Insight & advice on Critical care(ICU) VS. general Med-Surg floor?

RUcon08 · Feb 16, 2007

Thanks all for the great posts; they were definitely taken into consideration.

At this moment I'm basically leaning towards taking the CC position, which unfortunately isn't at the #1 hospital I wanted, but ah well. Thanks again!

mced · Feb 16, 2007

"no brand-spanking newbie nurse is going to be ready for the full on assault that is our tertiary care ICU wards. It would simply be unsafe". Are there any solid nonbiased studies that back up these kind of statements being made on this thread? I have not been able to find any.

Rabid Badger, BSN, RN · Feb 17, 2007

"no brand-spanking newbie nurse is going to be ready for the full on assault that is our tertiary care ICU wards. It would simply be unsafe". Are there any solid nonbiased studies that back up these kind of statements being made on this thread? I have not been able to find any.

I don't think it takes a rocket scientist to figure this one out. Benner's "Novice to Expert" theory and research is widely accepted and incorporated into schools of nursing and licencing bodies. Novice nurses are not equipped for the independent and quick problem solving required for ICU work.

Stage 1: Novice

Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases; hence the rules tend to be applied universally. The rule-governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no "life experience" in the application of rules. "Just tell me what I need to do and I'll do it."

Stage 2: Advanced Beginner

Advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience.

Graduate nurses are widely accepted to work on at the Novice stage of development. Reaching the competent level was found to require approximately 2 years of experience. Personally, I've finally reached the competent stage, and I know this by introspection and reflection. A grad nurse who is unable to realize their limitations is clearly at the novice stage and requires closer supervision. If you've ever worked with students or been one yourself you know full well that when you first start out you need plenty of guidance, help with prioritizing, and have greater difficulty recognizing changes that require intervention. It also doesn't take a million studies to know that overconfidence kills patients.

Cross research in any field and the evidence solidly points to greater experience = better outcomes. If the nursing research lacks publications on such matter, let me know, and I will be more than happy to conduct the first study. I honestly have a little difficulty understanding how we are even questioning the veracity of this.

I honestly think the US idea that grad nurses can head into ICU with 14 weeks of training is based on widespread ICU staffing shortages. If you require experience and 8 months of additional unpaid training, it is more difficult to staff such areas, understandably. Our ICUs are short staffed as well, but despite that, our health authority has sought to aggressively recruit using incentives for experienced nurses, while maintaining a standard of care and minimum expertice requirements.

I've gone online and researched ICU positions in the US, and I've seen that I can hop right into an ICU position, without further training. That my dear, should frighten us all. I guarantee you don't want your family members cared for by a novice overconfident nurse. Don't get me wrong, I love working with students, I love teaching, I'm precepting a senior student nurse currently. So I'm more than fully aware of their capabilities.

marilynmom, LPN, NP · Feb 17, 2007

I don't think it takes a rocket scientist to figure this one out. Benner's "Novice to Expert" theory and research is widely accepted and incorporated into schools of nursing and licencing bodies. Novice nurses are not equipped for the independent and quick problem solving required for ICU work.
Stage 1: Novice
Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases; hence the rules tend to be applied universally. The rule-governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no "life experience" in the application of rules. "Just tell me what I need to do and I'll do it."
Stage 2: Advanced Beginner
Advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience.
Graduate nurses are widely accepted to work on at the Novice stage of development. Reaching the competent level was found to require approximately 2 years of experience. Personally, I've finally reached the competent stage, and I know this by introspection and reflection. A grad nurse who is unable to realize their limitations is clearly at the novice stage and requires closer supervision. If you've ever worked with students or been one yourself you know full well that when you first start out you need plenty of guidance, help with prioritizing, and have greater difficulty recognizing changes that require intervention. It also doesn't take a million studies to know that overconfidence kills patients.
Cross research in any field and the evidence solidly points to greater experience = better outcomes. If the nursing research lacks publications on such matter, let me know, and I will be more than happy to conduct the first study. I honestly have a little difficulty understanding how we are even questioning the veracity of this.
I honestly think the US idea that grad nurses can head into ICU with 14 weeks of training is based on widespread ICU staffing shortages. If you require experience and 8 months of additional unpaid training, it is more difficult to staff such areas, understandably. Our ICUs are short staffed as well, but despite that, our health authority has sought to aggressively recruit using incentives for experienced nurses, while maintaining a standard of care and minimum expertice requirements.
I've gone online and researched ICU positions in the US, and I've seen that I can hop right into an ICU position, without further training. That my dear, should frighten us all. I guarantee you don't want your family members cared for by a novice overconfident nurse. Don't get me wrong, I love working with students, I love teaching, I'm precepting a senior student nurse currently. So I'm more than fully aware of their capabilities.

I'm still in nursing school and I think you make some very valid points.

mced · Feb 17, 2007

Dude, Benner's Novice to Expert Theory is exactly that, A THEORY. Below are some publications that back up actual practice. New graduates with adequate orientation programs and preceptorships function and survive in a critical care setting without increasing M&M to the patients they care for. Almost everyone I am in school with now went straight in to critical care after graduating from their nursing program. None of us had any trouble functioning at a competent level after completing an orientation and preceptorship program mentioned above. Though my statement only speaks for a small number of nurses (n=19), the articles cited below show that when applied nationally, these programs work.

Ihlenfeld, JT. Hiring and mentoring graduate nurses in the intensive care unit. Dimens Crit Care Nurse. 2005; (24) 4 175.

Lindsey, GL. & Kleiner B. Nurse residency program: an effective tool for recruitment and retention. Journal of Health Care Finance. 2005; (31) 3; 25.

Nibert, AT. New graduates a precious critical care resource. Critical Care Nurse 2003; (23) 5: 47.

Reising DL. Early socialization of new critical care nurse. Am J Crit Care. 2002;11: 19-26.

Seago, JA. & Barr, SJ. New graduates in critical care. The success of one hospital. J Nurses Staff Dev. 2003; (19) 6: 297-304

Thomason, TR. ICU orientation and postorientation practices: a national survey (Intensive Care Unit). Critical Care Nursing Quarterly. 2006; 11: 237

jamonit · Feb 17, 2007

this is such an old school argument. i'm done contending with it. i love my job and i'm glad that new grads in america have the opportunity to begin their careers in critical care or where ever they please. one of the perks of entering nursing now, the shortage has kind of blown this argument out of the water. they need us there, otherwise we wouldn't be hired there.

the end.

jamonit · Feb 17, 2007

and besides, what does evidence based practice state on this topic? what was posted from the person with the biggest problem with this appears to be a generality, not fact.

okay, enough. done.

that's my pinning ceremony! hehehe. enclosed for giggles.

Logan · Feb 17, 2007

Rabid Badger, I'm sorry you're experiencing such rudeness from some of these posters. I'm proud to be an American, but hardly proud of the attitude I'm seeing here. Really shameful.

Frankly, "slapping someone upside the head" isn't exactly an attitude I find admirable nor appreciable coming from someone who claims to be an 'experienced nurse'.

No matter how "insubordinate" the other person may be.

We have a "report post" function on this forum for precisely this purpose.

On topic:

I actually agree with Rabid Badger in principle - I don't think new grads ought to work critical care (ER included). This doesn't mean that I think med-surg is "ok" to "let loose inexperienced nurses on".

On the contrary, floor nurse experience is INVALUABLE in building core nursing skills. There is no better place for new grads to start out on than a good med/surg floor - the sheer variety of patients, the need to be able to balance tasks and time, delegation and responsiblility... just some of the things that a new grad is exposed to and expected to learn.

And stuff that will stand them in great stead when they have to take care of intense care patients.

When I was a new nurse, I was offered med/surg or the Neuro intensive care unit. The Neuro care unit was more tempting - better patient care ratio, better pay, more perks etc. But I chose med-surg on principle --- I wanted to hone and improve my nursing skills as a new grad before I attempted critical care.

This is of course, MY opinion. People are free to take it or leave it as they choose.

Thanks,

Matthew

Rabid Badger, BSN, RN · Feb 18, 2007

and besides, what does evidence based practice state on this topic? what was posted from the person with the biggest problem with this appears to be a generality, not fact.
okay, enough. done.
that's my pinning ceremony! hehehe. enclosed for giggles.

Thanks for proving my points so eloquently throughout this thread! Simply genius!

TazziRN, RN · Feb 18, 2007

I've gone online and researched ICU positions in the US, and I've seen that I can hop right into an ICU position, without further training. That my dear, should frighten us all. I guarantee you don't want your family members cared for by a novice overconfident nurse. Don't get me wrong, I love working with students, I love teaching, I'm precepting a senior student nurse currently. So I'm more than fully aware of their capabilities.

I'm having a problem believing this one. No hospital in its right mind would allow a non-ICU-trained RN to take a true ICU-type pt load without training. ICUs are willing to take grads straight out of school and train them without prior acute care experience, but ICU training is required before being turned loose on the unsuspecting public. Not to mention all the certs that critical care nurses must acquire and keep current. New grads are never without a preceptor and new critical care nurses are rarely left alone without backup.

We may not have the stringent system that Canada has, Badger, but it doesn't mean our system is wrong or unsafe. I think Jamonit's response may have been defensive but you weren't exactly kind either.

Tweety, BSN, RN · Feb 18, 2007

First of all, as a moderator of this forum, we need to respect each other's opinions as valid, based an individuals perceptions, experience, or etc. No needs to be slapped upside the head. Let's discuss the issues without talking back and forth.

2nd....gorgeous pic of above of the pinning.

My opinion is based on what I see. Our ICU hires new grads, and there are plenty of old folks there to help them out. The take classese and get many weeks of orientation, (I think 16). I think they do just fine.

No nurse coming out of school is going to be ready for any department....period, critical care or med-surg. But with proper orientation they can gain the skills they need. Forcing a nurse with a desire to med-surg, or who even hates it, and then orienting them a year later to where they really want to be is a waste of talent, money and is demoralizing.

Yes, those of us with experience see new grads flounder in the ER and in ICU. Guess, what, I see them struggle and drown in med-surg too. It's just the new grad experience. With support and time they somehow make it through.

That's my two cents. :)

jamonit · Feb 18, 2007

thanks tweety, tazzy and logan! i don't think i need a good slap, i just need some great preceptors, didactic training, and lots of critical thinking. i am an orientee with strong passion to be an amazing novice and eventual expert in pediatric critical care. i want to continue to learn, know that i have a long way to go, and for all those that believe and help us newbies, i commend you and have nothing but respect and gratitude.

as to those with contrary opinions, to each his/her own. this is what nursing is today, they need smart, quick, passionate, gracious and eager new grads like me to fill our nursing deficit. there's a place for all of us in this profession, i just so happen to be proud that i've found mine in critical care and that someone believed i had what it takes to get there--right off the bat.

xo

one more pic of my pinning for posterity!