new grad needs opinions of ICU nurses

  1. Hi everyone,
    I graduate in May. I would really love to go into an ICU. The hospital I want to work for has an excellent mentorship program for new grads. It is a 1:1 pt ratio with a preceptor for four to six months.

    I currently work in bone marrow transplant as a CNA and venipuncture tech. I have been there for 5 years. I am "comfortable" there as far as skills and knowing rationale. I am probably on the above average side as far knowledge of assessment skills. I am fairly comfortable with pulling the data I need from labs and what is going on. I know there is soooooooooooooo much I have NO idea about, soooooooooooo much I need to know.
    I am not sure if I am comfortable knowing the amount I do to go directly into ICU when I graduate and I actually am probably at the top of my class.

    Does my hesitancy mean I really should wait?
    I am not sure that new grads going into ICU is a good thing. I want to do right by my patients and give them the best I can. Can I do that as a new grad?
    What has your experience been with new grads in ICU? How do you feel about new grads being there?

    Any input would be much appreciated... Thanks
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  2. 10 Comments

  3. by   VickyRN
    Just be careful of the culture of the ICU.... Most ICU's that I have encountered are NURSE EATING units and you have to be very thick-skinned to survive.... not very nurturing environments. I personally believe that every new grad needs at least one year in med-surg to hone assessment skills--makes for a great backdrop for whichever field of nursing you eventually choose. However, let me add this caveat to the above: be VERY choosy of med-surg units. Some of these units I would not recommend to ANYONE---awful, awful conditions. VERY SICK patients, horrible nurse patient-ratios. Choose a NICE step down unit for your first nursing experience. This is my recommendation. Be aware and be very choosy.
  4. by   whipping girl in 07
    I graduated last December and started in ICU this past January. I really like it and got an excellent orientation. If the orientation you are going to get is really as good as it sounds, I say "Go for it!"

    I was initially a little scared; it helped that two of my classmates started with me. I have taken several classes this year to increase my knowledge and most of the nurses I work with are extremely willing to teach if you are willing to learn. I also got a really good critical care handbook (available at www.kathywhite.com ) that has been a lifesaver as well. I look up everything I don't know and ask for help whenever I need it. I have formed relationships with the more experienced nurses and feel comfortable asking them what to do in a situation (like deciding which doctor to call with a problem; what to suggest to the doctor when I call at 3 AM and he's half asleep).

    I personally don't think a year in an area you don't want to work in will help you if what you really want is ICU. And I think my assessment skills are BETTER working in ICU, because I have time to actually ASSESS my patients. The times that I have either floated or picked up shifts on the floors, I have barely had time to make an assessment of my patients at the beginning of the shift; there were just too many patients and too many meds, not to mention too many call bells going off CONSTANTLY.
  5. by   ceecel.dee
    Know what you are doing. They expect no less then "good" assesment skills/critical thinking skills. Must be a rich ICU, with the ratio's you state. Know exactly what the doctors expect of the nurses.
  6. by   Pretzlgl
    Graduated in 1996 and went directly to the ICU. Great experience - did not get nearly the orientation that you will receive. If you want to be an ICU nurse then do it! Your hesitance is good, it shows that you know what you don't know. But are willing to learn.
  7. by   Tweety
    Be good to the med surg nurse. When they have a patient that isn't doing well, their first and only priority is to get them to you. Don't get all snooty with them.
  8. by   UVaRN2Be
    I know what you mean 3rd shift. My current unit is a like astepdown icu and when one of our patients go bad the nurses want them gone. I understand. It isn't good for the patient to be where a nurse is not familiar or comfortable doing what needs to be done. I have been on the receiving end of "snootyness" so I know how that feels.

    The ratio is for new grads. That must be the reason why we haven't gotten raises this year.

    Thank you all for your responses. My manager is really wanting me to stay here. That wouldn't be bad because I love it here. I just do not want to continue to do oncology/transplant.
  9. by   lee1
    As an experienced critical care nurse of more than 30 years I can tell you that the best PRE experience is on a telemtry floor which directly takes the type of post ICU patient you like.
    Many hospitals do offer precepting programs and many do not.
    In my 14 bed CCU unit for example we can only take 1 new grad every year. It takes at least 3-4 months to precept them, then they need at least 3-4 months before floating to any of the other ICU units to gain some solid experience always with more experienced ICU nurses surrounding you for support.
    IF your hospital cannot guarentee at least this, DO NOT DO IT.
    Yes, you will be eaten up by other ICU nurses especially when their own acuities get out of hand, they will expect you to be able to work on your own and carry your weight.
    Make sure your charge nurses does not have a pt assignment if they are large ICU (greater than 8 beds)
    Also make sure there is a CNS---clinical nurse specialist--- for support of the ICU staff.
    And last of all make sure that the Director and Head Nurse of the unit support their staff. Do they help relieve the staff for meals/breaks if their charge nurses have pts. Do they help relieve the staff to go to hospital committee meetings??? If you are already working even as a tech at the hospital you are interested in listen to what is going on before jumping in.
    Be aware that there are still many mismanagers still in nursing. They do not necessarily become managers for the love of the position but to get OUT of bedside staff nursing, have every weekend/holiday off, etc.
  10. by   Gardengal
    It sounds like you would probably do fine in ICU as a new grad, and the hospital sounds like it has support for a new nurse in ICU. We hire new grads into my ICU, but only in groups of 2 or 3. (I never like to have just one new grad because I think that new grads need to have a social support system and someone who can relate to their experiences with them)New grads are typically pretty quick to pick up tasks, as they are still in a learning mode. I always look for new grads who are Sure that ICU is what they want...and that their rationale is that they want to concentrate on the details and physiological intricacies of the patient. I also look for where they want to go in nursing.......If I hear that they are coming to ICU for 1-2 patients I immediately question if they are really ICU candidates.

    My biggest concern with going to ICU straight out of school is not that a new grad can't do it...It's more because of overall professional longevity. Although I have seen many new grads do fine straight out of school.....I have also seen many nurses who started in ICU stay in ICU and wonder what they can do. There are many ICU nurses who will admit that they feel stuck, or burned out. There are also many who are happy with their choice 20 years later. I've worked with both, just feel that I see more of the ones who really don't know where else to go.

    One thing that is interesting about ICU is that it makes us a bit isolated. I think that nurses who start on general floors or telemetry floors have a better global view of healthcare as a whole and thus can see more future job options later. On the floor you share your patients more with the other disciplines as opposed to controlling more of the coordination inthe ICU. You also get to see patients go home. Sometimes I think you need to clearly remember that piece as an ICU nurse, so you can remember what we're shooting for. On the floors you become accustomed to multiple interactions with others: PT, OT, dietary, going for tests and procedures, teaching your patients and families about tests and meds, interacting with diabetic educators, case managers, etc. You do this extensively inthe ICU as well, but to a different degree.

    I agree with lee1 that telemetry is an excellent starting point for ICU, I also think it is a good place for a motivated new grad. You can learn your basics thru repetition on many patients and start learning more advanced skills to prepare you for ICU.

    As an ICU nurse I always try to caution people to not look at ICU as the epitome of nursing. I have had just as great an impact on patient's lives on the floor or telemetry. We need all specialties in nursing.

    The real question with your first job as a nurse should be where do I want to go in nursing and will it get me there. Sometimes starting as a generalist on a floor allows you to see your potential career options later in life.
  11. by   BadBird
    If you know that you want to work ICU then go for it. I am a ICU nurse and I love students, you learn something from each other every day. Not all ICU nurses like students, some are just too old and nasty to do anything but retire and not soon enough !!! I think it is that way in every ICU, don't be discouraged by the sour pusses just follow your dream.
  12. by   JMP
    I would suggest AT least 8-12 months out on a floor- surgical or medical. May not be what you want to do, but you will gather your TIME MANAGEMENT skills as you go, ability to use CRITICAL JUDGEMENT and THINKING SKILLS.

    THese things are not taught....THEY ARE LEARNED by doing. Only a floor can BEGIN to teach them to you. I think you need to start with a mild case before you handle a CRITICAL-CRASHING case.

    My opinion.

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