that neuro really interests you and you wish to transfer to the Neurology floor. Or that ICU is SOOOO not your thing and you'd like to try OR. If you've put in a solid two years (after your orientation) and wish to transfer elsewhere, that's part of the learning process. The new grads I take issue with are the ones who have absolutely no interest in learning the job well because it's their dreeeaaaammmmm to do something away from the bedside. That serves no one -- not their patients, their bosses, their colleagues and certainly not themselves.

    By burn out, I mean leaving nursing. Or that "I never want to touch a patient ever again" rush to non-bedside jobs that the person doesn't really learn to do well, either, because they're "so burned out" on nursing.
  7. by   Tacomaboy3
    Quote from SamTansey
    You're right. This HAS been asked NUMEROUS times before.
    Indeed. Thanks for your brilliant insight.
  8. by   saskrn
    Quote from Tacomaboy3
    Indeed. Thanks for your brilliant insight.
  9. by   SummitRN
    It went great.
    I felt well supported.
    I'm glad I started in ICU and not somewhere else.

    But that was my experience on my unit...

    You should be a self-starter and self-learner in addition to the unit having a good education/preceptorship program for ICU new grads
  10. by   Cvepo
    Quote from Ruby Vee
    I started in Med/Surg, and that worked for me. I had already learned the basic nursing skills plus how to talk to patients, families, physicians, pharmacists, etc. I had organizational skills and a solid knowledge base. I had already developed my critical thinking skills. All I had to do was add in the ICU specialty skills, so it was a relatively smooth transition.

    Speaking as an experienced preceptor, some new grads will thrive in the ICU, some will fail and some aren't interested in ICU at all other than as a stepping stone to "bigger and better" things. I'd advise anyone to get some Med/Surg experience first. I realize that's an unpopular opinion these days, and many new grads who started in the ICU feel that they're doing just great without the med/surg experience. Some of them actually ARE doing just great. Many of them are more confident than they are competent, which is a problem. MOST of them would have benefitted from either CNA experience or Med/Surg experience.

    The pros of starting in the ICU -- avoiding Med/Surg, which seems to be unreasonably hated and disrespected.

    The cons -- learning all the basics at the same time you're learning the specialty. It's difficult. Never getting the opportunity to see the wide variety of patients seen in Med/Surg which may challenge your idea of what you really find interesting. And nurses who start in the ICU seem to lack career longevity. They burn out faster. I used to think that was a function of having started in the ICU; now I'm wondering if the kind of people who skip the basics aren't just the same kind of people who burn out faster and lack career longevity anyway. It would be an interesting area to study.
    Could not say it better myself. Especially about many feeling more confident than competent! I could tell who never worked on a floor when I started in the ICU: they had a completely lack of respect and regard for every other type of nursing and thought they were doing god's given work in the ICU, as if no other nurse is capable of helping people.

    With the proper training and orientation, some new nurses will do fine. But the reality is that hospitals across the country are cutting down new grad-to-ICU internships from 6 months to as short as 3 or 4 months! These patients are too sick to have someone caring for them without the foundations that come from a good solid year of floor/step-down working.

    ICU nursing gets held on some weird pedestal and I'm not sure why. I mean, I get it, the patients are sick, unstable, and we do many great things. But it is hardly what I would consider the be-all-end-all of bedside nursing.

    Anyway, I digress. ICU is tough and can easily burn you out. It's not uncommon for new grads to start there and realize "holy crap, I hate ICU"... and there's nothing wrong with that! But Med/Surg truly exposes you to everything. Give it a chance.
  11. by   ayysolapsu09
    Another aspect is the mobility you gain in nursing with a strong base. I just graduated and started in Med-Surg because I don't intend on staying where I am at in the long term (5-10 years or so). I think that being able to put 1-2 years of med-surg experience on my resume will help me greatly in any future nursing endeavors I choose to pursue. If you want to change hospitals in the future and only have ICU experience, you may find it hard to transition into a position that is not an ICU job, whatever that may be. A good med-surg background will help you work basically anywhere.

    There is also the argument that new grads today see themselves as the exception, rather than the norm, which builds that confidence without competence that puts patient care at risk. If we graduated with more of a realistic idea of our skills, maybe we would all start in a "lower acuity" floor and learn competence, which builds real confidence.

    Just my 2 cents.
  12. by   SummitRN
    Quote from ayysolapsu09
    If you want to change hospitals in the future and only have ICU experience, you may find it hard to transition into a position that is not an ICU job, whatever that may be.
    Now that is pure comedy. ICU experience opens at least as many doors as Med-Surg, typically many more. Any Med Surg manager will take an ICU nurse. ICU is the door you need to pass through to get to PACU, IR, CCL, EP, GIL, Dialysis, vascular accss, etc. ICU is a better background for ED. In fact, the only position where a manager might want Med Surg over ICU is... Med Surg, Rehab, or LTC (there are always exceptions). Med Surg is a great background and a specialty in its own right IMHO, but to imply that it opens more doors than ICU is comedy.
  13. by   OnceMorewithFeeling
    I was a new grad in the ICU.

    How did it go?

    Not so good at first.

    Orientation and the initial year after orientation was pretty terrible. For both me and my patients, honestly. I should not have started in my ICU--I had zero health care experience, not even as a CNA. I was also horribly nervous and timid and unsure of myself. Looking back over my first few months after orientation, I can't believe that I didn't kill anyone. I cried every day. I threw up from stress many times.

    It was not a good experience. If I had it to do over again, I would have started on a med-surg floor and worked my way up.

    That was my experience (pretty timid person, scary-sick ICU patients, no healthcare experience, but Unit is super-short-staffed, so you got hired!), your experience might be different.

    Having said all that, I did make it. I'm still there, eight years later. We've had a new Manager for the last five years, and she is wonderful. I am a resource and expert to many other staff members. I am the go-to preceptor. It's pretty great, and while I might grumble sometimes about having to wake up early to go to work, I love my job. I am exceptionally good at my job, and that feels amazing, every day.

    Do you wish you had prior experience in another unit before the ICU?

    I absolutely, 100% wish I had. I would have been so much better prepared with a year or two of med-surg under my belt. I am not exaggerating about how bad that first year after orientation was.

    Having said that, I have precepted quite a few new grads. Nearly all of them have been equipped, inquisitive, delightful, knowledgeable, valuable members of our staff. I have been so impressed by their drive to learn and how well and quickly they have adapted to our Unit.

    I don't know what they have that I didn't, but they are way better than I was.

    Did you feel well-supported as a new grad in the ICU?

    Not at all.

    Our unit now has a program for new hires for the first year. They meet every few weeks to work on projects?
  14. by   Tacomaboy3
    Quote from OnceMorewithFeeling
    I was a new grad in the ICU.

    How did it go?

    Not so good at first.

    Orientation and the initial year after orientation was pretty terrible. For both me and my patients, honestly. I should not have started in my ICU--I had zero health care experience, not even as a CNA. I was also horribly nervous and timid and unsure of myself. Looking back over my first few months after orientation, I can't believe that I didn't kill anyone. I cried every day. I threw up from stress many times.

    It was not a good experience. If I had it to do over again, I would have started on a med-surg floor and worked my way up.

    That was my experience (pretty timid person, scary-sick ICU patients, no healthcare experience, but Unit is super-short-staffed, so you got hired!), your experience might be different.

    Having said all that, I did make it. I'm still there, eight years later. We've had a new Manager for the last five years, and she is wonderful. I am a resource and expert to many other staff members. I am the go-to preceptor. It's pretty great, and while I might grumble sometimes about having to wake up early to go to work, I love my job. I am exceptionally good at my job, and that feels amazing, every day.

    Do you wish you had prior experience in another unit before the ICU?

    I absolutely, 100% wish I had. I would have been so much better prepared with a year or two of med-surg under my belt. I am not exaggerating about how bad that first year after orientation was.

    Having said that, I have precepted quite a few new grads. Nearly all of them have been equipped, inquisitive, delightful, knowledgeable, valuable members of our staff. I have been so impressed by their drive to learn and how well and quickly they have adapted to our Unit.

    I don't know what they have that I didn't, but they are way better than I was.

    Did you feel well-supported as a new grad in the ICU?

    Not at all.

    Our unit now has a program for new hires for the first year. They meet every few weeks to work on projects?
    I appreciate your response. I work in an ICU (and its step-down) as a CNA while currently in school. I have a great relationship with my managers and am confident they would extend a job offer for the ICU residency upon my graduation and passing the NCLEX - many new grads right now are entering the ICU residency, then working in the step-down for 6-12 months before transitioning to the ICU. I think want to follow the same path.

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