Go to ICU without MedSurg Experience?

[nurse4theplanet]

I hear it all the time from experienced nurses when I say that I want to work in critical care, "You need at least a year of med-surg experience because you will get to see and learn sooooo much". It worries me.

Right now, I am a nursing tech at two separate hospitals....one in ICU, the other in Med-Surg. I thoroughly enjoy my ICU job and enjoy each day I get to go to work. I dread my med-surg job and feel like I am wasting valuable experience that I could be getting from my other position. However, I am cautious not to throw out more experienced opinions about the needed med-surg experience. I want to be the best nurse I can be.

Do you think that it is wise to go straight into ICU after graduating, without first having worked a med-surg floor?

[ZASHAGALKA, RN]

The options are there to go straight to ICU. But, let me give one caveat:

If you choose to learn to drive on the nascar circuit, don't be surprised when some of the drivers run you down. It happens. It happens, alot.

I'm not saying don't do it. But, it IS a choice that YOU are making. As a result, you really can't complain about being 'eaten' when there are obstacles and attitudes to overcome based on your choice.

I'm an advocate of a year on med surg. I had 3 before moving to ICU 10 yrs ago. Did it stop me from being run over by assertive nurses there? Oh, no, not at all. My first year in ICU was far from certain and mostly due to a few key personalities.

But I WILL say this. I had 3 yrs of experience in time management, meds, skills, critical thinking AND maybe most important, unit politics. I wouldn't have survived that without those previous skills.

You hear that a year of med surg is recommended for a reason. Yes, you will hear voices that say otherwise. But different perspectives help inform the whole picture, and not necessarily the one perspective.

I know this was such an encouraging thread before I posted. But, a reality check is in order:

IF you go right into CCU, you will meet some resistance from a few of your peers. While most might be accepting, it is the few that can undo your world and taint your experience. That will translate to some "assertive" behavior. If anybody tells you that such attitudes don't exist in THEIR unit, or in most units, then they are whitewashing it for you. I'm not saying it's right, just that it IS an obstacle to overcome in order to persevere.

On top of that, you will have a higher learning curve because you are learning BOTH critical care AND basic nursing.

It's a large amount to bite off. If you choose to do just that, then you really can't complain later about how difficult it is. Learning to be a nurse is difficult enough (and school doesn't teach the real skills, experience does). Go to the first year of nursing threads and read about how difficult it can be. Now, add at least a 20% premium to that difficulty.

For some people, this is a challenge, and they rise to such challenges. That's fine. My point is this: are YOU that type of person.

But all these people telling you how great it is to go straight into critical care and how they did it and do fine, ask them this: what is the attrition rate that they've seen over the years, generally, and for new grads specifically?

In my group of 5 critical care students, 10 yrs ago, I'm the ONLY nurse to my knowledge that is still practicing as a critical care nurse. 3 never made it through the first year. The other quit after about 4. I will confess that THAT unit, 10 yrs ago, was a difficult place for new critical care nurses to excel. But, that is a common, if not universal or majority, reality.

Sorry to be the 'keep it in perspective' voice. I wish you well.

~faith,

Timothy.

[nurse4theplanet, RN]

Timothy

Thank you for your very honest comments. I have considered much of what you have discussed over the last few months, but I do think that my personality requires me to take on the challenge...otherwise, I feel...bored...like my full potential is not being reached...I really don't know how to explain it...I crave knowledge/experience/challenge/puzzles/etc. I feel disconnected in other specialties but my heart soars when I am in the critical care setting, or even when the medical response team responds to a call on my med surg floor when I am working there. I know it will not be easy by no means...but I am up for the challenge.

[cardiacRN2006, ADN, RN]

Timothy

Thank you for your very honest comments. I have considered much of what you have discussed over the last few months, but I do think that my personality requires me to take on the challenge...otherwise, I feel...bored...like my full potential is not being reached...I really don't know how to explain it...I crave knowledge/experience/challenge/puzzles/etc. I feel disconnected in other specialties but my heart soars when I am in the critical care setting, or even when the medical response team responds to a call on my med surg floor when I am working there. I know it will not be easy by no means...but I am up for the challenge.

Good for you! I think you'll do great.

[MistyDawnRN06, BSN, RN]

Go where you love it because you'll perform better. I say go to ICU. Went straight there as a new grad. It's tough, but I wouldn't want it any other way. I had my fill of the floors in nursing school clinical rotations.

My only piece of advice is to make sure the ICU you choose has a very good orientation program. Make sure you are put into an ICU course or some sort of critical care education. Make sure that you are put through an EKG course. Make sure that you will be offered opportunities for certifications such as ACLS. Also, make sure you get an extended orientation (I recommend no less than 16 weeks). Don't choose a facility that hangs you out to dry. You'll get in trouble!!! Make sure the facility you hire in to wants nurses that know why they are doing the things that they are doing for patients, not just mechanical robots there to hang drugs. Make sure critical thinking skills are encouraged.

Much luck!!

[sunshineCCRN]

I went straight to ICU, and it was okay. I actually did 13 wks on med-surg after working ICU, and I was bored, frustrated, and stressed.

I agree about finding a hospital with a good program. What is most important is that you are teachable AND stand up for yourself. Does that make sense? If management wants to give you 6 wks orientation, or give you a different preceptor every day, etc, and you're not ready, you need to say no. No one else will say it for you. I know it's a fine line, but it's your license, and there are people out there that love to dump on the new nurse. On the other hand, you can't be too negative, either. There were many times when I was hearing the same diatribe on straightening cords, drawing blood, or ventilator settings every day. The tendency is to roll your eyes and say "Can you teach me something I haven't learned yet?" But the worst thing in critical care (besides coming off as incompetent) is to come off as cocky.

I'm glad I did ICU; it's the only place I feel challenged enough. And despite the hurdles, I would do it the same way....but a little more self-assured. Be kind, thorough, conscientious, and don't EVER let yourself gossip at work. Have a good attitude, ask questions, and you'll be fine. Good luck!

[trebor1]

Direct from school to the ICU - its the best way. I think there is no need for med-surg expirience to be a excellent ICU nurse.

[tde1992]

Go to ICU, do what makes you happy. If you are in Maryland University of Maryland Medical Center (Medical Intensive Care Unit) needs nurses. We hire new grads (I was one of them). Our orientation is now 4 months. We have an excellent mix of experienced nurses mixed with new grads, mixed with nurses from various countries. It is an amazing experience. I could not imagine trying to locate a MD. Our residents, interns and fellows are always on our unit. I think that I would not survive on a med-surg unit. I say this because it is nothing like a sedated/ventilated patients. You got to love who ever invented propofol, fentanyl, ativan, and midazolam. Nothing like a comftorable, quite patient.

[Ruby Vee, BSN]

i wouldn't want timothy's to be the lone voice of dissent. so i'll agree with him.

after 28 years in nursing, 23 of them in icu, i've seen a lot of new icu nurses come and go. the ones that last the longest without burning out are the ones who started with some med-surg experience. icu is difficult, and there's a lot to learn on top of your basic nursing skills. i think those nurses who have the basics down before they try icu do a lot better in icu, and tend to be happier for longer. they also tend to survive the politics better.

a lot of nurses who went straight from nursing school to icu will tell you that they did just great. and maybe some of them did. maybe all of them did. i wonder what their charge nurses and preceptors would say, though. i've seen an awful lot of stupid newbie mistakes made by new grads who had no idea they were making mistakes . . . there was just so much to absorb all at once that some lessons didn't get learned as thoroughly as they might have.

[Alexsys]

went straight to the ICU after nursing school, they had a 3 month precepted

orientation . That was 2.5 years ago , NO problems CVICU/CCU.

Never worked any other floor or type.

good luck

I received a BSN w/ my RN

Same here!(I just wont have my BSN until April)

I went straight to the ICU/MICU and I love it! (Done a few months on cardiac, but went back to crit care. Missed it too much)

Best of luck to you!

[augigi, CNS]

I did 4 months on an ortho ward in my grad year before doing an ICU rotation - and they asked me to stay. So I did my critical care course and stayed for 8 years. If you're the right personality, and have basic experience (I worked as an aide throughout my RN degree) and a willingness to learn, you'll be fine.

[nogzilla]

I was a CNA in a nursing home for 3 years, a nurse tech on a rehab and med-surg floor for a year and then to an ICU as a RN. I value my experience but I work with plenty of competent nurses that came here without a lick of any other experience. Do what you want. The ICU is an amazing place to learn, jump in with both feet if thats what makes you happy.

[Proudnurse1978]

Don't waste your time in Med/Surg. You learn a lot more in the ICU.