[neko11111]

Hello,
I'm currently graduating as an RN this week - and decided to go for the critical care area. I absolutely loved my ICU rotation. I do know that there is much controversy with new grads in the ICU's vs. the shortage right now..... I've had many interviews and currently awaiting an 'official' offer in a neuro ICU at a huge teaching hospital. The mgr offered it over the phone, but we are still awaiting the official letter from HR....

While I'm waiting - I'm begining to second guess this start. I've always been confident, and in the top 5 in my class with skills and experience - but now I'm wondering if i should take the safe road and do med/surg for a year first? Although - I know i probably won't be happy there....

The thing that really scares me - is that, even though the manager I interviewed with was very nice - she flat out told me that she doesn't believe new grads belong in ICU, when I asked her how she personally felt about it - (this was in my first interview with her - but yet she's offering me a position?)

Do I go for this ? - knowing ahead of time, that it's going to be a constant uphill struggle and I'll have to prove myself everyday? Or do I do something I know isn't for me - so that i can get my experience and feet wet?

[neurogeek]

First of all....congrats on graduating!!!! :mortarboard: So very awesome! Ok, is there an internship in your ICU? If not, how long are they going to provide you 1:1 training with a preceptor? Before you get nervous get all the facts. If they are providing you with good solid direction and training then you'll be fine. Forget all that garbage about starting out in med-surg first. They do an entirely different job and it won't help you. I've heard....it helps you get better at assessment. LIE! Med-surg nurses do not do nearly as intense of an assessment as an ICU nurse so it will not train you to be more adept at assessment. God love them though, cuz if it weren't for med-surg nurses where would we be? Just not a job I ever want to do......

[neko11111]

Thankyou for your input - I know I should stick to my guns - but it's hard to ignore that little doubt in the back of my mind...

This ICU provides a 20 week orientation period. The first few weeks are strictly classroom - and then we are put on the floor with a preceptor for the remaining time. I've shadowed a couple of nurses - and some were new grads - they said the orientation was awesome - and they worked with you to make sure you felt comfortable.....
I keep hearing about horror stories though - and someone who graduated in the class before me (back in may) landed a job in a different ICU - and ended up getting fired after 4 months!!! That really shook me up - and scares me now!

[mark2climb]

Congrats on finishing school!!! Take a breather...and celebrate.

I agree that starting in an ICU as a new grad is not necessarily a bad idea assuming there is a good orientation. Judging from the evaluation of that new grad you spoke with, it sounds like the orientation is a good one. Still, I would warn that you would still feel overwhelmed with all the information and the pace at which ICUs tend to run. Just keep at it. Keep going to work when you are exhuasted. Keep going to work when you are scared to death. Every time you step into the unit is another chance for you to learn and get more comfortable. That day will come but it will take some time. That happens for everyone, even RNs with experience. Feeling a little anxious is a good thing. You are dealing with very ill patients and you can save their lives. A little fear is not so bad, just don't let it overwhelm you. Ask lots and lots and lots of questions, even the ones that you think are stupid.

I should know because I am changing from pediatric critical care to adult critical care and I feel like a new grad. I'm sure that some days my preceptor thinks I'm an idiot!! Still, I clock in and try to learn as much as possible each day!!

You can do it!!

[CarVsTree]

You have to do what you think is best for you. There are pros/cons to both choices. I was going to go straight to critical care, but decided to do transitional trauma instead. We have 4 low level critical care beds and 26 med/surg/tele beds. I am glad I chose this route. I have learned more than I can tell you and my assessment skills were not aided by monitoring. You learn what it looks like to see a patient that is very healthy start to deteriorate. The fight that you have on your hands at times, to get the docs to take it seriously. You learn how to pick your battles and how to assess your patients.

As for med/surg assessments not being nearly as intense as ICU assessments, I'm not sure I buy that. I've gotten report from ICU nurses whose reported assessments were so far off from what I received that I'm not sure they reported on my patient! We do head to toe assessments just like the units. We just don't have lines/monitors to assess or vents to maintain.

One nice thing about getting that year or two on the floor is that it gives you perspective, allows you to see patients that come from the units and the impact that their care has on your patient now. You see what happens when a patient comes to the floor too soon and how to keep that patient stable until they go back. Also, when you start in the unit, GN or experienced RN it is a frightening thing. At least with a year or two behind you, you have basic nursing/assessment skills down pat. You need to learn so much, but you are at least already comfortable around patients, family members, residents, attendings, etc.

I started out in TTU as a tech in December 2004. I started there as a nurse in January 2006. I begin my critical care internship in November. I'm glad I've gone this route. Med/surg is tough, but it is also rewarding. I think the reason a lot of ppl don't do it is because they think it is boring, but that is NOT TRUE! Med/surg nurses and there advanced assessment skills are the reason many patients are discharged and not going to the units. I've also seen patients with nurses that took poor care of them and they ended up going to the unit as a result. A good med/surg nurse will get the residents to order what her patient's need. And believe me that is NOT always easy.

I'm sure I'll have more wisdom on whether or not floor to ICU is a good choice after I spend some time in ICU. I'll be posting lots I'm sure!

I'm sure you'll do well going straight into ICU, but could you do better by getting some floor experience first? Only you can answer that question for yourself.

[Zookeeper3]

CONGRATS

For my unit it's not an issue at all, infact all our ICU's take new grads, they go through a 3 month ICU program with clinicals then 12 weeks of orientation. It's very successful. Now it really still takes 12-18 months to feel comfortable, but I think thats true of any new type of nursing set.

Only you will know what's right, it's worked both ways with those with and without floor experience. It IS a ton of hard work at first, and gets easier in time for most.

congrats again.

[RNNPICU]

I was a new grad that went straight into PICU. Whatever unit you start off in will teach you the skills and assessments you need for that specialty. If you want critical care, you should start there. If you start with Med/Surg, you will learn the skills and assessment for that specialty, and then if you go to the ICU, you will have to learn how to be a Critical Care nurse, which is very different. I have known people who have tried to transition from the floor to the ICU and not been able to hack it becaiuse it is so different. As a new grad you are going to struggle regardless of where you start, just stay focused, be determined, listen to your preceptor and read up on diagnosis and treatments. read read read. Oh and Good Luck too regardless of where you start.

[NeuroMedic]

I have been a critical care nurse/practitioner for more years than I care to admit to, and over the years I have come to learn that you are going to meet arrogant superiors, know it alls, and my over all favorite: The Superior Society of Sidewalk Physicians; one comes with every patient(usually a CNA who knows EXACTLY what interventions you should take and why you are wrong for your current intervention, whatever it is.). On the bright side, you will meet superiors with wisdom, nurses with extensive knowledge that they are ready to share with you, and patients/families that you will not trade the world for. Darlin, if you want to start off in the critical care I.C.U., You have at it. You be the best nurse you can be. Just remember there are 2 right answers in the ICU

1. The correct answer
2. I don't know

because, if there is something you dont know, we will make sure that you know it before you leave. Good luck in your ventures.