New nurses in ICU - page 3

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Will be graduating as an RN in May and want to know what experienced nurses think about starting right out in critical care as opposed to the traditional one year on a med-surg floor? I've worked on a med surg floor as an intern... Read More


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    Originally posted by hollykate:
    These Med Surg experts are certainly pros.

    and its now a specialty in its own right. There is a specialty certification exam for med-surg thru the AACN.
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    hi! i just wanna say that having a really good preceptor makes a big difference. i graduated last dec. and started working in MICU in january. can't tell u how much i love it! im really learning so much and i'm improving my assessment skills. i also took my board exam last tuesday and just found out today that i passed the nclex.
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    Every unit has its pros and cons. As a nurse with the 3.5 years since graduation in the trenches of MS (and a non-dedicated ortho unit), I think I may be ready for a change. I will, however, be forever thankful for these years of MS. I've cared for 12 patients on a team with an LPN and CNA, I've done primary on as many as 8 (on day shift) and left them smiling and thanking me. I've cried with widows/widowers, held hands with a dying COPDer as the morphine drip I'd just hung began to take effect and he asked me if I believe in God. I've searched for the urethral meatus on an 80-year-old virgin (can you say atrophy?), I've been puked on, pooped on, hit on, had my boob about twisted off by a weak little 90+-year-old who squirmed out of her posey, hung bucks on fx hips, stood up to irate docs, admin, and families, saved more than one person's life though my assessment skills and notifying the docs, dealt with diagnoses from CA with chemo drips to obstipation. I've made some great friends and lost some great patients. I've gone home dead on my feet and dreading returning the next day. In the end, I always go back because I make a difference and I am damned good at my job. I feel as if I could choose any area of specialty and be successful if I put as much into my specialty as I've invested in MS. In the last two months I've been offered 8 jobs(yeah, ok, so there is a major nursing shortage ;-)) and, with my MS history, I can pick and choose. Is a solid base in MS a good idea? You betcha! Don't look at it as doing time: its an investment in your future from which you will reap benefits for a lifetime.
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    My first job in the medical field was a two and a half year stint in a nursing home. I figured that if I could make it there I could make it as a nurse. Well, the job was hard but I really enjoyed it. The clients weren't really sick. Just old, feeble and pretty confused. We really had a good time there. Their senility was so off the wall you just had to laugh. From there I went to my first hospital job. Two years in the Nuclear Medicine Dept. Drawing blood and running tests in the RIA lab. That also was a good experience for me. I really enjoyed it. I tried to make the PT's a little more comfortable about the hurt I had to inflict on them. A little humor goes a long way. In the meantime I was not sure of where I wanted to go in the medical field. But I knew I liked it. My next job was in Cardiology. Performing EKG's and applying Holter monitors. Later to become a scanner. Still loved the medical field. Next came a job in the telemetry unit as a Critical Care Technician. Gosh, things got hairy but I survived. Then as our hospital was going through a merger with another hospital, we closed the building and move down the street to another hospital. I was asked to come work in the Critical Care Center. It was bigger and much more intense then I expected. We had four units consisting of 31 beds and only 2 techs on the day shift. We were dying. Tech work is much more harder than I thought. Everybody wants a piece of you at any given moment. Still did not go to nursing school. I had 2 children a home and husband. After 10 years I had seen more nurses and Dr's come and go. Some good and some scary. I couldn't believe what some of the nursing programs were turning out. These graduate nurses coming into my ICU were as dumb as a box of rocks. Me with no training was showing them the ropes. Some were useless in emergency situations. I did a lot of closed curtain procedures. My nurses trusted me and let me do a lot of things for them. I still loved the medical field. As the years went by my knee was becoming quite bothersome. Years before I had surgery to remove some cartilidge from it. And it was taking it's toll on my health. My bones were rubbing against one another and I needed a total knee replacement. It's been a year since my surgery and the hospital has dropped me like a hot potato. I have been terminated.They had no job for me because I had restrictions. Limited standing, walking, lifting etc. When I looked into my pension I was floored to find out that they do not furnish health insurance when you retire. What a blow. You spend all those years saving lives and end up with no health insurance in your golden years. What's wrong with this picture? So now after 20 years I am fighting with SSI disability. And probably will not get it. The nursing field needs to take better care of it's workforce. The money is just a ploy to get you in. What good is it if you cannot function. They will just get someone younger and cheaper to replace you. Long hours, weekends, holidays and liabilities are what you get for your dollars. The new nurses just are not aware of the downfalls of nursing. They see dollar signs and are upset that they have to do real hard work. They think the dirty work belongs to the Techs. Well, we are burned out. There are so many nurses that are "Tech" dependent that the techs are ready to scream. I think nurses should do some med-surg before coming to my ICU. Our mortality rate is high enough. As for me, I am out of the medical field and glad that I never became a RN.
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    Wow! What an interesting saga! I could swear I'd heard this story before...are you sure you weren't a neighbor of mine once???? No lie! HA! So glad you took time to share your story. I am sure you were an excellent tech and have a heart of gold. Your patients were very fortunate, and so were the nurses you helped out every day. I agree that it would be difficult--to say the least--to work with "green" nurses who were supposed to be operating at optimum level--but did not have the experience yet--or the skill--and most likely, the support. In my opinion, critical care is typically not meant for a nurse right out of "traditional" nursing school. Special training and mentoring for at least a full year would be the minimum requirement I would think. Unfortunately, you were witnessing the very thing that can destroy nurses and techs alike. First of all, why was there such a turnover rate? I wonder if the hospital provided the proper orientation/mentoring/educational support to the new staff? Perhaps they were not attracting the best and brightest nurses, just some very naive ones, who bought into their promises of gaining an exciting critical care position. In my personal experience, administration will do ANYTHING to meet the bottom line as long as it can look good on paper. Usually, saving money looks good on paper. Unfortunately, it may mean skimping on needed staffing and support to run an effective, efficient unit. As it plays out, the workplace becomes toxic, it ruins morale and good people leave. Sometimes for good. You mentioned the fact that nursing doesn't take care of their own regarding retirement and health insurance--especially when you wear yourself out doing the work of caring for others throughout your career. Good observation that a better job needs to be done about this. If you've read any of my other posts you would see that this is a BIG issue on my mind too. All the best to you in your new life. As for me, I'm not quite ready to bail out on nursing yet. I still have a little "fight" left in me! L.Smo RNC

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    L.Smo RN
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    I went to ICU straight out of school but I had 8 years of critical care Respiratory Therapy experience! I knew all about ventilators and ABGs and A-lines and PA's --I even took a critical care course elective. It was STILL tough to be a new RN in ICU. ICU nurses are expected to be "experts" even if you are a "novice RN"; ICU nurses tend to be really tough on ANY new nurse in their ICU--experienced or not. It depends on you and what you can handle. Not every nurse can "hang" in there and learn the technical while learning nursing. If you have NO medical experience, personally I recommend a step-down unit to get your feet wet with drips and EKG interpretation, ACLS algorithms and equipment, then transfer to ICU. A new nurse to ICU has to be a Gladiator to survive unless you work at an institution that ACTUALLY supports education and has real, trained, "preceptors" that will be with you until you are out of "orientation." Good luck!
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    I have to agree that jumping right into a critical care unit after graduating is not for everyone. I started in the Emergency Department right out of school much to many veteran RN's astonishment. I must be the exception to the rule because I have had nothing but great reviews from my Director. I have seen new grad's attempt the same career start, and not all are successful. I have also seen veteran ICU and Med-Surg RN's try the switch into the ED without success. I believe that we all have our own calling, and that our uniqueness, and special skills allow us to reach the levels that we are comfortable with in our nursing career. If you are up to the challenge, JUST DO IT!
    One year out of school, I am now working Registry and traveling all over the city working for different Hospital ED's at the drop of a hat! Try this on for size: New Hospital ED, no orientation, here are your room assignments, here is where the Physician orders are, here is your Drug Code, have a nice shift! I thrive in this type of environment, but again, it's not for everyone. What a great profession!!

    Originally posted by natalie:
    I think this is the wave of the future although I agree with jt. Stargazer, you're presuming alot when you believe janine will have a strong preceptor and theory classes, along with a 3 month orientation.

    janine-you have to ask yourself..

    -Are you ready to refuse an assignment outside of your "orientation" role, because your hospital will most likely use you as a "regular" on a short-staffed day?
    -Are you ready to insist on the availabilility of a preceptor?
    -Are you ready to refuse a patient assignment outside your scope?
    -Are you ready to insist on your FULL orientation?

    It's hard enough to begin your first nursing job, but the "tabula rasa" theory on med-surf vs ICU doesn't hold water. ALL NEW NURSES ARE TABULA RASA.
    The only difference with ICU is you're dealing with CRITICALLY ILL patients. CRITICAL being the operative word.

    So if you are the type of person to be intimidated by management, if you are not able to explicitly define your NURSING STANDARDS to management, if you are not able to handle a mistake in a CRITICAL DECISION, and if you don't trust your hospital's administration, then don't do it. Most of us cannot say we had all that together in our first job, AND protect these sick, sick patients.

    If, on the other hand, you know you're a quick learner and you have developed great assessment skills in school, and none of the above warnings apply, then you might succeed.

    To go from nursing student to critical care nurse just doesn't make sense.

  8. 0
    I too am a new grad. I graduated in Dec. I went straight to the PCICU and Love it!! I was a PCT for 3 years and an EMT.

    I believe to make it in the ICU right out of school you have to Work hard. I have a great preceptor. There is also a 4 hour a week learning lab that I go to and a Peds Critical course that I will be attending. My orientation is 12 weeks long.

    Another big plus that I see is that there is a great deal of team work in my unit. No one is ever stranded and there is always a Doc around.

    Your work environment and preceptor can make or break you in the beginning!
  9. 0
    I just had to add my two cents. I went into NICU the next day after school ended, and got the Preceptor from HE**! She was very experienced, but had a terrible disposition. She was good at what she did, even though she tried to make me think I was the worst nurse she had ever seen. I was almost in tears everyday I was with her. A fellow grad, and I both came into the unit at the same time, and I envied the interaction she had with her perceptor. One nite, almost at the end of our orientation, we were asked to fill in on the nite shift. Man...this nurse went around saying how she hoped the babies would still be alive in the morning! To say the least, she didn't do anything for my self confidence. But the babies survived without incident, and the nurses on the nite shift were glad to have us. When I finally went on the nite shift, one of the senior residents, came over to me, and complimented on how much more confident I appeared to be since my orientation ended. Gee...I wonder why...LOL!
    I also worked L&D, Ante/Postpartumn, doing a lot of OT. I just couldn't get enough of being able to care for others. I gained a great deal of experince in my time at this hospital. I don't know if it was because I challenged myself, or the experienced I gained by working in this unit, but after one year I left, and started working agencies. I had no problem working on any floor, or unit! I was always called back, and have been offered a job at every facility I have worked at. I'm traveling now, and I'm continually asked to come on staff, in ICU, CCU,MICU,SICU, and Trauma ER (even offered a $5,000 bonus, while doing 4 back to back contracts in one unit). I sincerely feel, that if I had went to work on a Med-Surg floor, back when I first graduated almost 22yrs ago, I would have never had the confidence I had to explore outside my comfort zone. I do agree, that it depends on the person. As for having a background in nursing prior to school...I had none! When I walked into school, I was greener, than most patients are. I didn't even know how to read a glass thermomenter. But I learned fast, and had an excellent memory. I asked questions, and I challenged myself to learn everything I could, and sought out more. I didn't just want to pass the exams, I strived to MAX them, plus get extra points. Also during this time, I had a child in NICU for 60 days, and who almost died several times. Took her home with a trach, had to save her life due to a T-tube becoming blocked, while her father was caring for her. In his terror, had given EMS the wrong address, and by the time they arrived, the emergency had been taken care of by me, ...at that time was still a student. My daughter was sleeping comfortably in my arms. When EMS told me, that they had went to MD's homes, during an emergency, who hadn't been able to keep their cool, and work on their own child, I knew then, that I would do just fine in the real world. I also believe, that dealing with the level 3 infants, where I was kept by this preceptor, and constantly held to the level of prefection she required, this nurse unwittingly, helped me become, the highly skilled nurse I am today. Not that I would wish her on my worst enemy! Remember all of you who precept new grads....treat them as you would want to be treated. Good Luck, to all the new grads, and remember to always...do no harm...to ANYONE!

    Brownie

    [This message has been edited by Brownms46 (edited March 12, 2001).]


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