New nurses in ICU - page 2

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... Read More

  1. by   MickeyI
    I have been both in ER and ICU and have precepted several new nurses in both areas. Some did well, and some were very discouraged and wondered why they ever wanted to be a nurse.
    For the most part I think it better to get a little experience in a less demanding and less stressful area. Just like any new job or skill, it will take a bit to develop your routine and how to put to use the knowledge you already have to use, as well as learn new things. It's hard to go straight to a race car when you are just learning how to drive. It can be done, but is it best for you OR your patients? I know they 'told' you you would have training, a precepter etc, but I agree with the earlier post, in an emergency ( and there may be more than one pt crashing at one time, requiring the nurses to be spread out) you may be left on your own.
    Also, you can better believe the hospital won't back you if you inadvertently make a mistake. Look out for yourself too.
    Sorry if I sound cynical, but lately you have to protect yourself as well as the pt.
    Good Luck!! Sounds as if you are really thinking ahead trying to find out the pro's and con's. And I hope you do make it to critical care. I think it is a great area.
  2. by   natalie
    Hey jt!

    Congrats to that new grad for standing up for herself. I know the grievance process will take a few months, but am very curious to follow it and know of it's outcome. If you can, keep us informed. It's hard enough for old birds like me to work with short-staffing. VERY nice to hear of a fiesty new generation of nursing. I would like to pass this incident's outcome on to the new grads in my hospital. They are routinely deprived of their orientations.
  3. by   -jt
    Originally posted by natalie:
    Hey jt!

    Congrats to that new grad for standing up for herself. I know the grievance process will take a few months, but am very curious to follow it and know of it's outcome. If you can, keep us informed... I would like to pass this incident's outcome on to the new grads in my hospital. They are routinely deprived of their orientations.
    Yes they arent scary stories. Unfortunately they are the reality of the present bottom-line-maintain profits-continue cost-cutting hospital administrations practices nation-wide. Grievance is scheduled for Feb 8th. I'll let you know.

    Its nice to know that there are still some places that do provide the support a new grad needs in a specialty area but I agree with the person who said "its hard to go straight to a race car when youre just learning to drive". Besides, getting a good foundation makes an RN more marketable. An experienced med-surg RN can handle any kind of pt & will have more flexibility & range for future available job opportunties in other aspects of nursing.
  4. by   chaseloff
    Hello there Janine...

    I have to say a couple of things... For the most part I must agree with the majority of the postings BUT I do believe that a new grad should be able to go into a critical care setting based on a few points. I am a new grad (graduated in december) and I am working in a Surgical Trauma ICU at a TraumaI hospital and I love it. Maybe I just have not had time to "burn out" yet but I can guarantee that I would be burnt out much faster on a med-surg floor.

    I dont believe that every new grad is ready to be in a critical area though. It depends a lot on what their schooling was like, what kind of family life they have, and how hard they can really work to get there. No I do not know everything and I probably never will but I just got out of school and I am still in a learning mode. I can actually apply the critical care that I learned my last semester to the "real world" whereas if I started in med surg I would feel that I was starting all over when i got to icu.
    I also do not have a family and am not married so I have the time spend trying to master this content.
    One more thing... I had the world's best ICU instructor my last semester of school and learned more in 1 day of clinical with her then I did my entire 2 years of school.
    Like I said before, I think it depends on the person but I know that this is the best thing that I have ever done for myself and would not change this for the world. If you want it bad enough.. anything is possible!!!
    Camille
  5. by   janine3&5
    Thanks to everyone for all of your help! I've decided to stick with the med-surg for at least 6 mo. (I'm sure the nursing shortage will still be there!) Although I feel that I'm a quick learner, I don't feel confident enough in my assessment or technical skills to be taking care of these critical pts. on my own. I'm glad I now know what sorts of questions to ask re preceptors and orientation. As I've said before, our instructors don't tell us this kind of crucial information--just adding to the reality shock when we do get out there on our own! In our nursing program, clinical experience consists of one 8 h shift/week throughout the entire program--not a lot of time to get much experience doing anything. For me, I need more time to get comfortable with the basics before I try to hang with the pros! Thanks again.
  6. by   hollykate
    Just a thought- don't look at med surg as a step down and not "hanging with the pros" I have only worked ICU and I am in awe of nurses who take 7-8 pts- who have no monitoring (egads- scares me to death not to have tele on a pt)and do it all with grace. These Med Surg experts are certainly pros. I don't wish I had done med surg- but I can see how challenging their days are.
  7. by   MickeyI
    I agree with the previous, it takes alot of work and courage to work Med-Surg. Dont think this is the minor leages by any stretch of the imagination!!! Just know that once you master this area, that ICU and ER will seem a whole lot easier-- just extra technical skills and a bit more in depth knowledge-- which you will be more able to concentrate on if you don't have all the other routine things to get straight too.
    But on the Med-Surg floor you can have a bit of extra time to think and organize things as most things are not life threatening (although there are always surprises).
    Good Luck!!! Nursing is harder these days, but I think it is definately worth it.
  8. by   -jt
    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.
  9. by   bixbie
    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.
  10. by   TracyRN
    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.
  11. by   Nancy Jo
    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.
  12. by   lsmo
    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
  13. by   MartyL
    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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