Training pathways in ICU

[LibertarianNurse]

I wanted to put out for discussion the various training pathways in ICU that I have observed to see what all you other ICU folks think. First, some background: I work in a MICU at a level II trauma center hospital. We also have a SICU/CVICU and a stepdown unit that are connected, yet somewhat separate from the MICU, but all are governed by the same management and some nurses float to all units from day to day or within a scheduling cycle. There have been unofficial as well as official ICU training programs throughout the years there.

One pathway, is that experienced nurses in other units of the hospital apply to ICU, interview with a panel of management and current ICU nurses, and are then chosen from the group to participate in a 4-6 month training program. There are classroom portions and then many shifts with a preceptor or two after which they are hired into an official position in the ICU.

Another pathway is for new grads which is essentially the same as above, except they all train for 6 months and have slightly more content in the classroom portion of the program.

Another pathway, which is the sticky wicket, is when some nurses who work in the stepdown unit are unofficially handpicked by charge nurses and/or management to train little bit by little bit to the MICU or SICU, without a specific application process or interview. They often end up as ICU nurses in much less time too, like maybe only a month or two. These nurses are generally very bright, they bring their A-game, they show potential for high level critical thinking, and take to critical care very easily.

Some of the ICU nurses who come through the training programs will look down on those nurses who come to ICU "unofficially" and resent the fact that they didn't truly apply for training. It seems unfair to some, and that argument is valid. However, to me, it seems that if some one has the skill and ambition for ICU, why does it matter which path it took them to get there? Everyone ends up at the same place.

For this topic, I would love to hear what other training possibilities are out there and whether any of you experience this type of phenomenon at your hospitals. And further, is there one right way or a variety of ways to train to any unit or role in the hospital? Is there an amount of time required for some one to train or is it dependent on the combination of their skill, ambition, and aptitude for learning, etc?

[WestCoastSunRN, MSN, CNS]

I was one of those "sticky wicket" nurses who was recruited into ICU from tele. But so was everyone else. We didn't have residency programs (or much of any kind of "orientation" for that matter). You know -- it was the whole having to walk uphill in the snow both ways kind-of-thing.

I became one of the first preceptors for that institution's ICU residency program, in which we hired NEW GRADS. I promise you, I thought they would all fail (some did, but most did well). I laugh at that idea now. Now, in my area, nurse residency is pretty much how one gets into ICU. And you know what? It makes me jealous -- all this amazing education these nurses are getting. I think it's incredible and so wish I could have gotten that. But I get to be a part of it as an experienced nurse mentoring and precepting the newbies. I'm happy for them they are getting the support they need, and I am a proponent of nurse residency. That said, I don't like to see experienced nurses who would like to work in ICU get beat out for residency positions by new grads. I still think floor/tele experience is VERY beneficial as a foundation to build upon.

[CowboyMedic, DNP, APRN, CRNA]

I started in our Step Down ICU but went through the ICU residency program that our facility offered. When I was finally able to move to the ICU I had all the classes that the people hired into ICU and it was a seamless transition. For our facility, everyone that is hired into the CVICU, BICU, MSICU, or SDICU will go through the ICU residency program.

[seaofclouds21, BSN, RN]

I believe Residency programs have their place, especially for new grads. When hiring experienced nurses though, I believe the orientation needs to be individualized based on each nurses knowledge base and experience. That being said, there needs to be a quick and easy way to get to know what those new nurses need in regards to their orientation to make sure all the needed areas are covered.

[AceOfHearts<3]

I think your poll needs to be a select all that apply. I agree nurse residencies for new grads are beneficial. I don't think experienced nurses need to go through a residency, but should be given the required time with a preceptor and critical care education as needed.

I was a tele nurse before being hired into an ICU. I had a couple of classroom days and I also completed the ECCO modules through the AACN. Nurses with ICU experience that were new hires took the BKAT to assess what areas they needed to work on and then completed just those specific ECCO modules. The amount of time spent with a preceptor was dictated based on each nurses experience- new ICU nurses received a couple months and experienced ICU nurses received a little less. More time could and would be granted for experienced ICU and new to ICU nurses if needed.

ETA: It's not a one size fits all, but I do think all new hires to ICU need a formal orientation process with a preceptor and any needed education.