[johnboy]

I graduated in 1993 from a BSN program, while attending school full time and working nights full time at the local university hospital/trauma center as a "nurse tech" This was during the Humana/Galen/Columbia days, and I basically got my first RN job in another state in the ICU only because i happened to work for the "company."

It was a full-blown trial by fire experience. This hospital decided not to have a critical-care training class due to "unexpected operating expenses." (Note: they've since gone out of business!) So I basically was thrown into the mix--really into a den of wolves of scheming, bitter nurses, and even nastier scheming, bitter doctors! I'll never forget the time I pushed IV Dilantin into a patient's line. I went innocently up to the charge nurse wondering why his blood pressure was so low ("huh, you're supposed to dilute it first? But i did a really SLOW IV push, i swear...")
Needless to say, I was literally having palpitations even on my days off while at the Barnes and Noble! I only survived that one because I was determined to tough it out with the help of some great older nurses who took me under their respective wings. I wouldn't wish that on anyone, and hopefully you won't be in that situation.

I tell this mainly to illustrate that it CAN be done. If some recommend Med/Surg for a year, why not just go to Medical ICU? or Surgical ICU? My heart lies more toward Medical though, because you get a much greater variety of stuff coming through. But if you're set on Neuro, I suggest getting a feel for a couple of experienced yet cynical nurses on the unit. In return for listening to them ***** and moan about everyone else, you're bound to get some invaluable tips, build close bonds, and have some fun in the process.

It helps having either a)supreme confidence, or lacking that, b)sheer bull-headed stubbornness. At times I had to bite my lip when dealing with some people, but I kept on repeating to myself, "It's all for one purpose." You can take away a "pearl of wisdom" with every interaction with another medical professional or any average idiot.

If you think that's bad enough, after two years of ICU experience (no floor work at all), I let some fool talking me into "traveling nursing." Perhaps I was a full-blown masochist by that time, i dunno. I enjoyed that too. Besides it got me my job in the Bay Area, which is where I wanted to be all along.

When it comes right down to it, I think it all depends on your personality and how you react to "curve balls" that life throws at you. Certain people thrive on this type of thing. I'm not talking about that "adrenaline" rush that "code junkies" adore, but a sense of pushing yourself and pursuing goals. Common sense and a little "sweet talk" never hurts either!

Good luck, don't let anyone play mind games with you, and always try to clean your room before the next shift. Because even if they swear they don't, they really WILL talk bad about you!

[zapperbapper]

I graduated 4 years ago and struggled with the same decision. There was no fellowship program only a lengthy orientation. I decided go directly into the ICU because there I would have only 2 patients (max 3) that I knew were critical and would need a high level of care. On the floor I would be faced with 8-10 patients, any number of which could become critical at any time. I could not imagine the stress level of being responsible for 8-10 sick patients. Let's face it, if you're in the hopital these days you are REALLY sick and floor nurses are pushed to the limit.

[kdoodles]

I went straight from nursing school into Neuro ICU. The hospital did send me through a critical care course, but it certainly doesn't teach you everything you need know. I absolutely loved it. However, I quit when pregnant with my 2nd child. (almost 5 years ago). I just recently started working one day a week doing chart audits for a rehab hospital. I really miss the patient care and the ICU setting, but shift work and 12 hours shifts just aren't suitable for our family having 3 small children and my husband works long hours.

Getting back to being thrown into the ICU setting......there were times I felt very overwhelmed, but I feel that I had pretty good resources.

[traumarns]

i was an lpn for 10 yrs. first year or so in ltc. the next several years on a neuro surg floor. the last three trauma er.

i started as a new grad rn in icu.
i think new grads CAN work icu right out of school IF the orientation preceptorship is good.

i got 6 months of preceptorship, and now that i am on my own, I am NOT really on my own. i still have several "mentors" they are my pod mates and the charge nurse. there are a couple nurses who have been burned by new grads, and really dont want to precept, so i steer clear of them, but when the crap hits the fan, i KNOW they will be there for me but mostly the patient.

during my 6 months of orientation i attended a 6 week basic ekg class that was 2 days a week for 3-4 hrs a day.
any less of a class i personally believe you dont learn what you need to know to read and analyze strips. this is a different class than a 12 lead class.
i also attended a 3 month critical care class that was written by aacn. it helped but i did not learn as much as i do while working.

next week i take a cardiac pharma class that is two different days. and then i will do my acls.

there is sooo much room for growth at this hospital. and the management is very supportive of education.

i interviewed at two different hospitals for icu. i wanted a general icu so i could see and learn everything, not just surgical, cardiac, or medical. i was offered positions at both. the first was more money and a trauma center, i turned that job down because the manager asked me to start a month later as she had just hired 17 travelers.
the hospital i am at now, is not a trauma center, is a tertiary care center, attempting for magnet status (whatever that means) we get everthing but trauma.
the experience on the night shift is amazing. about 90% of the nurses i work with have >10yrs experience. of that 90% approx 75% have >20yrs experience in the icu at this hospital.

we have a very low turnover rate and that was the most important issue for me as a new grad. who is going to be there when i am on my own.

i dont believe med/surge is a must before going to icu. the way you think, organize your time, chart, most everthing is almost completely different.
i had to retrain the whole way i did everthing including critical thinking going from er to icu. in the er you stabilize, in the er you are fine tuning the pt.

good luck to you, and dont forget when you interview to ask questions.

[zambezi]

Hello...i am a new grad about six months out...i went directly into our CCU...our school had a neat program, i was able to orient in the CCU for six months as a student, i was able to meet staff, become familiar with docs, techs, procedures, policies, etc. I then had three months of orientation as when i became licensed. I work nights with an excellent staff that always has time for questions if i have any...if a patient is crashing, the unit that i work in works together...i am lucky to work with such a great staff. I am glad that i chose to follow my heart and start working in the CCU...sometimes i wonder if i should have gotten med/surg or some other experience first but i am glad with my decision...just had my six month review with the manager and she said that i was doing well...to keep it up...didnt even really have any constructive criticism at this time...good luck with your decision..

[geekgolightly]

traumarns,

it sounds as if you have had a really wonderful experience in a hospital setting that is ideal. and i agree that new grads who are given the opportunity you have can do well as an ICU nurse. generally speaking, though, i feel that it is unsafe for the patient to be handed a new nurse when theya re in a critical position in their lives. i want to work NeuroICU and have even been offered a position when I graduate, but I have decided to take the Neuroscience position instead so that i may have a year of floor experience before i move to strictly critical patients. although i am biting the bit for the chance, i am making this decision for the safety of patients. i do not know hat type of situation i will be walking in when i start working in neurotrauma, as each unit is vasty differnt depending on policy and who is in charge, so i wan tot have experience under my belt, rather than relying on the safety net of others' experience.

if i wanted to work in denver, though, i would look up your unit for sure! it sounds amazing.

[pc2006]

Originally Posted by KR

I am in the process of interviewing for a new grad into the ICU fellowship program. The hospital has 2 ICU. The program is 4-5 months long. We work with one nurse in the one unit for 20 hours a week, and work a different nurse in the other unit for 20 hours a week. We have the same two preceptors throughout the entire program. We attend a 120 hour Critical Care Class, 45hr Trauma class, a BAsic EKG class, and a ACLS class by the end of the program. I know there is a lot of controversy over new grads being in the ICU. This is really where I want to work. I work in a different hospitals ICU now as an assistant and I love it. I was just wondering if there was anyone out there that went through a similiar program to talk to. If anyone has I would appreciate a post or email. Thanks. Kim

I graduated a year ago and went to the ICU immediately after graduation. The hospital offered a similar fellowship program. I have thoroughly enjoyed this year and learned so much. I too had only two preceptors. They were seasoned nurses and very supportive. I believe that success in the unit is dependent on the individual. You can't look to what others have done to determine your likelihood of succeeding. You will have to work really hard. There is so much to learn. If you are willing to work hard and continue to pursue knowledge with a healthy respect for nurses who are willing to help you acquire it, positive outcomes are attainable.There will be stressful days, but you will have them no matter where you work. You will have some nurses who will be more than happy to help you. Others will let you know that they don't think new grads should be there. I made it my project to do my best to prove otherwise. We have very intense intensivists. I have tried really hard to remember that they are there advocating for the patient, they don't have anything personal against me when they are making critical observations about my performance.. If I made a mistake ( I should say when) I tried to learn from it and avoid it in the future. Most docs are looking for nurses who are honest, and willing to take care of their patients. If this is what you want to do, then I think the ICU would be fortunate to have you. Most important key in everyday is prayer. It changes everything. Trust God. He will lead you in right paths.

[nurseabc123]

New grad in the ICU here. I graduated this past May, took and passed boards in early July. The hospital I work at offers a Critical Care Internship program for any one new to critical care (including ICU/progressive care). The interns were mostly new grads, a couple RNs with 2-3 years exp., and one with 10-12 years. We did over 100 hours of classroom time (ekg, trauma, acls topics, crrt, etc.). Most of it redundant, and painful to sit through. But a few good topics. And some good hands-on days (mock codes, etc.). The time on the unit with my preceptor was most valuable. I had 12 weeks orientation that was split between classroom time and unit time (and 3 weeks on nights with a 2nd preceptor).

I'm now 3 weeks off orientation, on days (considerably busier- a different kind of busy, than nights, on my unit). Our first month, we are assigned a resource person (a nurse we can go to with our questions and not feel 'bad' for bugging them) and the charge is very supportive and usually allows us to some our assignments first (at least on our first day). However, you get to a point on orientation where I felt that I could not be prepared any more for the things that were going to inevitably going to happen. It's the ICU, and it's unpredictable.

And they tell you - first few days off, take stable and/or chronic patients. First day, I took stable post-op heart awaiting transfer - brady'd down to 25 in the chair and had to emergently pace him. Or last week, I took two stable patients again - however, we needed a bed, pushed the transfer, and I had the only patient on NC, so I got the unstable belly from the OR with a pressure in the 30's! My best advice would be just keeping your cool, knowing when to ask for help and asking for it, always ask questions, even if you think they are stupid (it's better to look stupid, then doing something stupid that hurts the patient).

A couple more things, as in my unit as I am sure it is in many other ICU's - the nurse are very autonomous, especially with our CV patients. And give meds, draw labs, hang gtts and just write the verbal order, and update whomever later - and I would say 99% of the time it's okay. (There are some standing orders, but not for everything). But as a new nurse, the surgeons/residents/whomever do not know me yet, don't trust me, etc. - and I don't have the confidence/knowledge/experience. I make sure I get orders for everything. And when before calling for things/asking for things in rounds, I bounce things off another nurse. For example, "Pt's on 3mcg nipride, started on her po beta blockers yesterday, can't wean the nipride, I was thinking I needed to add an ace, maybe lisinopril." I would just run this by another RN to make sure this sounds reasonable before I suggest it to the NP/resident.

And if you can help it, as one my co-workers always says, "I'm never in a rush, it's not like anyone's dying or anything." When you're in a hurry, you make mistakes. Take the time, look things up - meds especially (fyi, iv hydralazine when mixed with insulin forms a nice little white precipitate in your tubing). When things hit the fan, chances are there will be at least 10 people in the room helping you out.

If you're lucky, the unit you decide to work on will be very supportive of new grads and new RNs in general and they will be understanding and support you. I feel that I am very lucky to be on the unit I'm on and couldn't do it without everyone's help - unit staff, nurses, nps, residents, surgeons, all. Hope this was helpful, good to luck to you.

[ELKMNin06]

Originally Posted by MSU_nurse07

New grad in the ICU here. I graduated this past May, took and passed boards in early July. The hospital I work at offers a Critical Care Internship program for any one new to critical care (including ICU/progressive care). The interns were mostly new grads, a couple RNs with 2-3 years exp., and one with 10-12 years. We did over 100 hours of classroom time (ekg, trauma, acls topics, crrt, etc.). Most of it redundant, and painful to sit through. But a few good topics. And some good hands-on days (mock codes, etc.). The time on the unit with my preceptor was most valuable. I had 12 weeks orientation that was split between classroom time and unit time (and 3 weeks on nights with a 2nd preceptor).

I'm now 3 weeks off orientation, on days (considerably busier- a different kind of busy, than nights, on my unit). Our first month, we are assigned a resource person (a nurse we can go to with our questions and not feel 'bad' for bugging them) and the charge is very supportive and usually allows us to some our assignments first (at least on our first day). However, you get to a point on orientation where I felt that I could not be prepared any more for the things that were going to inevitably going to happen. It's the ICU, and it's unpredictable.

And they tell you - first few days off, take stable and/or chronic patients. First day, I took stable post-op heart awaiting transfer - brady'd down to 25 in the chair and had to emergently pace him. Or last week, I took two stable patients again - however, we needed a bed, pushed the transfer, and I had the only patient on NC, so I got the unstable belly from the OR with a pressure in the 30's! My best advice would be just keeping your cool, knowing when to ask for help and asking for it, always ask questions, even if you think they are stupid (it's better to look stupid, then doing something stupid that hurts the patient).

A couple more things, as in my unit as I am sure it is in many other ICU's - the nurse are very autonomous, especially with our CV patients. And give meds, draw labs, hang gtts and just write the verbal order, and update whomever later - and I would say 99% of the time it's okay. (There are some standing orders, but not for everything). But as a new nurse, the surgeons/residents/whomever do not know me yet, don't trust me, etc. - and I don't have the confidence/knowledge/experience. I make sure I get orders for everything. And when before calling for things/asking for things in rounds, I bounce things off another nurse. For example, "Pt's on 3mcg nipride, started on her po beta blockers yesterday, can't wean the nipride, I was thinking I needed to add an ace, maybe lisinopril." I would just run this by another RN to make sure this sounds reasonable before I suggest it to the NP/resident.

And if you can help it, as one my co-workers always says, "I'm never in a rush, it's not like anyone's dying or anything." When you're in a hurry, you make mistakes. Take the time, look things up - meds especially (fyi, iv hydralazine when mixed with insulin forms a nice little white precipitate in your tubing). When things hit the fan, chances are there will be at least 10 people in the room helping you out.

If you're lucky, the unit you decide to work on will be very supportive of new grads and new RNs in general and they will be understanding and support you. I feel that I am very lucky to be on the unit I'm on and couldn't do it without everyone's help - unit staff, nurses, nps, residents, surgeons, all. Hope this was helpful, good to luck to you.

do we work at the same hospital? this sounds exactly like my new grad experience. I work in a neuro icu and had a great preceptor who still looks out for me. I work nights and we have great team work...in fact we were just talking about that last night..I have made some mistakes but for the most part my exp as a new grad in the neuro icu has been good and i have learned sooo much and feel like i am a better nurse for it..

[barsk103]

Hi There,
I started as a new grad in a neuro step-down unit and it worked out great. I did have friends that started right in the ICU, and while i know it is a subject of controversy... they all excelled in the Unit. I knwo its not for everyone, but if your up to the challenge i say go for it. You do NOT need a year of med-surg. first!