Welcome to the ICU

by Ruby Vee

7,038 Views | 13 Comments

Welcome to the ICU! Weíre happy to have you here. Not only are you going to ease our staffing issues, but hopefully youíll be here to take care of me when I need care. Iím looking forward to teaching you what I know, and Iím hoping to learn from you as well. I have never ever had an orientee who failed to teach me something!

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    Welcome to the ICU

    Itís January, and the December graduates from nursing school will be taking their NCLEX exams, looking for jobs and starting those jobs (if theyíre lucky enough to get them!) in the next few months. That means that the ICU is going to have another huge influx of new graduates sometime in the next month or two. It happens every year. Some of them will actually want to work in the ICU, but most will be on ďthe two year plan,Ē meaning theyíre here to get their two years of ICU experience before they go on to graduate school. It doesnít take long to identify those on ďthe two year plan,Ē and as few of them are actually interested in doing the work of a bedside nurse most of us old ICU nurses would rather spend our time and energy on the new grads who are here to stay. This advice is for them.

    Welcome to the ICU! Weíre happy to have you here. Not only are you going to ease our staffing issues, but hopefully youíll be here to take care of me when I need care. Iím looking forward to teaching you what I know, and Iím hoping to learn from you as well. I have never ever had an orientee who failed to teach me something!

    If youíve gotten a job in the ICU because itís your dream to be an ICU nurse, or because you think you want to be an ICU nurse and want to try it out or if you have ANY plans other than ďthe two year planĒ, let us know. We may assume that youíre on ďthe two year planĒ unless or until you inform us differently and even then we may be skeptical until you prove differently, but if we think you WANT to be in the ICU, you probably will be treated differently. Itís a lot more fun to show my best tips and tricks to nurses I expect to want to be around to work with me in a couple of years when they become competent. Something about knowing a new grad doesnít intend to stick around makes even the best preceptors reluctant to invest a lot of energy and emotion in their orientation.

    I understand that Iím going to get flamed by those of you who canít wait to go to anesthesia school or become NPs and think you deserve the very best a preceptor has to offer. Perhaps you do -- but with a constant revolving door of new graduates, we develop ďpreceptor fatigue.Ē

    When someone isnít really interested in the ICU it often shows the very first time you show up on the unit to get your locker key and meet your preceptor. These are the newbies who are clustered around the schedule book and the vacation request book on their very first day, making sure they get their many requests for days off recorded for posterity. Donít spend your first hours on the unit complaining about the nights and weekends on your schedule and whining about the seven weddings you have to attend in the next two months and how can you possibly work weekends when you already have these commitments? If youíre committed to your job, you may have to miss a few social outings and you WILL have to work nights, weekends and holidays. Make it clear that you understand the concept of 24/7/365 scheduling from the get-go and youíll get along every so much better with the rest of the staff.

    Expect to do some studying on your own time. No one graduates from nursing school knowing everything, and we more or less expect you to graduate and show up on the unit without knowing anything. I donít mind explaining Swan Ganz catheters to you or showing you how to put in a Foley, believe me, I donít. I love to teach. But after six weeks of taking care of patients with Swans and Foleys, I expect you to know what they are, where they go and what information they can give us. If you donít study at home, itís going to take you a lot longer to learn the necessary concepts to do your job.

    Donít diss the senior staff. Iíll never forget the day I was introduced to a young woman who had just graduated from nursing school at a famous Bible college. Sheíd been on the unit for less than a day, and I happened to be sitting at the monitors when she sat down next to me. ďThe male nurses on this unit are all immoral,Ē she said. The male nurses of whom she spoke were my friends and colleagues -- did she expect me to AGREE with her? Sadly, that one interaction colored my opinion of her for the 23 months she remained on our unit.

    The Nurse Educator is also a friend of mine. Donít act out in your critical care classes, because believe me, word will get back to your preceptor, your manager and the person who does your evaluations. It never ceases to amaze me how many new employees show up underdressed, late or unprepared. Youíre a professional now so act like it.

    I already know I donít do things the way your nursing instructor showed you . . . thatís because I actually work at the bedside full time and she doesnít. Iím sure she demonstrated the very best practice and youíre eager to demonstrate to me that you know that method. Thereís more than one correct way to do most things, however, and my way might be faster or easier than the way you learned in school. Or not. At least give me the courtesy of paying attention and considering my way before you dismiss it out of hand.

    We see many posts on allnurses.com from new grads who see an experienced nurse doing something they think is wrong and who want to know if they should ďreport themĒ and how to do so. The answer is DONíT. Unless youíre absolutely 100% convinced that the patient is in immediate danger AND you can afford to lose your job, develop a ďwait and seeĒ attitude. It could be that something you think is wrong is actually the most efficient way to go about things, but if youíve run to the manager to report that Hildegard is flushing dialysis catheters incorrectly youíve already generated significant ill will -- from Hildegard, her friends, the colleague who taught her out to flush dialysis catheters, your preceptor (who wonders what youíre going to ďreportĒ her over) and probably from the manager as well. As unfair as it seems, youíre the newbie, and everyone else will probably side with their experienced colleague. (Unless THEYíVE already generated significant ill will by being vocal about being uninterested in their job and spending all of their time soliciting recommendations for graduate school. Then itís a toss-up.)

    Show up on time in appropriate attire -- business casual for classes and scrubs for clinical days.

    If you chew gum, do it with your mouth closed. If I know youíre chewing gum, itís not discreet. And please donít ever give gum to your patients -- especially your intubated patients!

    Be flexible -- sometimes you wonít be with ďyourĒ preceptor. It sucks, but it canít be helped. Sometimes you wonít be with your preceptor for weeks at a time. Understand that your preceptor has an eye on your progress and your needs anyway, and weíre really looking out for you.

    Be friendly and introduce yourself to everyone you encounter. If someone is surly to you, donít take it personally -- they may not have meant to be harsh, they may not realize they were harsh -- or you may be overly sensitive.

    Make the most of every learning opportunity youíre afforded.

    Demonstrate a desire to fit in and become a part of our staff . . . chocolate helps! Be ready to show pictures of your family and pets if asked. (And itís a compliment to be asked!) To those of you with non-traditional families -- most of us donít care. If youíre gay, straight or bi, weíll still care that your pets are cute, your SO is supportive and you have adorable kids. (Most of us donít care about your sexual orientation, religion or whatever -- and those who do care arenít worth worrying about anyway!)

    Scheduling flexibility cannot be overemphasized. Sometimes we may have to move you around in order to get you time with your preceptor, OR time, or some other experience.

    Never ever be afraid to ask questions. There is no such thing as a stupid question -- except the one you didnít ask and should have. Nothing scares me as much as an orientee who doesnít ask questions! I canít trust that they wonít do something stupid because theyíre afraid to ask. And itís impossible to teach anything to someone who already thinks they know everything!

    If you make a mistake with your schedule and donít show up when youíre supposed to, come in late or take a too-long lunch break because you couldnít find your way back from the cafeteria, apologize. Profusely. We all make mistakes, but weíd hate to think you just doníe care.

    Donít start off expecting people to ďbe mean to you.Ē Our providers are really nice people as are most of our colleagues. (The ER and OR charge nurses are the enemy sometimes, but your colleagues are not.) Somehow it seems that if you expect negative interactions, youíll find them. If, despite your best efforts, you do find negative interactions, assume that at least 50% of the fault is yours. If you have many negative interactions, revise your fault estimate upward.

    Welcome to the ICU. We hope you find it so interesting and exciting that you want to work here for a long time.
    Last edit by Joe V on Apr 17, '12
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  4. About Ruby Vee

    Ruby Vee was once a new grad and (despite popular opinion) hasn't forgotten what it was like. She got off on the wrong foot with her first job, and hopes you don't do the same. After three decades at the bedside, she's seen a lot of new grads come and go -- and she hopes you come and stay!

    Ruby Vee joined Jun '02 - from 'the Midwest'. Ruby Vee has '38' year(s) of experience and specializes in 'ICU/CCU'. Posts: 8,130 Likes: 27,858; Learn more about Ruby Vee by visiting their allnursesPage


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    13 Comments so far...

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    Can I come work on your unit?? lol

    Seriously I'd love to work in the ICU one day. But I think I fit into your category of trying it out. I haven't been exposed to an ICU environment or even critical patients. (I have no interest of being a CRNA. I heard a student in my anatomy and physiology class saying to the girl sitting next to her, "Oh I'm going to be a CRNA.. you make $160,000 a year and its a step down from Anesthesiologist(My blood was boiling)).

    I've been at my job a year now, I plan to stay there until I finish RN school or they fire me(whichever comes first lol jk) I love working as a team. I'm always 10 minutes early.(One time I was 5 minutes late and I felt so bad). I like to go on 1 cruise a year. I request off a couple days here and there but I'm very flexible when it comes to the schedule. I bring tons of snacks to work(chocolate included) and keep pictures of my pets and beautiful goddaughter on my phone.
    beckster_01 and smily nurse like this.
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    Very nicely stated Ruby...
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    I think Ruby is a little jaded..... reminds me of my first job in an ICU in NYC and one of the nurses said to me "it will take awhile to get this S on your chest"........ I hope I don't give this impression!!!
    Last edit by smily nurse on Feb 8, '11 : Reason: spelling
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    I recall a time when being an ICU nurse was somewhat a prestigious position only held by nurses who had experience. The salaries were more because of the specialty area. New graduates could not even apply to critical care areas. Then the critical care nursing shortage occurred and if you had a license and a warm body you were hired.

    If I am in ICU I would rather have a good 10 year experienced nurse taking care of me instead of a good new graduate with 6 months of experience.

    Instead of having to write this long list of advice to new graduates. Lets hire mature experienced RN professionals back into our critical areas.

    Lets offer incentives and increased pay for experienced RN's willing to work in this specialty area.
    CCL RN, Meriwhen, resumecpr, and 1 other like this.
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    Ruby Vee, thanks for the time and effort you put into your posts to share your wisdom and mentor new grads along. You're a worthy successor to our much-missed Daytonite. To new grads: Ruby Vee can sometimes come across abrasive but you have to get used to her style--she really cares and wants to help you succeed!
    azcna likes this.
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    beautifully written!!!! these are things that i already know, but i am in need of reminding! it's good to know that people out there appreciate common sense and courtesy! i have just completed one year on a telemetry/step down unit and i had an interview with our icu tuesday! i should find out beginning of next week whether or not i got the job i will definitely use your post as a reference and refresher.

    thanks!!
    azcna likes this.
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    Hi Ruby,

    Thank you for the advices. They are awesome and I will always keep them in mind.
    However, I have a question to ask. My dream job is ICU, however I always want to go back to school to learn more and more. There are things I can learn in Graduate School than I will not learn from working in ICU. From what you said, the one who comes in with an intention of staying two years or going to graduate school does not get the same investments from preceptors (My plan is to stay longer than 2 years or until I learn everything about ICU.) Is that true? Or fix me if I interpret it wrong. I understand that it can be a burn out for a preceptor to train someone and the unit keeps becoming short because of someone leaves for school. I read comments about nurse managers or people appreciate employee to inform them about their plan on the unit or hospitals promote continuing education so this advice makes me confused. I really do not mean to provoke your thinking at all.

    Thanks,
  12. 0
    Thanks Ruby!!!
  13. 2
    I tried working in the ICU, hated it. Too much death and emotionality for me. My hats are off to all ICU nurses, I've seen what you deal with, and you can keep it. Hopefully all of you can handle the job better than my sister, who's worked ICU for 13 years and all of her hair is falling out from stress. Seriously, it's a rough job, and new grads need to learn this pronto. Just because you have 2 patients does NOT make it easier than other nursing jobs.
    Sugarcoma and OnlybyHisgraceRN like this.


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