New Graduates In The Icu? - page 3

Should new graduates be able to work in the ICU? Do they have the experience to make critical decisions? How long should they have to work on a general med-surg floor before being allowed to work... Read More

  1. by   sarah_bellum
    She left the room because it was crowded? Man, I would have been right in there, trying to see!

    It sounds like she isn't the right personality for the ICU. We are a unique bunch. I think in order to be in the ICU you have to be able to think on your feet, be fascinated by nursing stuff (drips and dressing and art lines Oh my!) but you also have to be extremely organized. I think these attributes are valuable everywhere in nursing, but ICUs tend to turn it up a notch.

    As for the crying, well I'm sure some doc will yell at me when I screw up and I will cry. I'm not the first, and I won't be the last.
  2. by   sarah_bellum
    I don't know if any of the other newbies have done this, but I have found it helps. On the back of my report sheet I write follow up in big letters and all the labs, x-rays and docs I need to call, I list by pt. I even put semi minor things like central supply didn't send something, pt likes sprite and we are out, etc. Then, I cross it off when it is resolved, if its a doc calling back, I write the time so I can chart it later. It seems to work.

    Remembering everything, and looking at the whole picture is the hardest thing for me.
  3. by   Rage
    LoriLou.... without a doubt she is overwhelmed. Regardless of med-surg experience or not ICU is known for being a very stressful location. I have no doubt that some new grads should start in med-surg first and then progress into ICU, that said, I also believe that there are some new grads that do fine in ICU.

    We seem to want to split this question in a nice clean line right down the middle between med-surg or not, and have yet to realize that nothing can be cut so cleanly when dealing with people of different ages and different backgrounds. And I think the reason for that is because we just don't have the information we need about the person or because we just don't have the time to really get to know the person.

    In your case LoriLou I would recommend to the manager that the new grad be allowed to do "some time" on a step down unit or a med-surg unit. Your frustrations are not only affecting your emotions but is probably spilling over to your co-workers as well. Which isn't fair for you or the person your precepting since your co-workers are forming a lot of their opinions based on your perceptions.

    I'm going into ICU as a new grad when I pass the boards in June because I have always had high stress jobs and love the pace, call me an idiot if you wish, but I couldn't see myself in any other department. I'm motivated to learn everything I need to learn and am actually pushing my hospital (which is a teaching hospital) to give me all the information they can while I'm a NT in MICU. To me this isn't a party, a disco, or a heebee jeebee (reference to talking heads....lol) it's a privilege. I go in on my own time to take classes I need to take to be better at my job. I treat everyone with respect, and as to the nurses on my unit with admiration for the job they do.

    If you are precepting any new grad who is less committed then this to doing their job, then do yourself and your co-workers and the new grad a favor and get the new grad off the floor. You are way too valuable to your hospital, your co-workers and yourself to have to deal with a situation like this.

    Ok.....I'm done.
  4. by   lorilou22RN
    Thanks you are right, I really don't want to get so frustrated, and I certainly do not want her to think she has done the wrong thing (by going into nursing). I don't think you'll have an issue going into ICU, you have been working in the hospital. She NEVER has. I really think that puts her at a dissadvantage. Well thanks for the advice, Im back with her the whole weekend, and I really, really, want it to go better. Wish me luck
  5. by   shortlittleRN
    Quote from lorilou22RN
    Thanks you are right, I really don't want to get so frustrated, and I certainly do not want her to think she has done the wrong thing (by going into nursing). I don't think you'll have an issue going into ICU, you have been working in the hospital. She NEVER has. I really think that puts her at a dissadvantage. Well thanks for the advice, Im back with her the whole weekend, and I really, really, want it to go better. Wish me luck
    I'm a new grad orienting in SICU level 1 trauma and it's been overwhelming. Like your new grad, I've never worked in a hospital setting before; I also did my practicum in the med surge unit. therefore, I am at a double disadvantage. My first 2 weeks with my preceptor were great. This week was so stressful, makes me wonder of my own capabilities. I'm sure my preceptor is frustrated as much as I am. But the ICU is where I want to be and I will continue to try my best. Speaking on behalf of your new grad, it can be overwhelming. The hardest part with being a new grad is that I don't want to do the wrong thing so I ask questions even when I think I know the answer. However, thinking and knowing are two different things, thus, I ask. I've been orienting with my preceptor for 3 weeks. I don't know how long you've been precepting yours, but try to take into consideration of her disadvantages.
  6. by   Lisa CCU RN
    I am a new grad and newly licensed and I am going straight into ICU ONLY because there is a 12 month internship in place and I have worked on this floor for six months as a nurse tech and I asked and observed all the grads of this internship and they have proven to be very good nurses.

    We have classes for six months, rotations through EVERY department, even the dietitian (sp). I have learned so much so far. We choose our own preceptors and I love mine.

    I think I will do just fine in the ICU.
  7. by   stephlucasrn2008
    I am a firm believer that you should follow your heart. There were probably a few people who doubted your ability to enter nursing, but you indeed followed your heart. Your brain may think your heart is an idiot after a few months or even years, but this is the prime reason why nursing really is the BEST profession on the plant. You have the freedom to do so many things. I started in critical care because most things I want to do when I "grow up" require critical care experience, I enjoy being mentally challenged, and I like "family-centered" care. FCC is very prominant but not very obvious in ICU. In ICU, you have the whole family of a 25-year old overdose patient in the waiting room waiting for your words. On med/surg, you have patients with appys, choles, and thyroidectomies and generally only one or two family members may be present. No that I have gone off on a tangent... DO WHAT YOUR HEART TELLS YOU, YOU HAVE EVERY OPPORTUNITY IN THE WORLD!!!
  8. by   sweetsmiles2007
    I went into a SICU (w/ majority of post-op CABGs) immediately after graduating from a BSN program. had a 6 month orientation and loads of classes---and it really sucked, but i learned a ton! After being there for 9 months, I decided to float to the tele floor because our ICU has had a really low census for the last 4 months, and my paychecks started suffering.
    Annoyingly, tele has bored me out of my mind. I obtained the organizational skills to care for 5 pts from caring for 1 pt in the ICU, and i'm constantly informing other tele RNs various facts about labs, assessments, ect. I miss the pace of the ICU, i miss the brain work, i miss doing everything for my pts.

    My opinion is that working on the floor was not necessary to make me a good ICU nurse. Part of what makes me such a good ICU nurse is my team--their willingness to teach and my willingness to learn, another part is my compassion for the pts, also my technical skills (which you cannot learn anywhere but an ICU), and among other things, my personality (able to deal with chaos and stress without freaking out)
    all of these things have also made me a very good floor nurse, but i prefer my ICU. thanks!
  9. by   NursKris82
    Quote from Lisa CCU RN
    I am a new grad and newly licensed and I am going straight into ICU ONLY because there is a 12 month internship in place and I have worked on this floor for six months as a nurse tech and I asked and observed all the grads of this internship and they have proven to be very good nurses.

    We have classes for six months, rotations through EVERY department, even the dietitian (sp). I have learned so much so far. We choose our own preceptors and I love mine.

    I think I will do just fine in the ICU.
    What an INCREDIBLE opportunity!! WE don't have programs that extensive where I'm from, they're decent- but that's great. Congratulations on getting in and being able to take advantage of this wonderful opportunity.
  10. by   Rage
    I have been in MICU for the past several months as a nurse tech. Since I grad in May the hospital does an interview for new NGs and was offered and accepted a position in MICU as a nurse. We have a 3 month orientation program in place although the unit tries to get you out as soon as possible due to the nursing shortage.
    My hospital is a trauma level 1 teaching hospital, and MICU gets it's share of SICU overflow. Since I have been there I have participated in 2 swan-ganz placements, observed 3 PICC placements, assisted in 5 CRRT set-ups, observed 3 then assisted in 4 central line placements (jugular, femoral, subclavian) and am considered the "par excellence" in compressions on the 5 codes I have been on (being 6'2 ad 245 pounds doesn't hurt). I have observed and and helped the nurses with patients who had Guillain-Barre, Turner's syndrome, Van Willibrand as well as all of the "normal" stuff as CHF, COPD, ARF, and suicide attempts by ingesting all kinds of strange stuff.
    I work full time and go to school full time..............and wouldn't change a thing. MICU to me is what envisioned nursing to be, and it has lived up to every expectation. I can exercise my understanding of labs, etiology and treatment of a variety of diseases. And I love change, so with a average stay of 3.8 days per patient this is where I want to be. I know more than some nurses as far as diagnostics and I know al ot less than others, I need to hone my skills area which I can see as being below the level it needs to be, so in whatever free time I have, I practice the procedure in my mind and if I have any questions the nurses are more than willing to help me out.

    As far as the ICU nurses eating their young syndrome, I have found that when your standing next to them doing compressions as they are pushing the epi, atropine, epi protocol of ACLS to keep their patients alive they are a lot more forgiving of you as a person.

    ICU isn't about inactive, it's about total active. If you want to spend your time observing and questioning then be prepared to encounter an attitude. But if you understand what your doing there and are offering your skills to the best of your ability and showing that your willing to learn and be part of the team, then you'll do fine.

    At least that has been my experience.
  11. by   MarkHammerschmidt
    I can't get past the feeling that a new grad has enough on their plate just learning the basics of practice, without the added stress of the ICU. There are lots of pros and cons to this, lots of opinions, and sure, some people do fine. But I think there's so much to learn to start with... people consistently underestimate the difficulty of the job, both technically and emotionally. I tell the new kids that it's "right up there with nuclear submarine", which is quite true - and they always laugh, as though it couldn't possibly be so. It is. Doesn't mean they can't do it - but I was never sorry I worked the floors first.
  12. by   TX_ICU_RN
    Quote from witnurse


    I am not sure I understand your post. Our nursing leadership team has decided to require one year of med/surg before any cross-training. I feel strongly about this in our facility because our ICU nurses are responsible for their own vents, we don't have Resp Therapy. Also, the care of med/surg patients really does build experience and confidence. I wish you the best though. Critical care nurse for 25 years.
    I am usually all for new grads going to the ICU if they have a unit with a good internship program. However, in your hospital, I would not want anyone to go work in the ICU without at least one year of med-surg experience. I can't imagine not having RT to manage the vents!
  13. by   neko11111
    I honestly think it depends on the individual. Some people have that certain drive, whereas others don't. Everyone is different. They say med/surg is more task oriented, whereas critical care requires more pathophysiology and critical thinking.

    I don't believe it to be fair to judge someone on there amount of experience alone. I started straight out of school in a CCU unit - and thrive on it. I learn something new every night that I work and apply that knowledge. I also know enough to ask for help and keep my eyes open for every learning opportunity available. Also, some of the old school nurses ask questions about what they are teaching these days.... I've helped some with tricks of the trade when it comes to starting iv's...

    If I had to start out in med/surg, I honestly would have shoved a pencil in my eyeball a long time ago and quit nursing all together. I knew that critical care/trauma was my calling,, the very first day I stepped foot on the ICU floors during school. It has been my drive, and I plan to advance my knowledge in this area for many years to come!

    So- please, look at the individual before blowing them off just because they lack years of experience. And that's my

close