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

RNsRWe, ASN, RN · Feb 18, 2007

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.

Since you quoted my post when posting this of your own, I guess I should respond. I made no comment about the "slapping someone upside the head" remark, or whether I found it appropriate. I DID comment about the rude posts made prior to that one. The posts that I found juvenile and unprofessional ("whatevs." is a comeback?).

I wanted Rabid Badger to know, publicly (rather than a "report post" button) that I found the rude posts to be out of line. The attacks on Canadian citizenship in comparison to American citizenship was completely uncalled for. I didn't see the need to hit "report bad post" for either those remarks OR Rabid Badger's.

I also chose not to comment on whether or not I agreed with RB. Actually, I think at this time I will: I don't agree. I do believe that recent grads can be very effective in ICU, if given an appropriate orientation. I don't believe 14 weeks is sufficient, but I have seen some really good nurses come out of 6 month orientations for ICU and do admirably. However, the quality of the orientee chosen for the unit has everything to do with their success. Pick the wrong grad nurse and yes, you're going to have the wrong future ICU nurse. Pick an appropriate choice, and there should be no problem.

To the Original Poster, I'm sorry you've had such a string of nonsense on your thread. Now that you've gotten some GOOD information related to YOU, maybe you can now make the choices you need. And now I can leave this thread as well, since its purpose is apparently done.

nurse4theplanet, RN · Feb 18, 2007

I took an intern position at two different hospitals in two different areas. One was ICU and the other Med-Surg. I gained more knowledge from my ICU internship in one day than my entire med-surg internship.

After school ended, I was certain which area I wanted to go to and I am now in the Critical Care Orientation Program. It is minimum of 24 weeks with a preceptor. All our preceptors have attended special training to prepare them for training new grads. My preceptor happens to be a former nursing instructor. She's really great. We alternate our time initially between working on the floor with our preceptor, attending classes on various topics related to care of the critically ill pt, completing an online orientation module that covers each body system, case study days, and feild trips to various other departments throughout the hospital. I have been working 40 hours a week and studying harder than in nursing school on my days off. It is very intense. As the orientation progresses, we check off on competencies and have a weekly evaluation. We then begin spending more time on the floor and taking on more responsibility until we work our way up to a full pt load. For the next six months after orientation, we still are accountable to our preceptors to complete all unit competency requirements, training/classes, and evaluations.

The new grads that finished the orientation program before me have done quite well. I feel that working as an intern for over a year has given me invaluable experience that makes the transition to nurse somewhat easier on my unit in comparison to the other new grads in my orientation group.

I have had a really positive experience. Ultimately, the choice is yours. I think it is best to choose the area where you are most interested, because you are more apt to go above and beyond to learn the things you need to know.

Things my MS internship taught me:

How to get a pt ice

How to transfer a pt from the bed to chair

How to ambulate a pt

How to change linens/give a bed bath

How to take vitals

(actually nursing school taught me these things but my MS internship turned me into a professional:rotfl: )

Things my ICU internship taught me:

How to take/give a good report

What to have ready before you call the physician

A thorough physical assessment

How to care for a central line

Interpretation of EKG waves and what to do when your pt has a rhythm change

How to do trach care, suctioning trached and vented pt's

Plenty of opportunities for IV starts/restarts

Plenty of opp. to insert catheter

Hemodynamic monitoring

What to do if your pt codes

Monitoring a pt during CRRT

Recovering a post-op CABG

What to do if your pt is declared brain dead and is an organ donor

postmortem care

comforting pt's families after death of loved one

I could go on and on but I am tired and my brain is not working well

(Whether I was performing the task, following behing the RN and comparing my findings with his/hers, or observing the RN...I learned SO much that I can apply to my current practice)

You may find you get more experience in the ICU as an extern. However, functioning as a tech is not the same as functioning as a nurse and if you do not feel comfortable in your abilities then perhaps you should start at a lower level of care once you graduate. I feel I am capable of functioning safely in the Critical Care Environment. Good Luck to you.

Tweety, BSN, RN · Feb 18, 2007

asoldierswife, it sounds like you were oriented on MS to be a CNA. That's very disappointing.

The MS unit I work on we do basically what you described in ICU, except maybe the brain dead, post-CABG (but we obviously get post-ops) and a few others. But we do assessments, hemodynamic monitoring, interpreting EKG's and trachs, central lines, and other tasks. Too bad. But nonetheless that's off topic. Obviously the two areas are not the same, but being a med surg nurse is definately more than being a CNA doing "tasks" such as fetching ice.

Good luck to you.

Rabid Badger, BSN, RN · Feb 18, 2007

Things my MS internship taught me:
How to get a pt ice
How to transfer a pt from the bed to chair
How to ambulate a pt
How to change linens/give a bed bath
How to take vitals
(actually nursing school taught me these things but my MS internship turned me into a professional:rotfl: )
Things my ICU internship taught me:
How to take/give a good report
What to have ready before you call the physician
A thorough physical assessment
How to care for a central line
Interpretation of EKG waves and what to do when your pt has a rhythm change
How to do trach care, suctioning trached and vented pt's
Plenty of opportunities for IV starts/restarts
Plenty of opp. to insert catheter
Hemodynamic monitoring
What to do if your pt codes
Monitoring a pt during CRRT
Recovering a post-op CABG
What to do if your pt is declared brain dead and is an organ donor
postmortem care
comforting pt's families after death of loved one
I could go on and on but I am tired and my brain is not working well
(Whether I was performing the task, following behing the RN and comparing my findings with his/hers, or observing the RN...I learned SO much that I can apply to my current practice)

Well this is unfortunate.

Actually everything you listed for what you learned in ICU we do on my Medical ward! Except we don't do CRRT, but we recover HD.

What else I do:

Manage codes, on a virtually daily basis.

Run 4+ IV continuous infusions on a single patient.

Have a patient code, work on them for 2 hours, send them up to ICU only to discover your second (of 6) turns up a pressure of 70/30, spend the next 7 hours bolusing, giving 11ty billion cc's of albumin to, vitaling q5mins, hoping you don't lose a second in 1 shift.

Manage central lines on all 6 of your patients.

NGs/trachs/ostomies/chest tubes/vac drsgs/tpn/etc etc.

Give every imaginable blood product.

Airborne isolation.

Assist in an on-ward endoscope

QID drsg changes on a coccyx wound the size of a dinner plate, wherein intestine and spine are exposed.

What to do when your patient collapses and bleeds out 3 litres in 2 minutes.

What to do when your doc doesn't want to take the above bleed seriously.

What to do when your patient goes into flash pulmonary edema.

What to do when your patient starts hitting your staff and threatening your life.

Take in 2 unstable admissions in at the same time while you are transfusing another and doing above mentioned drsg changes and trach mgmt on your others.

Learn how to not kill yourself after the first 3 months.

Manage non-intubated ICU patients where there is no bed for them in ICU.

Recieve transfers from ICU, have your patient code 20 minutes later, then ship them back upstairs. Thanks for stopping by!

This is only the tip of the iceberg.

I'm sorry your med/surg experience was a whole lot of CNA work. But that's certainly a far cry from what I do on a daily basis. Medicine on this ward is a constant case of :uhoh3: :uhoh3: :uhoh3:

wonderbee, BSN, RN · Feb 18, 2007

Oh how I wish I had a better general experience (one I got in med-surg) before making the leap from nursing school directly into critical care. I watched others go through much the same experience. There were lots of tears and awful days. Some make it and some don't. Getting off to a bad start can really sour one on a career choice. I think lots of nurses get into water far deeper than they can tread right off the bat and wind up becoming real estate agents before the end of their first year or two. In the grand scheme of things, what's one year out of a lifetime to devote to the basics for a good foundation.

BTW, I have a lot of respect for med-surg nurses who stay in that genre. We need good generalists out there to keep patients out of the ICU.

mced · Feb 18, 2007

Rabid Badger,

What you are stating as your job description is what many nurses that work in modern day Medical/Surgical, Telemetry, and ICU stepdown units deal with continuously in the United States. It is a hard job, but people with adequate orientations and preceptorships negotiate these tasks and other complications each day they come to work!

WolfpackRed · Feb 18, 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

Thanks for finding these.

Freedom42 · Feb 18, 2007

I'm an intensive care nurse, and I have to say that its an entirely different mindset in there. The more experience you have on a med surge floor or in the ER would help greatly before advancing up to the ICU.
My advice would be too get as much experience as possible before jumping into something such as the ICU. The ICU takes a certain personality and certain level of skills. The more experience the better you'll do when you get there!

Interesting thread. I've had the same discussion with my adviser about whether starting out in med/surg is necessary. She's adamant that it is.

Antidote, what personality do you think the ICU requires? And how many years of experience do you think a nurse needs to have before working at that level? This interests me because I spotted a want ad today for a "new grad" in critical care, and I wondered what nurses would think of that.

nurse4theplanet, RN · Feb 18, 2007

asoldierswife, it sounds like you were oriented on MS to be a CNA. That's very disappointing.
The MS unit I work on we do basically what you described in ICU, except maybe the brain dead, post-CABG (but we obviously get post-ops) and a few others. But we do assessments, hemodynamic monitoring, interpreting EKG's and trachs, central lines, and other tasks. Too bad. But nonetheless that's off topic. Obviously the two areas are not the same, but being a med surg nurse is definately more than being a CNA doing "tasks" such as fetching ice.
Good luck to you.

Yes. That was my point. While I could have gotten many of those experiences on a MS floor, I was not able to for many different reasons (short staffing, high pt loads, nurses who didn't have enough time to teach me, etc.). I was put into a CNA position basically, and while I loved taking care of the pts I just didn't get alot of helpful experience in my nursing skills and critical thinking. Every unit is different and there will be others that did an internship in MS that have much better experiences then I had...and of course, when you have your license and go through the nurse orientation then you will gain these experiences then. I feel like choosing an ICU internship gave me a head start.

nurse4theplanet, RN · Feb 18, 2007

Well this is unfortunate.
Actually everything you listed for what you learned in ICU we do on my Medical ward! Except we don't do CRRT, but we recover HD.
What else I do:
Manage codes, on a virtually daily basis.
Run 4+ IV continuous infusions on a single patient.
Have a patient code, work on them for 2 hours, send them up to ICU only to discover your second (of 6) turns up a pressure of 70/30, spend the next 7 hours bolusing, giving 11ty billion cc's of albumin to, vitaling q5mins, hoping you don't lose a second in 1 shift.
Manage central lines on all 6 of your patients.
NGs/trachs/ostomies/chest tubes/vac drsgs/tpn/etc etc.
Give every imaginable blood product.
Airborne isolation.
Assist in an on-ward endoscope
QID drsg changes on a coccyx wound the size of a dinner plate, wherein intestine and spine are exposed.
What to do when your patient collapses and bleeds out 3 litres in 2 minutes.
What to do when your doc doesn't want to take the above bleed seriously.
What to do when your patient goes into flash pulmonary edema.
What to do when your patient starts hitting your staff and threatening your life.
Take in 2 unstable admissions in at the same time while you are transfusing another and doing above mentioned drsg changes and trach mgmt on your others.
Learn how to not kill yourself after the first 3 months.
Manage non-intubated ICU patients where there is no bed for them in ICU.
Recieve transfers from ICU, have your patient code 20 minutes later, then ship them back upstairs. Thanks for stopping by!
This is only the tip of the iceberg.
I'm sorry your med/surg experience was a whole lot of CNA work. But that's certainly a far cry from what I do on a daily basis. Medicine on this ward is a constant case of :uhoh3:

Yes, we do most of the same things you do on your unit. However, our pt load is not as high (2-3 at the most) and we don't experience that many codes a day. Sometimes we go several days without a code. That's an accomplishment, IMO. Our nurses work very hard to prevent that from happening.

Your unit sounds very intense and I am sure you are a great nurse. I can say that without a shadow of a doubt, I would be intimidated on your unit. Ours is not quite as intense. I think the smartest thing you can do as a new grad is to admit your limitations.

Thank you for sharing.

Tweety, BSN, RN · Feb 18, 2007

Yes, we do most of the same things you do on your unit. However, our pt load is not as high (2-3 at the most) and we don't experience that many codes a day. Sometimes we go several days without a code. That's an accomplishment, IMO. Our nurses work very hard to prevent that from happening.
Your unit sounds very intense and I am sure you are a great nurse. I can say that without a shadow of a doubt, I would be intimidated on your unit. Ours is not quite as intense. I think the smartest thing you can do as a new grad is to admit your limitations.
Thank you for sharing.

I haven't had a patient code in years, and I mean years. Med-surg sometimes does because like a mini-icu with borderline unstable patients. It can get scarey sometimes.

Tweety, BSN, RN · Feb 18, 2007

Yes. That was my point. While I could have gotten many of those experiences on a MS floor, I was not able to for many different reasons (short staffing, high pt loads, nurses who didn't have enough time to teach me, etc.). I was put into a CNA position basically, and while I loved taking care of the pts I just didn't get alot of helpful experience in my nursing skills and critical thinking. Every unit is different and there will be others that did an internship in MS that have much better experiences then I had...and of course, when you have your license and go through the nurse orientation then you will gain these experiences then. I feel like choosing an ICU internship gave me a head start.

I understand, your MS didn't pave the way for ICU experience. ICU nurses are very quick to point out that ICU is so much more complex and skilled than ICU, but yet are quick to make us work a year in med-surg to prepare ourselves. Seems a bit contradictory.