New Grad RN - ICU - page 2

Hi There, I'm a recent New Grad RN hoping to get my start off in the ICU. I've read many posts both for and against this issue and I was hoping to get some advice either from New Grads who had gotten their start in the ICU or... Read More

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    I haven't read what others may have commented, but I'll weigh in on your post. I am also a new grad (last May) from a BSN program and I also did my preceptorship in the ICU. Because of my comfort in the ICU the nurse manager interviewed me for a position while I was still a student and then hired me a week after graduation. I chose to pursue ICU because I enjoy a difficult challenge and to fulfill the 1 year requirement for CRNA programs. Also it doesn't hurt that you get paid more money per hour as an ICU nurse. I'll admit that when orientation was over and I was "let go" out on my own it was very frightening. Suddenly that ease and comfort I felt with a precepting nurse beside me was gone. The safety net is no longer there and it's your licence, your nursing judgement, that keeps the patients alive.

    If you can get over this terrifying hump and get through this initial shock phase, you will make it. I'm about 4 months in now and feel much more comfortable than even 1 month ago. You'll be surprised how fast your clinical judgement develops (because it must) and because you will be using it almost always. I view the ICU like the phrase "Sink or Swim" you will thrive or you will transfer depts.

    As far as resources, use all those offered. I mostly use the online medical reference that the unit has. Anytime I have a specific question I ask a fellow nurse. Hope this helps!
    missE and californiarnbsn like this.

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    Thank you everyone for all your advice!! I received my offer today for nights. Any suggestions to help me get through a night shift in the ICU?
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    I've found that on 3rd shift the actual shift is not hard to get through, you will be able to stay busy most of the time. It's the "off" days that are so rough to handle. If you want to have any kind of a normal life you'll find yourself switching to day shift during your off days then night shift on your work days. I use melatonin supplements to help me fall asleep at a decent hour on my off days. Good Luck!
    californiarnbsn likes this.
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    Quote from casias12
    I personally burnt out at 18 years. At 7-10 years life was good, but ICU's are changing rapidly. This new quality initiative requires way too much time documenting nonsense, and places too much emphasis on the wrong things. At the last ICU I worked, we had an "open" ICU with essentially no rules. We would have the entire family (sig other, two toddlers, and grandma), living in the patients room next to their bed. Pull-out beds were provided, and families never had to leave. It made care of the patient very, very difficult. I was never against family involvement, but not having the ability to have a family "step out" for an hour or so at a time was very tiring.

    So I am now in my last few months of NP school, and can honestly say that I am really loving the office.

    Take care,
    You are not kidding about documenting nonsense! I feel like If I didn't have to document what I did every 2 hours I would actually have plenty of time to do it. The PCU I worked on had no visiting hours and we had families living in the patient rooms too. It's draining enough dealing with patients sometimes but they're patients and that's your job. You can say that about families and you get some families who think they're in a hotel and you're room service wanting coffee, blankets, pillows, toothbrushes, a bigger room... non stop even when you are clearly busy doing something else. We had one woman who was staying with her mother and she was incontinent (the family member) and she was continually calling for us to get her more chux pads and stuff to clean herself up with when she wet. I wish I were joking...
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    Hey! I just finished my first year in the ICU. I was slotted for 6 months of orientation 1:1 with a preceptor but ended up "graduating" at 4 months because I was functioning pretty well independently and I use my resources (staff) well. I work in a level 2 trauma ICU with neuro, cardiac, medical, surgical, etc. We do open hearts... I can take a 1st day postop heart but no fresh hearts yet until I've been there for a few years.

    I had NO ICU experience at all and it was a HUGE adjustment... a whole new world! I learned fast and spent ALL of my time outside work taking the AACN course and reading everything I could get my hands on. You either float or sink, and your preceptor can make or break your experience. I had a wonderful, patient preceptor who was a fabulous teacher. Attitude really is important too- you have to be extremely humble and open to learning. NOBODY likes a "know-it-all" new nurse in the ICU and quite frankly that attitude is very dangerous to patients. Don't feel dumb about asking questions and getting second opinions. If something feels wrong, trust your instinct and figure it out.

    There were times when I wanted to run run run home and find an easier/slower paced job... but I adjusted. Now when I have a "boring" moderately stable patient, I am like... bummer. Because you end up loving sick patients that keep you busy. I do often get the crappy assignments, but they like to challenge me as well. Sometimes I have to speak up and ask for a sicker assignment if I've been stuck in boringland for a while.

    I love it. Just remember to be humble, be helpful, ask questions, research, learn, and work hard. Teamwork is everything. If my assignment is a little slow, I run around asking people if they need help. I love my coworkers and my ICU, I love the independence, it is just great.

    Note- I work in a non-teaching hospital... I am not sure what the experience at a teaching hospital is but I have heard that we have more independence because there aren't interns/residents running around doing stuff. It is fun. We present our patients at rounds every morning and throughout my day I am constantly working with MDs/PAs to get the meds & orders I need, and I question their orders when necessary and help them figure out what the patient needs. It is neat to be the "expert" on the patient. Advocate!
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    Thank You so much for providing your experiences! I'm pretty excited to get started. From your experiences have you found any books or other study materials that have helped you out along the way? and the AACN course is that something that I could do now or do I have to already have hours working on the unit first?
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    I started as a new grad in a Level I Trauma ICU last November. My 20 weeks on orientation flew by and I can't believe it's almost a year since I started.

    Things that I studied:

    1. Vent Settings (including oscillator, bivent, etc)
    2. Common "ICU" drugs and their side effects (prop, vec, succ, versed, fentanyl)
    3. Brushed up on Sepsis, lactic acid, etc.
    4. Got to know ABGs very, very well
    5. Pressors for sure

    There's more, I'll probably think of some more as soon as I finish this post.

    As far as general advice (I didn't read all of the previous responses):

    1. Preceptors want you to ask questions. Take advantage of this and ask even if it seems stupid.
    2. You will make mistakes. Learn to forgive yourself, learn from them and move along.
    3. Learn your team. At the beginning of each shift try to identify one nurse who you can go to if something arises during your shift that
    you need help with who won't bite your head off.
    4. Someone else said it, but a good respiratory therapist is priceless. Know yours. Ask them questions. Usually, they appreciate
    someone's respect and they are really great teachers (IMHO).
    5. Know your support staff. We don't draw labs unless pt's have an ALine or a central line (and sometimes not even then) so I like to get
    to know our phlebotomists and one just commented the other day that she's so appreciative I took the time to learn her name and
    don't just call her "lab girl." You never know how far a little mutual respect might go. One of these staff members may be able to
    really help you out one day.
    6. Get yourself organized. Do whatever it takes to keep yourself that way.

    That's about it for now. Maybe later I'll post more about staying awake on night shift. I do love nights though .
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    Ok so this is so late, i know. I have recently graduated and I am looking to get hired into ICU as well. Iím very curious as to what hospital offered you the position. It seems like itís hard enough getting a job anywhere, let alone ICU. Any info would be greatly appreciated.

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