Welcome to the ICU

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

    It's January, and the December graduates from nursing school will be taking their NCLEX exams, looking for jobs and starting those jobs (if they're 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 "the two year plan," meaning they're here to get their two years of ICU experience before they go on to graduate school. It doesn't take long to identify those on "the two year plan," 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! We're happy to have you here. Not only are you going to ease our staffing issues, but hopefully you'll be here to take care of me when I need care. I'm looking forward to teaching you what I know, and I'm hoping to learn from you as well. I have never ever had an orientee who failed to teach me something!

    If you've gotten a job in the ICU because it's 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 "the two year plan", let us know. We may assume that you're on "the two year plan" 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. It's 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 doesn't intend to stick around makes even the best preceptors reluctant to invest a lot of energy and emotion in their orientation.

    I understand that I'm going to get flamed by those of you who can't 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 "preceptor fatigue."

    When someone isn't 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. Don't 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 you're 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 you'll 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 don't mind explaining Swan Ganz catheters to you or showing you how to put in a Foley, believe me, I don't. 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 don't study at home, it's going to take you a lot longer to learn the necessary concepts to do your job.

    Don't diss the senior staff. I'll never forget the day I was introduced to a young woman who had just graduated from nursing school at a famous Bible college. She'd 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. "The male nurses on this unit are all immoral," 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. Don't 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. You're a professional now so act like it.

    I already know I don't do things the way your nursing instructor showed you . . . that's because I actually work at the bedside full time and she doesn't. I'm sure she demonstrated the very best practice and you're eager to demonstrate to me that you know that method. There's 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 "report them" and how to do so. The answer is DON'T. Unless you're absolutely 100% convinced that the patient is in immediate danger AND you can afford to lose your job, develop a "wait and see" attitude. It could be that something you think is wrong is actually the most efficient way to go about things, but if you've run to the manager to report that Hildegard is flushing dialysis catheters incorrectly you've already generated significant ill will -- from Hildegard, her friends, the colleague who taught her out to flush dialysis catheters, your preceptor (who wonders what you're going to "report" her over) and probably from the manager as well. As unfair as it seems, you're the newbie, and everyone else will probably side with their experienced colleague. (Unless THEY'VE 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 it's 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 you're chewing gum, it's not discreet. And please don't ever give gum to your patients -- especially your intubated patients!

    Be flexible -- sometimes you won't be with "your" preceptor. It sucks, but it can't be helped. Sometimes you won't be with your preceptor for weeks at a time. Understand that your preceptor has an eye on your progress and your needs anyway, and we're really looking out for you.

    Be friendly and introduce yourself to everyone you encounter. If someone is surly to you, don't 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 you're 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 it's a compliment to be asked!) To those of you with non-traditional families -- most of us don't care. If you're gay, straight or bi, we'll still care that your pets are cute, your SO is supportive and you have adorable kids. (Most of us don't care about your sexual orientation, religion or whatever -- and those who do care aren't 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 didn't ask and should have. Nothing scares me as much as an orientee who doesn't ask questions! I can't trust that they won't do something stupid because they're afraid to ask. And it's impossible to teach anything to someone who already thinks they know everything!

    If you make a mistake with your schedule and don't show up when you're supposed to, come in late or take a too-long lunch break because you couldn't find your way back from the cafeteria, apologize. Profusely. We all make mistakes, but we'd hate to think you just don'e care.

    Don't start off expecting people to "be mean to you." 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, you'll 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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    ICUMatador, workingmama77, Nrsasrus, and 20 others like this.
  2. Visit  Ruby Vee profile page

    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 has '38' year(s) of experience and specializes in 'ICU/CCU'. From 'the Midwest'; Joined Jun '02; Posts: 9,341; Likes: 35,218.

    Read My Articles

    13 Comments so far...

  3. Visit  Forever Sunshine profile page
    2
    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.
  4. Visit  CCL RN profile page
    1
    Very nicely stated Ruby...
    workingmama77 likes this.
  5. Visit  smily nurse profile page
    0
    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
  6. Visit  PACNWNURSING profile page
    4
    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.
  7. Visit  JeanettePNP profile page
    2
    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!
    workingmama77 and azcna like this.
  8. Visit  ICUMatador profile page
    1
    [font="tahoma"]
    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.
  9. Visit  Candyn profile page
    0
    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,
  10. Visit  OnlybyHisgraceRN profile page
    0
    Thanks Ruby!!!
  11. Visit  rntj profile page
    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.
  12. Visit  stephanie2012 profile page
    1
    nothing is easy ! Life is hard .
    OnlybyHisgraceRN likes this.
  13. Visit  E.niles profile page
    0
    I am printing this out and hanging it on my mirror! It seems to be the kind of advice a guy likes me needs to carry with him everyday and everywhere, not just into the unit for my first days.
    Thanks Ruby your my kind of nurse
  14. Visit  nursesharky profile page
    0
    Interesting to get insight into the eyes of a more experienced nurse and their views of the new grads in the ICU. After only two years in the PICU after graduation (and here to stay) we have not hired any new grads, but there are some coming this summer so I will be keeping this story in the back of my mind the entire time.


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