Insight & advice on Critical care(ICU) VS. general Med-Surg floor? - page 6

New here and just seeking some advice... I'm a third-year nursing student who's in the process of getting an externship at a hospital. Currently I have a choice between either University of... Read More

  1. by   jamonit
    Quote from Nursingstudentgirl77
    And, for Jamonit: CONGRATULATIONS!!!!!!!!!!!!!! You are a beautiful girl! (i know graduation gives the best of glows!) And i would have died if they made us wear hats for the ceremony...lol! Now, go rock the NCLEX! (i just took mine a few weeks ago!)[/IMG]
    you are too sweet! you look so cute in your white nursing dress! you are so lucky that you didn't have to wear the darn hat. totally a style cramper, hahaha. i take the nclex march 6th, i can't wait to just get it over with. i

    i think people took what i was saying the wrong way. i may have come off cocky, but i'm truly just thrilled and grateful to be in the PICU straight out of school. i got all a's, i worked hard, i interviewed well and they have faith in me. they aren't going to just set me loose, there are a lot of resources at my finger tips, and specified resource nurse as well. i will graduate as a level 2 (i'll be able to work with pts on vents at that time), after more training (usually 6 mos to a year, i will be a level 3, at which point i will be able to take part in the housewide codes, if they deem my skill level appropriate. level 3 and level 4 require that i complete all that is necessary to be a CCRN, including more didactic classes and skill advancement. level 4 and 5 are a few years down the road, this is when i will get to specialize in pediatric neuromedsurg icu or pediatric cardiovascular icu. my orientation (the 1st 14 weeks are not the only training i will have). so, as you can tell, my hospital takes the time to train, is big on education and has set up a specific ladder for advancement, requiring much more than i explained previously. i work at one of the largest PICUs in the country in an all pediatric specialty hospital. the picu is 40 beds and we were chosen from hundreds of new grads. the new grad program has been in place for 7 years, and it has served the hospital well thus far, as they have top notch and awarded intensivist, hemeonc specialists, and other peds specific departments. their nurses love what they do, and are proud to be a part of this hospital.


    thanks for finding those links, mced. and most of all, OP, i think by going into the ICU, you are making a wise decision. thanks everyone for your support.
  2. by   JourneyCC
    New grad opinion here.

    I too couldn't decide, but went straight to the ICU in a HUGE wellknown Hospital. I love it! I worked in the ER my last year of school and loved that, but felt like I was missing out (like a pp's reasons stated0. Now that I work in ICU, I see the disadvantage I was at in the ER. However, I still think I would have made an excellent RN in the ER despite my short coming in experience. I too am headed towards CRNA, and knew ICU was my pathway. Now that I am here, I just might stay LOL I love it. I occasionally float down to the ER and love that ability. But I think I love it so much b/c of the hospital I chose. It's a huge metropolitan, level 1 trauma hospital (by the way I work neuro/trauma ICU).....and I love the rush of the helicopters coming and landing on our helipad (ER has one too but more critical patients, not breathing on their own, usually come here ).....even though it's ICU, I feel more like a ER person that has the ability to see the outcome and manage that patients care. Just a thought. The downside is, ICU is not for everyone, or every personality.....it's tough and if you don't cut it, they let you know loud/clear. Our hospital has 5 adult and 5 PEDs icu's, like I said it's huge. If I were at a "normal" hospital, I would feel way less stressed. I learn sooooo much and I thrive on it.

    In a nutshell, I think the hospital you choose is more of a decision maker/breaker than what area you choose. Choose a hospital that has a great RN retention ratio and that has a great "teaching" reputation too. It opens doors and I think you'll ultimately love any decision/specialty you decide on if you love going to work everyday.

    Good luck!
  3. by   JourneyCC
    Oh and yes.........DEFINITELY choose a new grad program that is well known for it's reputation as being a great residency! It makes all the difference in the world! Truly, my residency is fantastic. My friends that graduated with me, many were "turned loose" on their own after 2 wks of "orientation". They come home in tears or pissed. They didn't choose hospitals/residency carefully, and they kick themselves daily over it. Just another thought LOL
  4. by   sprout
    If you can get an internship in an ICU you'll be able to see what it's really like. I work in ICU and love it. But, it's not for everyone. I worked at my hospital while going to nursing school and did my internship in ICU. I was fascinated by the pathophysiology of critical care patients and the specialized care. I knew I wanted to be in ICU but I really had to prove myself as a new grad, I also had to hit the floor running and think on my toes. I have been there for 2 years and it can be a very high stress environment.

    Sometimes I think doing some med/surg time would have helped my organizational skills and adjustment to nursing. I think working at the hospital while in nursing school helped a lot because that was one less hurdle to jump - I knew the staff, the doctors, the computer system etc. So transitioning to nursing wasn't hard. However, I see that new grads on on Med/Surg units have a great preceptorship and do very well. Med/Surg nursing has it's own sub specialities and acuity levels as well. Nursing isn't only ICU, OR and ER - there are so many areas. Research, ask questions, determine why the Med/surg nurse is not an ICU nurse and vice versa. The answers you get may surprise you.
  5. by   DNurse08
    Excuse me RUcon08, for spinning off of your original question, but it seems as though you made your decision. :spin:

    First post here: I have been recently thinking about applying for an ICU externship as well. I'm in my first year of nursing school, and the MS setting wasn't very appealing to me. BUT I feel that I lack confidence in my skills (anything from organization to IV pumps). Therefore, I am willing to experience one year with MS before going into the ICU if that is where I decide to go.

    So, my question is: Would it be smart to do an ICU externship, and then work on MS for a year before going into the ICU?

    There is also a geriatric externship I'm applying for where I'd be witnessing different aspects of gerontology (witnessing, not practicing). I've been told that there are many elderly persons in the ICU, and that the externship will help me somewhat understand geriatric care. I love the elderly, but am not sure if I would like to specialize in it. Still, the geriatric center would love for me to come and extern with them.

    I'm feeling like I need to have opportunities to practice skills, and am not sure about what path I should take. Personally, I'm a kinetic learner and need practice to make perfect. I think if i went straight to ICU, i'd fall to pieces since clinicals do not give me much room for experience. Also, I feel that if I have an ICU externship under my belt, than I'd have a better chance of getting hired.

    I love nursing, but my clinicals in the MS setting weren't as thrilling as I thought it would be. I've been on different floors and haven't found a setting that I have really liked. I have just recently been thinking about the ICU for several reasons: As much as I love patients, I don't enjoy conversing with them...I just love do skills, and see results from my interventions! My favorite time with pt's on MS was when they were asleep, because it allowed me to really concentrate on what I was doing. I also work best under stress and when I'm confident. As a CNA I always loved to be on the go and hated to sit down for breaks.

    I have yet to do actual research and still feel pretty ignorant about what ICU is really like, but that is just some of why I've been considering it. I just would like some input about what I should do as a nursing student. Should I go for the ICU, MS, or geriatric externship? Thanks!!

    -Dnurse08
  6. by   RUcon08
    Hi DNurse08,

    Your situation sounds pretty much EXACTLY like mine, (except for the geriatric part, of which I have no particular interest in :angel2:.)

    Anyhow, from the sounds of things, I think an ICU externship really would be beneficial for you. I can definitely understand the part about being most interested in hands-on actions with clear results, as opposed to a very intimate relationship with a patient. (It's funny because just the other day I was talking about how I personally don't have a ton of interest in garnering social relationships with patients-- I mean it's not to say I'm cold/careless and don't want to talk at all, it's that it just won't really be my priority.) And from what I've learned, ICU and OR are pretty conducive to this preference, especially OR.

    Anyways just a minor update, I had my interview yesterday for a unit that's sort of considered critical care (it's in the slow process of becoming a TICU). The unit seemed really awesome! The patient population consists of mostly thoracic surgery post-op, congestive heart failure, and pulmonary hypertension patients. And best of all I got hired on the spot, which I was very surprised about. I think the unit will be a great experience, not to mention one of my interviewers, the nurse manager, informed me that the experience could be counted as the critical care requirement for those who need it (as a pre-req for nurse anesthetist programs).

    Also think it's worth mentioning that you should DEFINITELY not be worried about your skill level, or lack thereof. They (and other hospitals) have really given me the impression that they're VERY aware that you as an extern are very new to clinicals and the hospital in general, so learning and practicing is paced accordingly. (They know most of us are only third-year students who've only had 2-4 clinical rotations!) For example, I asked the manager if there was any limit to the things we could do as an extern, and she replied by saying that it's basically up to the discretion of the preceptor you'll be working under during the 8-10 weeks. If they feel comfortable in your abilities to start an IV, or whatever other skill, then they'll let you! Of course this might vary between institutions, but I was VERY happy to hear that I wouldn't be limited in the things I could do/learn/practice since I'm used to certain limits in clinicals as a student.

    So in short, if ICU/critical care seems really appealing to you and you have the opportunity to take it with an externship, go for it! Don't be worried about not knowing enough or being good enough, because the externship is about learning. It's not supposed to just be a job. Most hospitals want you as an extern so they can acclimate you to their institution, because ideally they want you to come back as a new grad nurse. (Hell, the manager there made it quite clear several times that I should definitely be sure about the unit because she's very big on retainment of externs. And she almost made it seem like if I had any doubts about not coming back to work as a new grad, then maybe it wouldn't be a good idea.) Hope this helps!

    EDIT-- Also my decision to pursue critical care was because from what I know, and from what people discussed in this topic, I just felt more free to choose what I wanted for the sake of the externship. I DO plan on starting in med-surg as a new grad, but for my externship I'll at least get to do something I wouldn't normally be able to do at all without getting hired as an ICU nurse, etc.
    Last edit by RUcon08 on Feb 28, '07
  7. by   nurse4theplanet
    Quote from DNurse08
    So, my question is: Would it be smart to do an ICU externship, and then work on MS for a year before going into the ICU?
    The best answer to this question is to pick an externship site that is the MOST conducive to learning and gives you ample opportunities to practice your skills.

    For me, that meant choosing the ICU internship over the Med-Surg internship. However, all hospitals are different and all units are different...so it is possible that you find the very opposite to be true for you and your location.

    Check into what's available in your area. Ask how you will function in your role, what your assigned duties will be, who will be training you, etc.

    For example: in my ICU position, I was assigned to a nurse each time I worked. I assisted him/her with various patient care tasks, much like an aide on the floor, but there was ample time for teaching opportunities and supervised practice of skills learned in nursing school. I got to check my assessments against the nurse's assessments and follow every step of nursing care the patient received. It was similar to functioning in a student/orientee role.

    in my MS position, I was given no training and thrown into a CNA role. Keep in mind, I had never worked as a CNA before and found it quite frustrating to be put in that role with no training. Training to be a nurse and being given a full CNA load was quite different. I was not assigned to anyone, I recieved my own 12-14pt assignment. I took vitals, gave bed baths, and assisted with turning, feeding, ambulation, and fetching supplies/getting ice, collecting I&O's...sounds easy right? Might be if I had recieved any training about where to chart, where supplies were, a tour of the hospital (for transporting/discharging), etc. I was 'baptized by fire' and the nurses were unsympathetic...afterall...I was in nursing school right. I catch on quick so I was rolling with the best of them by the third day, but it was hell. I was soooooooo tired and worn thin when I got off, I felt like I learned nothing, I was never able to practice any skills, and I never got to witness any nursing care besides passing the nurse in the hallway as she went from room to room or saying, "pt in room number such and such has an elevated temp/bp/whatever..."

    It was not hard to make my decision. But I did give each area a fair chance. I suggest you find out what you are getting into BEFOREHAND, unlike me...and ask other students about their experiences if they are working on different units. Best of Luck whichever you choose.
  8. by   nurse4theplanet
    Quote from RUcon08
    I can definitely understand the part about being most interested in hands-on actions with clear results, as opposed to a very intimate relationship with a patient. (It's funny because just the other day I was talking about how I personally don't have a ton of interest in garnering social relationships with patients-- I mean it's not to say I'm cold/careless and don't want to talk at all, it's that it just won't really be my priority.) And from what I've learned, ICU and OR are pretty conducive to this preference, especially OR.
    What would make you think that you will not form many social relationsips with your ICU patients? Even if you can't form a relationship with the patient, you have the family to connect with. These patients are critically ill and having a therapeutic relationship with their caregivers is very much a priority. Just because we focus intently on maintaing homeostasis and hemodynamic monitoring does not mean we are lax on the psychosocial areas of nursing in ICU. Anxiety, grief, fear, denial....are all very common responses to illness that our ICU pt's experience or that the family may be experiencing.

    Alot of ICU patients have impaired communication r/t stroke, trauma, intubation, sedation, etc...this does not mean that their need for comfort and socialization is gone. Being alert and not being able to communicate verbally can be very frightening and the nurse must provide reassurance that their needs will be met, psychological support, and other ways to communicate nonverbally.

    Death is common in the ICU, and the nurse must be emotionally prepared to deal with a grieving family. This takes very good psychosocial skills and use of therapeutic communication.

    Some ICU pt's can remain on the unit for several weeks and you are with them constantly throughout your shift...you get to know them and their family members very intimately. They tell you their fears and look to you for hope and comfort. Please do not believe that forming social relationships is not a priority in critical care.
  9. by   burn out
    It sounds like you already have your mind made up. I wish I could say I agree. I started my first year of nursing on a med-surg unit until I could figure out where I wanted to go and believe me I have never regretted it. The skills that you learn that first year on med-surg are immeasurable and helped build my ICU skills on. Not just clinical stuff but how to manage care for 18 patients and meet all their needs , time management skill, delegation and trust of team members no where else but med-surg. Who said med-surg isn't a speacialty I have much respect for those nurses, I don't think I could do their job day after day.
  10. by   RUcon08
    To asoldierswife, I wasn't trying to downplay the possibility of the psychosocial aspect in ICU, or say that it isnt present. But I just know that from what I've seen so far (which probably isn't very much at all), regular floor nursing like med-surg just hasn't caught my interest. And it just seems like the socialization is a bit different between that and critically ill patients.
  11. by   DNurse08
    Thank you for all your advice. I'm going to try to get the ICU externship. I spoke with one of my friends who did it at the hospital that she externed at and she said that she for the most part acted as the nurse under a precepter and that she gained more confidence in her skills from it. I've worked as a CNA so I hope that the MS externship is not like that as well. I will have to look into that.

    Where is the quote button??
    From asoldierswife
    "What would make you think that you will not form many social relationsips with your ICU patients? Even if you can't form a relationship with the patient, you have the family to connect with."

    So obviously ICU nurses don't entirely connect with patients and do connect with the family. Personally, I am better at empathasizing than cheering someone on with a happy face. I'm like talking to families and explaining to them what the patient is going through. Death, I haven't witnessed enough death to really know how it will affect me.

    In my MS clinicals, I felt like I had to put on a happy show for my patients and it was very uncomfortable for me because I didn't want to come off as uncaring because I'm a very caring person. The more I read this thread the more I feel like I want to be an ICU nurse.
  12. by   MaryAnn_RN
    Quote from DNurse08

    So obviously ICU nurses don't entirely connect with patients and do connect with the family. Personally, I am better at empathasizing than cheering someone on with a happy face. I'm like talking to families and explaining to them what the patient is going through. Death, I haven't witnessed enough death to really know how it will affect me.

    In my MS clinicals, I felt like I had to put on a happy show for my patients and it was very uncomfortable for me because I didn't want to come off as uncaring because I'm a very caring person. The more I read this thread the more I feel like I want to be an ICU nurse.
    Try working a 7 till 7 shift with the same patient and their family. When you have been there for the pt all day, meeting and anticipating their every need - believe me - you will connect. Being able to build a therapeutic relationship with the patient and their family/significant others is one of the most rewarding aspects of working in ICU.

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