new grad in ICU.?!

LaurieCRNP2002, MSN, RN, APRN · Jul 10, 2000

Jeanne

First, congratulations on passing your boards! :-) As far as new grads in ICU, I say if you feel comfortable, then go for it! Just be sure to ask what kind of orientation program they have. Will you be paired with a preceptor? Will you be enrolled in a critical care course? How long will the whole orientation be? These are just a few of the questions you should ask during your interview. I wish you the best of luck and don't hesitate to email me privately if you have any other questions.

Laurie, RN

[This message has been edited by LLDPaRN (edited July 09, 2000).]

spunky · Jul 10, 2000

First off I would like to say I am amazed that in that hospital the ICU is the only opening, practiclly the whole US is crying for nurses.

As for your Q. I agree with above post check orientation length, and see if theyll give you an critical care course. You will prolly need a good 3-4 months of oreintation.

Now speaking from a noc nurses. DON'T assume because its nocs nothing happens. Do you really think people come into the hospital to sleep? NOT. Nights is where you need to be the most independent and confident in your skills. During the day its easy to pick up the phone and call the already awake doc or grab the nearest RN or even the 8-5:00pm, Mon-Fri only CNS. At nights you have none of that, the MD and CNS are home asleep, and your fellow nurses are running just as fast as you are to do damage control. Your assessments need to be good and you need to learn quickly the early signs of impending problems. Meaning 2 things: 1. before pt is in the toilet and 2. before it is the "golden hours" of dont call doc unless someone codes or is dead.

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A nurses prayer: Please don't let THAT be what I think It is. AHHHHHH

spunky · Jul 10, 2000

Congrats on passing the boards.

New grads are put on nocs not because it is a slower pace and better to learn but because no one wants to work the shift. Actually the better shift for grads is days, more support, less stress, less patients to care for. Nocs your on your own. Remember what you learned in school. I'll just remind you of two:

when do most people code?

when do people c/o most about pain?

You guessed it NOCS.

spitfire · Jul 10, 2000

Originally posted by spitfire:
Hi everyone,Friday I found out that I passed my boards!I am planning on applying at a small local hospital in the ICU.It is the only position they have open,I know ICU-CCU is a whole different type of nursing, does anyone have any opinions as to if this would be a good experience for a new grad??I think this would be a good learning experience(it is a night position)as I would only have 1-2 pts.Any opinions???Jeanne

Hi everyone-(I love this site)It is hard to believe that a noc position is all they are advertizing.It is harder to believe the cardio-pulmonary acute care unit where I have worked for 4 years as a cna did not hire any new grads.They have paid for half of my tuition. It was a huge disapointment not to be hired at my home away from home. Last year they hired around 30 with a 1000. sign on bonus and not many left.This year they said because of managed care the BUDGET can't take it.Last year also they hired many travelers and paid them big bucks,they also have a new life-flight crew and copter,with staff and pilots always in the hospital.I guess it is good PR but it does not seem like they keep them busy with calls out(no income). So there is supposed to be such a nursing shortage but I do not see that here in Maine.I know nights can be hopping I have worked a few.I have also floated to ICU-CCU and you have to admit it is a different type of nursing,big on assessments...Jeanne

hollykate · Jul 11, 2000

Go for it!!! I am also a new grad going into neurosurgical ICU. Several RN's I work with have tried to tell me that #1-I simply won't be able to care for these patients, or #2 that a neurosurgical ICU is somehow less intense than a MICU or RICU (proprofol drips- not complicated at all, i guess for some people.). Do not listen to the nay-sayers. I completed my last rotation in a SICU took care of a full load (yeah-2) of patients on a daily basis and handled my fair share of uh-oh's (yes one pt was accidentaly extubated and another ATE a thermometer:eek But, with help from my preceptor, I was able to pretty much get the day organized and going- in fact, they also offerred me a job when I finished.

If you are going the pm route, ask about the other PM nurses. Have they been there a long time- if so, they may be excellent resources (or they may be so burnt out, it's a toss up.) Good luck. Let me know what you choose

DonnaG · Jul 13, 2000

Originally posted by spitfire:
Hi everyone,Friday I found out that I passed my boards!I am planning on applying at a small local hospital in the ICU.It is the only position they have open,I know ICU-CCU is a whole different type of nursing, does anyone have any opinions as to if this would be a good experience for a new grad??I think this would be a good learning experience(it is a night position)as I would only have 1-2 pts.Any opinions???Jeanne

Hi. I, just like yourself, just graduated and was hired into ICU. I am really scared. My hospital has a great preceptor program and watches everything you do for 6 months. So hopefully your hospital will have a good program too! Let me know how you do. Good Luck!!! Donna ;}

nightshifter · Jul 13, 2000

Hi! Congrats on passing!

I work on a busy med-surg unit, working straight nocs now, but have done day/noc rotation. I haven't worked ICU, but I can tell you that as a new grad, it might actually be less stressful to only have two very acute patients, to whom you can give your full attention, rather than eight STILL very acute patients for whom you have to spread yourself thin, as it is in Med-Surg. If you feel confident in your knowledge and will have a good orientation, go for it!

As for the day/noc question, I was very lucky in that I had a very knowledgeable nurse with me when I started nocs as a new grad. She literally saved my patient's lives a time or two when I was too ignorant (not stupid, just new) to recognize a decline in my pt's condition. It is true that you have much less support staff on nocs - our house super on nocs is only concerned with staffing and acuities, she's useless as a nursing resource. As a new nurse, you have the potential to be very dangerous if you don't ask questions FREQUENTLY, and if you don't have someone who knows what they're talking about to help you. I graduated ADN at the top of my class, Honor Society, yada yada. Still, I did things as a new nurse that now make me cringe. YOU WILL NEED HELP! On the other hand, noc shift, while it can be just as stressful in that you are more on your own, is usually quieter and less fast-paced than days. There are fewer people (families, ancillary dept.s, DOCTORS) around asking, demanding, and generally distracting you from what you are trying to accomplish, which is pt care! Day shift as a new nurse was particularly frustrating to me because when you're new, you're still idealistic and believe in the holistic approach to pt care, listening, supporting, body, mind, and spirit, etc. Not to be cynical, but the reality is that especially on day shift, you barely have time to make sure the pt is bathed, fed, and received meds and treatments. Holistic care is simply not possible with eight very ill, usually geriatric pts (of course, having eight not terribly ill thirty-something-year old pts is also something to be experienced - ONCE!). Of course, again, as an ICU nurse with 1 to 2 pts to focus on, holistic care may be more possible even on days (although somwhow I doubt it). It is true, though, that on days, you have more accessibility to resource people. I do have to add that I find it easier and faster to reach the docs at night because they're all home in bed, not running around trying to respond to beepers, seeing pts in the office or another hospital, or playing golf !

hilas · Jul 14, 2000

Congtrats!! I am in the same position as you. I also am a new grad starting out in ICU but I was lucky enough to work on the unit for a year as a student nurse so that does relieve some of stress.I also am straight night shift which I heard they would never give to a new grad d/t less experience but they did it and here I am and I love it noc shift staff is closer because there is less of them and you need each other to get through the night (sometimes), also you can do more for your patient b/c you have more time. On days you have 3 meals,Constant visitors with millions of questions, MD's in and out,PT,OT,dietary, discharges, transfers, dx testing(sometimes patients are in CT for hours)I don't like days you never have time for your pt & your chart is always gone. Its a zoo. On good nights your pt has stablized out and you have free time; I recommend reading the policys and procedures also I read a book called Introduction to critical care skills (FLYNN & BRUCE)it explains everything and its easy to understand I got it at Barnes and Noble. They had 4-5 different critical care books but I like the above book the best but any reference will help you. Good luck

Originally posted by spitfire:
Hi everyone,Friday I found out that I passed my boards!I am planning on applying at a small local hospital in the ICU.It is the only position they have open,I know ICU-CCU is a whole different type of nursing, does anyone have any opinions as to if this would be a good experience for a new grad??I think this would be a good learning experience(it is a night position)as I would only have 1-2 pts.Any opinions???Jeanne

Trace · Jul 16, 2000

As a noc ICU nurse in a small hospital in northern Maine I have a unique perspective here. Our hospital is also in the midst of a nursing crunch especially in specialty areas so we are offering a preceptor program for ICU/ER and it is geared to the new grad-I hope the hospital you are considering is doing the same. In addition to this program our new grads are getting a 6 month orientation with me on nocs to get a taste of the real world so to speak. Ask if these things will be available to you-I also agree with another writer-we have openings everywhere in our hospital-this plae is lucky to only have ICU openings! Congrats on your boards! Tracy

nanjam · Jul 19, 2000

Congratulations on passing the boards. I'm a little concerned over a couple of comments, that the lower ratio, usually 2:1 on a good night, is somehow easier. Yes, it can help you focus, however the ratio is lower because the level of care required on an ongoing basis is more "intense". Keep in mind that night admissions tend be of a higher acuity. The preceptor program I hope will allow you the time to be competent on the floor. In many hospitals the least experienced staff, in years, can be nocs, so your resources are less. Your staffing numbers are also lower, but your census for the day may be its highest at 7am. Be realistic, be prepared. I hope it goes well, keep us posted.