New Graduates In The Icu?

  1. 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 ICU?
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  2. 55 Comments

  3. by   pink.edwina
    Quote from Aaron Catmull
    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 ICU?
    In the UK Yes, An RN here is expected to qualify here competent to practice at point of registration....with appropriate preceptorship package and suprenumery period they can fly if motivated and supported.
  4. by   bcjams
    I think you need to be a great ICU nurse before you can be a great med surg nurse. You still need all the critcal thinking skills and nursing knowledge in either area and med surg doesnt have all the infomation readily available..you have to just be able to look at the patient and know when something is going bad....I am going ICU first...then Med surg...it safer for everyone.
  5. by   witnurse
    Quote from bcjams
    I think you need to be a great ICU nurse before you can be a great med surg nurse. You still need all the critcal thinking skills and nursing knowledge in either area and med surg doesnt have all the infomation readily available..you have to just be able to look at the patient and know when something is going bad....I am going ICU first...then Med surg...it safer for everyone.
    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.
  6. by   suzanne4
    Quote from Aaron Catmull
    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 ICU?
    It all comes down to the type of orientation and how long your preceptorship will be for. No facility is going to put a new grad out to the wolves the first week that they are out of school. Critical thinking needs to be learned and practiced, it is not something that can be done overnight.

    If the nurse wants to work in the ICUS, then there is no reason that they need to put in a year in med-surg. Each is their own specialty. Each has its own nuances that can only be learned while doing.
  7. by   bcjams
    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 can see why an absolute newbie should work med surg for a year. However I have been an LVN for 7 years and feel more than ready to go to ICU....i hope that clears it up.
  8. by   NotReady4PrimeTime
    Our experience with new grads in our PICU (mostly CV and trauma) has been mixed. Some have been pretty on-the-ball, and some have been downright dangerous: they don't know enough to know when they're in over their heads and don't ask for help. The way our unit's census changes, it's not always possible to find an assignment that is appropriate for a lot of these new grads once they're off orientation, so they are assigned patients they shouldn't be. We're seeing this a lot lately because in the last year we've hired a more than a dozen of them (>10% of our total staffing). We may only have one or two stable single-system patients in the unit, and four new grads to find spots for. So the more senior nurses are left responsible for watching over these nurses and their patients to ensure nothing goes wrong, plus their own assignments. I seem to find myself riding herd on a group of new-grad or very junior nurses whenever I work nights. I really think that a stint on a med-surg floor would help them prioritize and organize their work, offer them practice in assessment and hands-on nursing skills and prepare them better for the pace of the ICU. My
  9. by   Eric1233
    I was upset when I heard my ICU was going to required me to go to med-surg for 6 months. Now, that it is all over and I'm in ICU, I can see how valuable it was. You get the basics down in med-surg, that way when you go to ICU it is not totally overwhelming. If you have been a LVN in a hospital for 7 years you will have no problem. For me a brand new nurse with not much prior experience med-surg was a good thing.
  10. by   CHATSDALE
    with prior experience as you would probably qualify as icu material
    depending on your facility requirements.
    however if my loved one was in icu i would prefer an experienced nurse..i probably wouldn't be told one way or theother
  11. by   RRT/RN
    Quote from Eric1233
    I was upset when I heard my ICU was going to required me to go to med-surg for 6 months. Now, that it is all over and I'm in ICU, I can see how valuable it was. You get the basics down in med-surg, that way when you go to ICU it is not totally overwhelming. If you have been a LVN in a hospital for 7 years you will have no problem. For me a brand new nurse with not much prior experience med-surg was a good thing.
    I am a resp therapist with over 12 years experience and have been working as a med surg RN since January. I voluntarily decided to work med/surg for a while before going to ICU, and boy am I glad I did. I miss working with vents and critical patients, but the skills that are learned on med/surg--basic nursing--are building blocks for critical care IMHO. I've seen (and spoken with) many nurses who have done it both ways, and most say that their time spent on med surg helped them imensely. Don't know how long I will stay med surg, but I think I made the right decision.
  12. by   PJMommy
    I have to weigh in on this one....

    First, I was a new grad in the ICU. Yes, there were a few times everything was totally overwhelming. But I love critical care and would not have started in med/surg in order to "do time".

    With that said, as a now more experienced nurse, I believe the ability of a new grad (or any nurse) to succeed in ICU depends totally on that person. I have seen new grad, 22 y/o nurses become excellent ICU nurses...but I've also seen those who have no clue how to organize and prioritize. But I've seen experienced med/surg nurses come to work in ICU and absolutely struggle...and those who hit the ground running.

    I guess I don't believe success as an ICU nurse can necessarily be learned by working in med/surg. I tend to think success in critical care comes more from a nurse's learning style and personality. Just my two cents worth....
  13. by   dlchap78
    I graduated in August and went straight to days in a busy med/surg/transplant/neuro unit. I worked there as a secretary and tech for two years before I graduated. I was still surprised at what icu nursing entailed. I knew that I wanted to be an icu nurse and that med surg wasn't for me. I work extremely hard at my job and at the end of my day I am mentally, emotionally and physically drained but I don't feel it would be any different if I would have started out in med.surg. I am lucky enough to have a great group of long term nurses to support me and teach me and all approved of me coming to days. I think it would be very difficult to start in a completely new ICU w/o any knowledge of the group of people you will be working with or how the unit runs. If you do start out in the ICU take as many classes as you can. they really help to supplement your knowledge.
    I have also asked the question "if my loved one was in the ICU would I let a new grad like myself take care of them?" YES. I think sometimes I am more aware of what is going on with my pt than other longer-term nurses. I am very anal about the status of my pts and when some of the other nurses think I am jumping to conclusions I have had families and docs thank me for inquiring about the problem. Anyway that is my 2cents. Take is or leave it.
  14. by   ThumbzRN
    I went straight from bartending into a busy 43 bed ICU out of an ADN program. The unit includes CCU, SICU(trauma level II), and MICU. It has been two years now and and I have learned alot. I would not trade the experience for anything. I continue to find ways to learn and improve my practice. Not to scare you, but I was like a deer in headlights for the first year and there were days I felt like I did not know enough to care for people with such a low reserve. I was lucky to have great mentors and other staff willing to answer all of my questions giving me guidance. Without there support I would not have felt safe. Now I have much more confidence. Starting in the ICU was very hard, but in retrospect very rewarding. I have seen many do well through our intern program. Many who did well were externs before the intern program. Just make sure if you go into a specialty area that that the training program is adequate and that the staff will support you in your development as a nurse. I think if your dedicated enough and ask plenty of questions you can survive in the ICU. Remember to take criticism constructivley, learn from your mistakes, and realize nobody is perfect. With every patient there is something to learn no matter what area you choose. The hospital should progress you as you become more efficiant and knowledgable in your practice. I feel at home in the ICU. I hope you feel the same way no matter what area you choose. Good Luck.

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