[kenesha212002]

I am a new grad and I work ICU. I resent some of the comments and generalizations that are being made about new grads. I work my butt off just like any other nurse in my unit. I sometimes feel like new grads in the ICU have it the worse because the experience nurses do not want us here and they think that we should start off in med-surg because we haven't earned our place.
I chose ICU because I wanted to think critically and build my assessment skills. After 3 months of being here I can honestly say that I have so much to learn and I am looking forward to it. ICU chose me because I am a good nurse. There were only 2 positions on this unit for a grad nurse. 11 of us started together. We went through a critical care course and preceptorships. Out of the 11, 2 were let go, 3 were placed in med-surg, 4 in telemetry and myself and another new grad are now in ICU.
I know that all the experiences nurses out there who work in ICU (or any other unit for that matter) did not come out of nursing school and know everything. So, why is it when a nurse becomes "experienced" she forgets that at one time she was fresh out of nursing school and was looking for someone with experience to help her.

[JazzyRN]

The answer to that question is pretty simple. Nurses leave the ICU because as everyone knows there is a nursing shortage, we are understaffed and overworked, theres not enough time to do everything you need or want to do for your patients. The difference between the floor and the ICU, is that not having enough time or staff or being too busy WILL contribute to the death of patients much easier than on the floors. The ICU pt is too unstable and depends on their nurse and doctor to keep them alive. There is too much responsibility on our shoulders, with not enough support. Thus you can burn out very quickly. Ive been doing PICU for 3 years and lately Ive been considering switching my specialty a lot. On a related note, I see alot of negative comments about new grads being in the ICU. With the burnout and high turnover rate of the critical care nurse, there is a huge shortage of them now. These new grad nurses need to be welcomed and embraced, because the shortage is so great, hospitals have to create their own ICU nurses. Would you rather work with a new grad nurse or have 3 or 4 patients in the ICU?

[bluesky]

Originally Posted by janfrn

The sort of working conditions that cause people to leave our ICU include things like a total lack of respect for the frontline staff from any level of management. Respect, which should be a two-way street, is expected to travel in only one direction and that's up. Anyone who questions a manager's decision, makes a suggestion that hadn't occurred to the manager, dares to complain about an assignment, or voices a concern about any aspect of the day-to-day running of the unit is asking for a visit to the office with both the manager on duty and upper management. It isn't only nursing management that is lacking in respect for the nurses doing the work; the physicians are also very guilty of this. Some of them make it plain that anyone without MD after their name is not worthy of their attention.

Chronic short staffing is another frequently mentioned issue. We are usually short-staffed, and when we aren't nine times out of ten the administration pulls the "extra" staff to another area. We are a unionized facility and have a very explicitly worded contracct, but it is violated in a number of wasy every single day. Staff aren't getting their statutory holiday days-off-in-lieu as they're supposed to, vacations aren't being granted, management is deciding how much time a person should require to deal with a personal pressing necessity and we have a huge number of people off on maternity leave, sick leave, short-term and long-term disability whose positions have not been filled temporarily. They rely on casual and part-time staff to fill in the gaps. but then whomever has signed up for the shift may still cancel themselves. Some help. We are often left with no unit clerk or nursing assistant because they've called in sick, or one just wasn't scheduled, so a nurse has to take on those responsibilities. There are never enough bodies to bathe, change, turn and reposition our larger teenaged patients (like our 95 kg 13 year old quad), because as our DON has repeatedly said, all our patients are babies so we should be able to do it all without help.

So in an effort to alleviate some of our staffing woes, they went on a hiring blitz and hired more than two dozen new nurses since January. However, most of the people they've hired are new grads who have yet to develop organizational skills, assessment skills and basic nursing skills. So the result is that the experienced nurse at the next bedside is expected to "watch out for" the new nurse. Our acuity level is always extremely high and thus making safe assignments is very difficult. I've had shifts where I was the only nurse within one half of the unit who had any experience at all, taking responsibility for the patients of four or more other nurses in addition to my own. But then many of these new nurses have already left or have dropped down to casual. So we're back to square one.

We are also part of a teaching hospital so we have a revolving door for second year residents and foreign fellows in every specialty. We often have to tell them what the order should say (it's easier to just write it myself and then have them sign it!), what our usual practice is in given situations, show them where things are, get things for them, clean up after them and do their charting. Every day nurses in our unit save patients from the follies of the medical education system. Our newest foreign fellow, from Brazil, has such poor English that trying to get her to understand what the problem is with a patient, we're having to use sign language some times.

Scheduling is a huge problem for our unit. About half of our staff self-schedule, at least in name. I used to be one of them but found that the schedule I had selected bore no resemblance to the schedule I ended up with. Our master rotation is very unbalanced, both in how the shifts correspond with pay days as well as which days of the week are worked. The master has five Mondays out of six, one Wednesday and one Thursday, and two of the three worked weekends are nights. See staffing problems above! Trading shifts is almost an industry... some people have to print up thier schedules every time they work so they know when their next shift is. The contract's rules about scheduling only apply when management wants to apply them, so a person may not be allowed to make a trade because it would give them too many shifts in a row, but management can then change their schedule so they have the same number of shifts somewhere else, based on "operational requirements"...

Recognition and praise are only ever horizontal. My coworkers will recognize and acknowledge a job well done, a good catch or a special effort, but it seems management expects every nurse to function at the "exceeds expectations" or "outstanding" level at all times. But there's an unwritten managers' rule that no one will ever exceed expectations in writing, as with our annual performance evaluation.

Our nurse practitioner, who has been away from bedside nursing for about fifteen years, keeps coming up with these lovely ideas for improving care, most of which involve filling out some type of documentation every shift. We are still using paper charts, and our daily pile of paper usually runs to some dozen or more pages not counting medication documentation. Of course, in order to cut back on auxilliary staff costs, we are expected to do all the filing of documenation, all the transcribing of information, all the processing of orders and such, order our own blood products and meds, as well as provide total care for our patients. So if I'm filling out yet another form that isnot considered part of the chart just so that she can have some numbers to reprot to justify her salary, when do I have time to do patient care? Another thing she likes to do is devise schedules for things like dressing changes and treaments that will accommodate family timetables, but which totally mess up the nurse's.

I could go on forever, but I won't. These are some of the things that are making me think long and hard about changing jobs. The only roadblock for me is that this is the only PICU in this area. The next closest one is 185 miles away. My local community hospital has some peds beds, but the acuity level is very low and I'd probably find it boring. The management knows that if you're a true PICU nurse, you're going to stay and take whatever they dish out because you have nowhere else to go.

Funny about the NP. I've been thinking for a while now how dissapointed I've been in the acute care NP;s that I've encountered in ICU. The ones I have worked with have seemed to have forgotten what it was like to be a nurse first.

[Lisa CCU RN]

Originally Posted by motorcycle mama

If that's the case, maybe I do have a shot at CRNA school after all!

I'm with you. This is good news. Last time I checked, had a pulse.

[christymwinn]

kenesha,

i can understand why you would take offense, but unfortunately it is true in many instances that there are alot of new grads who don't take ICU seriously and just use it as a steeping stone to something else.
I have been an LPN for 8 yeras, but went back for my RN and was a "new grad" in the ICU afterwards. i am very serious about my icu work , but I had to jump thru hoops to be acdepted into icu and was told that the hospital didn't have "good luck" when it came to hiring new grads in the ICU, and then.... they hired to brand new grads this year that didn't even have any nursing experience at all. It was like they were hypocritical vs. what they told me the year before.
I am all for new grads working where they feel comfortable, but it is not good practice for the new grads to outnumber the experienced nurses on any shift in any type of unit. It does not make for good medicine. It is not personal, but we can't be expected to "be there" for you if we are already overwhelmed w/ our patients, and also have more than one new grad working w/ us. It is unsafe and I think that either admin. doesn't understand, or they just don't care. I hate to say it, but things aren't changing for the better anywhere (and I am a pretty positive person about things).
You have to be VERY proactive about things needing to be changed, and sometimes even that doesn't help.

[laterria]

As a new graduate, all I can say is WOW!!! I understand the more seasoned nurses get burned out and frustrated, but don't take the burnout and frustration out on the new nurses. Have you ever thought that your attitude towards new graduates nurses are what pushes them away. No matter how much "experience" or "seasoned" you are now, you were once a "graduate nurse". Remember, everyone has to start somewhere to get where they are. Also, all new graduates are not in ICU for a year so they can go on to graduate school. I've always been taught if you can't beat them then join them. Meaning, older nurses are too stuck in their ways. Instead of criticizing the less seasoned nurses for trying to better themselves, maybe you should do something about your unpleasant life. I'm just saying..........

[DusktilDawn]

Originally Posted by laterria

As a new graduate, all I can say is WOW!!! I understand the more seasoned nurses get burned out and frustrated, but don't take the burnout and frustration out on the new nurses. Have you ever thought that your attitude towards new graduates nurses are what pushes them away. No matter how much "experience" or "seasoned" you are now, you were once a "graduate nurse". Remember, everyone has to start somewhere to get where they are. Also, all new graduates are not in ICU for a year so they can go on to graduate school. I've always been taught if you can't beat them then join them. Meaning, older nurses are too stuck in their ways. Instead of criticizing the less seasoned nurses for trying to better themselves, maybe you should do something about your unpleasant life. I'm just saying..........

Perhaps that may be how it seems to you. The experienced nurse has been there to get to where they are. Not all are "too stuck in their ways," most have learned the best way for them to do their job, and have seen the passing of many "a better mousetrap" through the years come and go. Not all seasoned nurses have an "unpleasant life," but they have been working long enough to see the continual decline of working conditions, increased patient acuity, doing more with less and that includes staff, unsafe practices not being addressed, others/or themselves persecuted for advocating for patients or their safety, management that refuses to deal with or ignores unit issues, more responsibility and accountability heaped on nurses without the authority or autonomy to deal with it, etc. You've never been the only experienced nurse on a unit with new grads, do you have any idea what that is like? I do, and it is not fair to either the new grads or the experienced nurse. How can one expect seasoned nurses to be the mentors they could or should be when the working environment in no way fosters such a thing?

I've seen lousy attitudes both in experienced and new nurses, neither group has that market cornered. You look for or expect the bad in people, trust me, you won't be disappointed. Have a little empathy towards another, and you may be surprised. Consider the fact that you may not be the only one in a difficult position, another may be in a different but just as difficult position.

[christymwinn]

Dusktildawn, I agree with you. I know many nurses who are burned out, but try to keep a good attitude. It is ALOT harder than most people think. I have tried to keep a postive attitude, even joining committees so that maybe I could help make more of a difference. I think that I do help, but I also am very realistic in knowing that it takes more than just me to do it.
I fell to the bad attitudes earlier this year, and I was just so unhappy. I didn't want to come into work ever!!!! It took some time, but I finally decided that I cannot let other people's attitudes affect me that way. I think it was after I came into my own ER and was admitted for gallbladder surgery and had to stay at my own hospital for almost 3 days.
I can say that here at our hospital, for the most part, our new grads really are treated well and usually have good experiences in orientation. With our last group last year, they are all still here. I hope that this wil help turn the tide for our institution!
Have faith everyone, you just never know what can happen out there.

[augigi]

I loved ICU. I left because of a couple of things. Firstly, I got a great opportunity in a medical device company which I felt would suit my skills and provide a new challenge.

Mostly, I was frustrated because I trained in cardiothoracics because I loved it. My unit then combined so we had a trauma/burns/cardiothoracic/transplant unit. I ended up often taking care of trauma or burn patients, which I didn't enjoy and wasn't trained for. In addition, it was a large teaching hospital, so we had a lot of students coming through, all of whom wanted/needed to be assigned to the high acuity cardiothoracic patients I loved, while also needing supervision. So I ended up looking after the stable longterm patient in the next cubicle so I could supervise the student. Which meant that I didn't get to look after the sickies myself, which is what I loved.

I find that a curious paradox in most professions - the better, and more experienced you get, the further away from direct care you have to move; management, teaching etc. You don't get to just do what you love.

Having said all that, I'm going back to nursing soon. I miss the direct patient care too much!

[SmilingBluEyes]

Originally Posted by laterria

As a new graduate, all I can say is WOW!!! I understand the more seasoned nurses get burned out and frustrated, but don't take the burnout and frustration out on the new nurses. Have you ever thought that your attitude towards new graduates nurses are what pushes them away. No matter how much "experience" or "seasoned" you are now, you were once a "graduate nurse". Remember, everyone has to start somewhere to get where they are. Also, all new graduates are not in ICU for a year so they can go on to graduate school. I've always been taught if you can't beat them then join them. Meaning, older nurses are too stuck in their ways. Instead of criticizing the less seasoned nurses for trying to better themselves, maybe you should do something about your unpleasant life. I'm just saying..........

I think there are some generalizations being made on both "sides". (old versus new nurses, specifically). That there are "sides" here at all is sad.

There are a lot of reasons ICU's can't keep nurses, and a lot of the posts say it well.

Too many nurses using it as their stepping stone "to bigger and better things" like CRNA school. Right or wrong, if you want to call it such, this means a lot of people leaving after only a year or two, taking what experience they DO gain with them, leaving the ones who stay to pick up the pieces and try to train the next crop of future CRNA candidates.

Too many burnt and crispy "older nurses" who want to leave, but can't for whatever reason----or finally do, taking years of invaluable experience with them. YOu can't replace them with 5 or 6 new graduates, as much as you might like to.

Too large a ratio of new graduates to experienced nurses. Whether we like it or not, pumping tons of new graduates is no answer to any shortage, least of all ICU/CCU. We NEED experienced and willing nurses to show the way. The older nurses need the TIME to be able to teach AND care for their critically-ill patients. Unfortunately, this is almost impossible these days.

Patient-nurse ratios in many places are unacceptable. Taking on 3 or more critically-ill patients is expected in some ICU's. It's too much for ANYONE to sustain this way for too long. The ones who want to preserve themselves or licenses, leave places like this.

The environment in many ICU/CCUs is "dog eat dog" for all these reasons. A little understanding of why and the viewpoints of everyone here might go toward a solution, versus volleying accusations right and left. JMO.