advice for new grad starting in ICU

RNforLongTime · Mar 16, 2006

Don't be afraid to ask questions. Don't act like you know it all. No one does. I've been doing this for 9 yrs now and I know I don't know alot of stuff. Be reading the professional journals (RN, Nursing 2006, AJN). Join the AACN (American Association of Critical Care Nurses). They are a great source of educational information. If you feel that you need more than 16 weeks, be sure that you ask for more time. Always be willing to help out your colleagues when you are not busy. I cannot stress this enough, if you don't know how to do something, ASK! Someone's life could be at stake. Good luck to you in your nursing career!

RN_BSN · Mar 18, 2006

I just started a residency program in med/surg ICU, 18 beds, day shift. WOW! I was an excellent student in nursing school, so I assumed it would be scarey but not too bad...I was wrong. As a student, we can go to our preceptor, or whatever, we are under their license..BUT as a licensed RN, we are 100% responsible for everything we do. Very overwhelming.

We graduate from nursing school prepared to learn how to be nurses. We know the information from the books, but now we need to learn how to apply it. By going directly into critical care we are learning basic nursing and critical care nursing at the same time, it can be a bit of a sensory overload. BUT! I am encouraged. Every day I learn something, and every day I get a little better.

One of the nurses I work with reminded me that there is a HUGE learning curve when starting in the ICU, as well as a very steep comfort level curve. I was not used to feeling so lost! Do not be afraid to ask questions, and learn to develope a thick skin. This will be YOUR practice, be your own advocate, dont let older nurses deter you from learning to be the best nurse you can be.

For me, studying didnt stop after graduation. You will need a good critical care book, and be willing to spend time reading it, along with journal articles to keep yourself up to date with evidence based nursing practice.

And finally - this site is a blessing. You will find encouragement and great resources here!

Good luck!

Lynn216 · Mar 18, 2006

Wow I wish I would have found this site when I was starting out as a new grad in the ICU- what a wonderful resource you have found at just the right time! I have been a nurse for only 9 months now and also started out as a new grad in the ICU. The advice these other two nurses have is GREAT advice. I would emphasize the asking LOTS of questions part... I think it is vital to ask, ask, ask and don't be afraid that others will think about you. This is your career. Your license. Learn as much as possible but at the same time, allow time for yourself and break from nursing. In the begining (after I got off orientation) I was so focused and nervous about doing everything right and learning as much as I could I became over-stressed and overwhelmed. It is all about balance. Let yourself be okay with not knowing everything. Sometimes I find that even nurses who have been in the ICU for 15 years still don't know some things. Also, the docs are good resources for questions- especially if you work in a teaching hospital with new docs- interns/residents. Everyone is learning together in a teaching hospital. Finally I would recommend finding yourself a good mentor. Your preceptor may be your initial mentor but after you get off orientation, find someone who perhaps works kind of the same schedule as you whom your trust and respect to share your thoughts and help give you guidance in your work environment. Good luck to you!! I know how it feels to be new too!!

CardioTrans, BSN, RN · Mar 19, 2006

I agree with what everyone has said. Always ask questions if you dont know how to do something, or dont understand something.

Along with the nursing journals, the internet is a great resource for information for nurses in any specialty. If you see something at work, that you are not familiar with, come home and look it up. Read about it so that the next time you see it, you will have some understanding.

Dont go in thinking you know everything, you dont. You will constantly learn new things, not only basic nursing but ICU nursing. You can expect to have some critical care classes, EKG classes, balloon pump classes, CVVHD classes, tons of classes. Learn everything you can.

The mentor is a great recommendation. Mentors can help you through work things and non work issues. They can be your sounding board.

This site can be your sounding board. I sounded off about my day yesterday in the CCU forum. Tons of help here, take advantage of it.

Good luck to you.......... wish you the best.

millkay · Mar 20, 2006

You are very fortunate that you facility that does 16-week internships. As a travel nurse, I've been to many facilities where the new grad nurses have little orientation, no classes to help build knowledge base for critical care. I can hardly believe that it is OJT from day one at some places out there. You are also fortunate that you found this forum. I wish I had this as a place to vent or go for advice when I first got into nursing. Amazon.com has some listmania sections. There's one where an ICU nurse recommends books to have as companions. I have a few of them. 'Pass CCRN' and 'Critical Care Skills' are among my favorites. You'll find your favorites. Congratulations on graduation and landing that exciting first nursing job. It is a profession so demanding, yet even more rewarding.

acebsn05 · Mar 20, 2006

I started as a new grad at the ICU as well, but I had to ask my manager to move me to a med surge floor. I believe I made the right decision. Although, if I had a new grad program that is as organized and consistent (one preceptor) as yours, I probably would have stayed in ICU. Good luck!

marl-1 · Mar 24, 2006

I'm amazed that you can start at ICU 'right out of school".... In my country, after graduating as RN you will have to work at least a year on a med/surg floor before going to ICU, and even then you will get 1,5 years of extra training/supervising...

I've started working ICU in september... loving it !! :nurse:

wilbur's mom · Mar 24, 2006

Hi! How would you eat an elephant??? One bite at a time. :idea: I worked in an ICU for 20 years and it gets overwhelming at times for all of us. Team work is vital, deep breaths help, and remembering the ABC's to decide what you need to do first. There is a big change in the wind for new nurses. Employers are so desperate for retention, that the old philosophy of needing med/surg experience before specialties is going out the window. Now, because of the nursing shortage, our local employers are seeing value in saying to new grads, "where do you want to work?" on the premise that if nurses are allowed to do the kind of work they love, if they are given specific training on the job with MORE THAN adequate mentoring and support, they are more likely to stay on staff after orientation and work happier under (yeah, we know), difficult working conditions. It is very costly to train new staff and in view of the higher acuity and multiple pathos the patients of today present with, new nurses quickly learn the med/surg foundation as they learn critical care. My students, in a 10 1/2 month LPN program, have multiple job offers weeks before they even graduate, and are working in ICU,ED, PICU, MICU and Ortho, to name just a few. sue

oldiebutgoodie, RN · Mar 24, 2006

Here is my advice to new grads in the ICU:

Make sure that you and your preceptor are a good fit. If you are uncomfortable with your preceptor, CHANGE! Unfortunately, in the ICU, many preceptors are control freaks who have a hard time letting go, and they spend the day reeling off lists of commands to the intern of what they need to do, rather than letting the intern develop (gradually) independent thinking. Make sure your preceptor lets you start IVs, assist docs in inserting a-lines and triple lumen catheters, put in foleys (yeah, I know, you're supposed to have done these in nursing school), etc.

So, make sure that your preceptor allows you some leeway, especially as time goes on. If he or she does not loosen the leash, it is time for a serious chat.

You don't learn until you do lots of these things yourself.

Oldiebutgoodie

MommyandRN · Mar 27, 2006

I started in a city ICU right out of school 6 years ago. I was terrified but I did it. #1 rule, don't be afraid to ask questions... no question is a dumb one.

Another thing which I still deal with, there will always be people who say that new grads should do med-surg first because thats what THEY did. That just doesn't make sense anymore. If you know what area you want to work in, why not go there. Critical care is different from med-surg!!

Good luck!