Quote from californiarnbsn
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 experienced ICU nurses! I have my first interview for an ICU unit this coming week and I'm both excited yet terrified. I know I am ready for the challenge and I did have my senior preceptorship as charge in a 12 bed ICU as well as many clinical experiences in the ICU.
What kind of advice do you have for me?
What should I expect? study?
Any help would be greatly appreciated!
I don't think starting off in the ICU is ideal, but in this economy you take whatever job you can get. I know many, many who have started off in the ICU and most of them are competent.
Your first year of nursing is going to be difficult no matter where you start. I think there's an advantage to starting somewhere less acute where you can learn to be a nurse before you learn all the extras that go into critical care nursing. But I know that's an unpopular opinion these days. Folks who start off in the ICU seem to burn out quicker and to last less long in nursing, but that's anecdotal. I have no studies to quote; just the observations of a few old ICU nurses.
Expect a 3 to 6 month orientation with 2 or three main preceptors. Expect to follow the schedules of your preceptors, to work weekends and nights and to skip vacations for at least the first six months. Expect that there will be days when you're abjectly miserable and absolutely convinced that you're the worst nurse in history. (If you don't have days like this, you have far too much confidence and are dangerous.) Expect a lot of feedback, much of it negative and most of it delivered in a way you find objectionable. (I mean to write an article about feedback one of these days when I'm not so freaking tired!) Preceptors, like most people, are quicker to correct mistakes than to dole out praise, and if you're someone who cannot function without praise, discuss that with your preceptor right up front and be sure to seek it out from time to time. In the ICU, mistakes can actually KILL someone, so mistakes may be jumped on quicker and more emphatically than in a less acute environment. I'm not advocating for this approach to precepting, and I try very hard to praise when it is due and deliver criticism as honestly, factually and softly as I can, but you did ask what to expect, not what to hope for.
Expect that you will be clumsy and inept with "skills" like NGs, IVs and Foleys. As you learn and gain experience, it will get better. Your preceptor will know this, but some cannot adequately express it. Expect to be quizzed about disease processes, medications, procedures and lab values. Arrive at work a half hour early to find out who your patient will be and look up the meds and lab values, etc.
Develop a thick skin. ICU nurses have strong personalities and they'll tell you when you've screwed up. It's not personal, and it might save someone's life someday. ASK for feedback. It defuses those who might be inclined to bite your head off and it impresses the rest of us.
Expect to study at home after work. What to study depends upon where you work. If there's an ECMO patient on your unit, go home and look up ECMO just in case you have the opportunity to care for that patient tomorrow. If you can, get your preceptor to give you some sort of an idea what kind of patients you'll be taking tomorrow.
Find someone safe to ventilate to -- make sure it is NOT someone you work with. You may have only been ventilating when you said Bed B's husband was probably a wife abuser or that Bed C is psychotic, but someone is bound to remember that you said that and hold it against you at some future date. And never, ever take part in a colleague-bashing session. Again, Matilda might be lazy and incompetent, and some of her alleged friends may be right in there bashing her, but they'll remember -- and may repeat -- what ever you contribute.
Expect to be challenged, overworked and worn into the ground. That happens everywhere in nursing, not just in the ICU, but we've lost some promising new grads because they thought they wouldn't have to work as hard elsewhere.
I'm sorry this has gotten so long. I've found ICU to be interesting, challenging, exciting and rewarding. If this is the path that you choose, I hope you find all of those things as well. It will not be easy, but few things that are worthwhile ever are. Good luck.