[Ruby Vee]

Originally Posted by SharonH, RN

Here we go with this again. Start them off in "general nursing" before they move on to the real thing?

But this doesn't apply on the med-surg floor?

I agree with you here. I just don't understand why you wouldn't think this would apply on a med-surg or "general nursing" floor?

I'm sure the same does apply on a med-surg or "general nursing" floor. The difference is the acuity of the patient and the tightness of the staffing. While patients on med-surg floors can and do crash, there is often enough warning to move them to the ICU before things get really dicey -- or they move to the ICU after they crash. Med-surg patients tend to be more stable than ICU patients, and the staffing has a bit more flex built in. If a normal med-surg load is 5-7 patients, and every nurse has 6 patients, one more patient isn't going to crash the system. In an ICU, staffing is 1:1 or 1:2, and if everyone has two patients, helping watch the novice nurse's patients suddenly becomes a really big deal, stretching the staffing to the limits. If half (or more) of the nurses on a shift are novices, what is safe and doable suddenly becomes unsafe and dangerous. Worse, those who make the schedules and staff the units don't seem to take this into consideration.

[Ruby Vee]

Originally Posted by DebbieSue

It is my strong opinion that, for the patients' sake, new grads should not start in ICU. The 12 or 18 months on a general nursing floor are invaluable in maturing from a total novice to an advanced beginner. Any new grad starting in an ICU is asking for the response she/he gets, because it puts too great of a strain on the system. Especially in this day and age when critical care classes/orientation are so much shorter than they used to be. No one forces new grads to start in ICU, so don't whine about the response you get from the experienced nurses who have no say in hiring and hiring policies.

So, here you are, new grad off orientation. The difference between what you know and what you need to know to provide safe, let alone competent, care is greater than you can imagine. Who pays alot of the price for you having the opportunity to start in an ICU? It's the experienced nurses. Experienced nurses get stress ulcers because YOU decided you just had to start in an ICU.

Starting as a new nurse in an ICU is hard, it's going to be very rough, and there are lots of times you being there is going to create potentially very unsafe situations. Those are just the facts. Expecting people to always be nice to you while they are expected to crisis-manage the situation is not realistic. Part of being a new grad in ICU is coping with your co-workers frustrations, some of which you have helped create just by being there. If you can't tough out the first year, including the hostility directed at you, go somewhere else. There doesn't seem to be a choice anymore: there WILL be new grads in ICUs. Just don't expect everyone to be happy about it all the time.

The amount of hostility you will find will depend on a number of things: unit acuity, unit staffing, percentage of experienced vs. novice nurses on any one shift, etc. Novice nurses are a drain on unit resources. Novice nurses consume the energy of experienced nurses. Some days, the situation allows less total demand from the experienced nurses and they will view you with more willingness to help/teach. On other days, the situation will be overwhelming enough without the added drain of the needs of the novice nurses.

These are realities. No matter how good the intentions are of the new grads in ICU, they just increase what is required of the experienced nurses on a unit for almost a year. If you are the only new grad in a moderate-acuity unit that is well-staffed and managed and always has an unassigned charge nurse, then, yes, you should and most likely will be treated with loving care. On the other hand, if there are 6 or 7 of you just off orientation at the same time, in a high-acuity unit, and it so happens that half or more of the RNs on a night shift consist of you guys, and the charge nurse has her own double assignment, don't be surprised when people snap at you. You being there feels like every nurse having an extra patient. And heaven help us when one of the patients of the novice nurses crashes.

The three realities: there WILL be new grads in ICU AND new grads in ICU make the experienced nurses hard jobs even harder AND the first year will be very tough and people may not treat you well all the time.

This is an excellent post, and I agree with you wholeheartedly. I'm afraid we're both going to be flamed for our "bad attitudes," however.

I cannot stress enough that newbies do not seem to realize the additional stress they bring to the working lives of the experienced nurses they're counting on for mentoring, teaching, troubleshooting help, advice, etc. They are quick to judge us for not being always nicey nice all of the time and don't seem to grasp how stressed WE are. They know THEY'RE stressed, and they're sure if we were just nicer to them, their working day would go so much easier.

I remember what it was like to be the newbie. I've been there, done that, got the T-shirt, and remember how it feels. The newbies, however, have NO idea what it's like to be in my shoes, the only experienced nurse in a room full of 8 critically ill patients, with 3 newbies and a nurse with 18 months experience who is sure she knows everything! There's just no freaking way I can watch over the other four nurses and keep up with my own assignment at the same time. And then the nurse from the next shift complains about my "time management skills."

If every new grad who absolutely HAD to start in the ICU walked in my shoes for a week, perhaps there would be fewer complaints about how mean and nasty experienced nurses are, and how we eat our young. Perhaps they'd understand how impossible it is to meet all the demands on our time and be nice every freaking moment of every freaking day.

[PANurseRN1]

Originally Posted by Ruby Vee

This is an excellent post, and I agree with you wholeheartedly. I'm afraid we're both going to be flamed for our "bad attitudes," however.

I cannot stress enough that newbies do not seem to realize the additional stress they bring to the working lives of the experienced nurses they're counting on for mentoring, teaching, troubleshooting help, advice, etc. They are quick to judge us for not being always nicey nice all of the time and don't seem to grasp how stressed WE are. They know THEY'RE stressed, and they're sure if we were just nicer to them, their working day would go so much easier.

I remember what it was like to be the newbie. I've been there, done that, got the T-shirt, and remember how it feels. The newbies, however, have NO idea what it's like to be in my shoes, the only experienced nurse in a room full of 8 critically ill patients, with 3 newbies and a nurse with 18 months experience who is sure she knows everything! There's just no freaking way I can watch over the other four nurses and keep up with my own assignment at the same time. And then the nurse from the next shift complains about my "time management skills."

If every new grad who absolutely HAD to start in the ICU walked in my shoes for a week, perhaps there would be fewer complaints about how mean and nasty experienced nurses are, and how we eat our young. Perhaps they'd understand how impossible it is to meet all the demands on our time and be nice every freaking moment of every freaking day.

I wish this post could be stickied!

[SharonH, RN]

Originally Posted by Ruby Vee

I'm sure the same does apply on a med-surg or "general nursing" floor. The difference is the acuity of the patient and the tightness of the staffing. While patients on med-surg floors can and do crash, there is often enough warning to move them to the ICU before things get really dicey -- or they move to the ICU after they crash. Med-surg patients tend to be more stable than ICU patients, and the staffing has a bit more flex built in. If a normal med-surg load is 5-7 patients, and every nurse has 6 patients, one more patient isn't going to crash the system. In an ICU, staffing is 1:1 or 1:2, and if everyone has two patients, helping watch the novice nurse's patients suddenly becomes a really big deal, stretching the staffing to the limits. If half (or more) of the nurses on a shift are novices, what is safe and doable suddenly becomes unsafe and dangerous. Worse, those who make the schedules and staff the units don't seem to take this into consideration.

I don't mean to get into a contest with you about who has it worse because that is not the point, but this is a prime example of how people get into their own world and do not understand how in many ways the whole hospital is interdependent on each other. On an ideal shift, we might each have 6 stable patients. And I bet you would be surprised at the acuity level of a med-surg patient these days. However, it only takes one unstable patient to drain the resources of even an experienced nurse and if the ICU is full and they can't take another patient or we have to wait to move the patient because there is a lack of either beds or staff then guess who has to deal with that unstable patient out on the "general nursing" floor? And if that one patient has a newbie nurse than that one patient will quickly take up the time of two nurses because the newbie will need the guidance of an experienced nurse. And then guess what, the rest of the floor is left to take care of not just their patients but they then have to help out with the patients for the rest of the floor also. And what I found before I left med-surg was that this type of scenario was becoming more and more "the norm" and not the exception. Once you figure in the typical call-ins, the agency nurse, the nurse who was pulled and the newbies and the system was close to crashing all the time. It was enough to make a nurse with over 10 years experience run away screaming.


At the beginning of this thread, someone made the following quote:

So, here comes the experienced staff, precepting someone who will essentially tell us on a daily basis that we are wasting our time: we are investing in their knowledge, future, experience, but yet, they are not investing in the unit/team, etc"

Don't you think that we general nurses would feel the same way training nurses for the ICU?


As I was reading this thread, I felt a lot of empathy and frustration for my colleagues in ICU because it sounded just like my experience on the floor. Can't we get a little consideration the same way?

[DebbieSue]

I worked on a 48 bed medsurg unit before I went into critical care. I know that the majority of the patients on a med surg floor are less acuitly ill than those in ICU. Medsurg pts generally are less vulnerable and less able to be harmed by what the new nurse doesn't know.

Now, not every pt assignment in an ICU is too hard for a newbie. And not all pts on a medsurg unit are well enough to withstand a new nurse. That being said, most of the time, what I said is true.

The sicker the pts are, the less appropriate it is for them to be cared for by a new nurse. Lots of close calls.

[SharonH, RN]

Originally Posted by DebbieSue

Medsurg pts generally are ......less able to be harmed by what the new nurse doesn't know.

If only that were true.



An error on a med-surg floor can kill you just as surely and as quickly as it can in the ICU irregardless of how stable the patient is.

[kevagonia]

Originally Posted by soliant12

The smart ones go on to advanced practice.

Wrongo.

[LoriLeahRN]

I started out on the med surg floor in a small, rural hospital, and am very thankful for all I learned there. It helped make me a competent, efficient nurse. I learned all that "practical" stuff that nursing school doesn't teach. I also devoted a lot of time to learning telemetry, because I knew that I'd eventually want to move on. The floor I worked on had tele available, and the floor nurses were responsible for their own monitor interpretation....again, it was a learning process. While it's true that med surg patients can die from an error just as easily and quickly as anyone else can, it's also true that they are much more stable, and you typically don't have to watch their every breath and heart beat.

When I started in the ICU, I absolutely loved it. I learned so many new things, and worked with absolutely awesome nurses who took the time to mentor me and encourage me. I probably would have never left the ICU if it weren't for the fact that the ICU nurses become the hospital slaves. When our census was down in ICU, guess what? We were either put on "standby" which is a major PITA on dayshift, but a total nightmare on nightshift.....OR......you guessed it, we got floated out to whichever floor was the busiest. Never knowing where you're going to be working if it's your "turn" and being expected to function efficiently in an unfamiliar environment is hell on us ICU types. There's never an "easy" night for the ICU nurses, it seems. There's never any "downtime" Supervisors don't take the time to think and consider the acuity of the patients in the unit and the experience of the nurses, they go strictly by numbers, and if it's your turn to be pulled, you're going, no matter what sort of mess you're leaving your coworkers in. After 4 years of being pulled here there and everywhere....I landed in the ER, which suits me fine, at least I know that when I show up for my shift, I'm going to be working in the ER.

[Alexsys]

I guess I am one of those people that do plan on going to CRNA school in the future. I have been in critical care for six years and I love it. I tried going to a telemetry floor and ended up back in critical care. Why? because I loved it and still do and found that regular floor nursing was not for me. I could have left five years ago after I got my one year of experience, but there were some of us new grads that came in to critical care from school and did a good job. I will not be able to apply to any schools for CRNA until next summer, but that was not the reason why I went to MICU. I discovered my love for critical care in my fourth term of ADN school and that was what made me decide to go back for my BSN, work in MICU, and later apply to CRNA school. I guess every situation is different. I dont feel burned out from critical care, but I have seen what it can do to others

[heathIam]

Nursing is hard work. It can be exhausting work in most places and is often more so in the ER and ICU. Now hard work is not necessarily enough to get you to quit work. There are other factors at play here and most of the posts have touched on those factors.

In truth, I like most of the younger nurses we have working in our unit. I find their enthusiasm for the job and their willingness to learn a pleasure to have around and frankly, there just are not enough senior experienced nurses to hire.

The younger nurses, in general, are not the problem - oh sure there a a few prima donnas who are in our unit because it is not a heavy unit, but the majority of them can and will be excellent nurses if given the guidance and the opportunity. The majority of our patients are under 3years of age, but we do go up to 17 and then we also have parents sitting at the bedside watching your every move all day and night........

We have a younger group of nurses now than when I started 17 years ago. The biggest problem we have in our unit and it relates directly towards the retention of staff is that our management team is also young. They are as a group, young and inexperienced clinically. The most senior one in the management group was never a very strong nurse clinically - she actually ran away from a code on shift while she was a bedside nurse - and the others have between them less clinical years experience than the senior nurses in the unit. They have only a cursory understanding of bedside nursing and as such they provide a poor support structure for the staff.

To retain staff you must understand their job and their issues and you must be willing to support them rather than demean them. You must be willing to work with them, accomodating sometimes and expecting concessions at other times.

Our current management group is so far removed from the care of the children and what it is to be a bedside nurse that they have chastised staff for providing what I call exemplary care. Apparently it is unacceptable to take that extra step and offer compassion and empathy to our children and their families.

The good nurses went into nursing because they knew they could help, they could make a difference in someone's life. So very often those differences are determined by small moments of humaness = the reaching out and connecting. Now nurses are told it is inappropriate.

This is why people are leaving. it is a hard, demanding job with very few rewards. Money is nice, but the rewards are simpler - the look in the patient's eyes when you share their fears and pains with them and they know, really know, that you can see them as an individual and that you connect as humans.

It takes a supportive environment to develop the skills to be able to do this. I look at what goes on at work now and I fear for our future health care. If the smart ones go to do some vaguely nursy activity that looks only at theory and process who will be there to take care of me when I need care?

Perhaps the idiocy of phasing out the hospital programs is finally coming home to roost.