Thoughts on/advice for new grads in Neuro ICU please...

  1. Hello there, I just graduated last week with my BSN and was contacted yesterday by a very prestigious medical center near me for a job I applied for a Neuro ICU RN position. I am completely shocked and also very excited to be contacted for an interview. My main dilemma is if I should actually start out as a new grad in a Neuro ICU. I have very little to no experience with neuro patients at all. I did participate in a summer internship and final clinical rotation in ICU but, not specifically neuro ICU. I know this would be a fantastic opportunity for me to take and I really have my heart set on working in an ICU, I just want to make sure I can actually do this. Anyone out there start out as a new grad in a neuro ICU? Is it do-able for a new grad? What was the orientation like? Any advice is greatly appreciated. Thank you!!!
  2. 19 Comments

  3. by   Imgettingthere
    Wow! I am a new grad, and this is EXACTLY what happened to me! I did my senior practicum in ICU, (not neuro) and was hired in a neuro ICU unit upon graduation. I have a TON to say about this, and will hit the high points here, but would be happy to be your "mentor" if you go into this position, because it is very unique and challenging....and I wish I had one! We can exchange phone numbers if you would like, and stay in touch about this.

    Here are my highlights.

    1. You can do this. Yes, it will be difficult. The only opposition you will have will probably be from seasoned nurses who think you must "walk through the trenches" before you will succeed at this. As a result, you might start out having to "prove" yourself....over and over. I had daily reminders of how long others worked in general nursing for years before they were considered for ICU positions. Respect them, but ignore any suggestion that you will not survive. Remember, there is a shortage of nurses. ICU's don't have time to wait for nurses to be "seasoned".

    2. Make sure the hospital had a top notch training/preceptor/mentoring program to support you through this, including a "zero tolerance" policy for lateral undermining or bullying. Sorry to say, it happens and it brings your learning to a screeching halt.

    3. Neuro ICU rocks. It is very complicated, patients are very sick, and outcomes are often not good for patients and families. You will feel your schooling didn't prepare you to be a nurse, (it didn't/couldn't prepare you for ICU) so plan on lots of at home studying, reference cards/notes hanging out of your pockets, and generally feeling like you are back in school. I found this a vey fullfilling experience as I was learning the "real" stuff.

    4. Neuro meds are terrifying, and you should have great respect for them. Google neuro meds and start studying them now. They always change.

    5. Study neuro anatomy. Have it down cold. As well as electrolyte imbalance/replacement. I do this all day long.

    6. Be prepared for double standards. You will hear, "ALWAYS ask if you don't know"...then when you do ask, someone will say, "what? They didn't teach you that in nursing school?" Just let it roll off of your back and remember, you are there for the patient first. Get accurate information.

    7. Find your support systems/people and utilize them. Family, friends, co-workers. Avoid those who will bring you down with bad attitudes or those who undermine you. You are a nurse. A new grad, yes, but a nurse. Be part of the solution in being the new generation of nurses who will not "eat their young" but welcome fellow colleagues.

    8. Last but not least, GO FOR IT. We need you. You will succeed.

    Please feel free to contact me at if you would like to communicate more. Good luck in your interview, and congrads on your graduation.

    Take care.
  4. by   AJ BSN 2008
    Wow, thanks so much for your words of wisdom! I don't have my interview until the middle of January so, who knows what will happen. I still cannot believe that I am even being considered for this specialty. When I applied, I was interested in the position but, thought I probably will never even be considered because of my lack of experience. Can I ask if you have had any prior work experience r/t critical care and if that has helped you at all? While I attended school I worked at a small community hospital near my university in the ICU as a patient care tech, unit clerk, and tele tech. I credit this experience for why I want to work in the ICU (prior to that I had no idea what type of nursing I wanted to do). I now currently work at a different hospital on a tele unit as a patient care tech and have been offered a job there. Despite the fact that I have pretty much gauranteed employment I decided to not limit myself and apply at other hospitals, just to see what else is out there. The way I look at it is if all else fails, I can take the job on the tele unit where I currently am employed since I know that would be helpful for transitioning into ICU later down the road. I just wish I had a sign to tell me where I should start out. I hate not knowing where I will be beginning my career. Thanks again for your thoughts. I will definitely be keeping in touch with you :typing
  5. by   HezzRN
    I graduated in '07 and started out in MICU and then moved to NSICU. This year I was a preceptor for the '08 grads and I am also working as a charge nurse for our unit. I hate to say this but I have had less mistakes and problems from our new grads then I have had from our nurses with 15+ yrs of experience. (especially with critical gtts)

    I am a firm believer that new grads can do very well in an ICU setting although it isn't for just anyone.
  6. by   His_girl
    Thank you all for your thoughts. I am a new grad starting in NICU this month without background in this area. I am very serious person, love studying and totally inlove with the brain. Thanks Imgetting there for all of your thoughts; that really encouraged me.
  7. by   Imgettingthere
    You're very welcome! I am finding more and more that new grads are moving into these positions out of nursing school, and it is a very unique challenge. It sounds like you have the right attitude, and your love of learning will serve you well. Keep in touch! I would like to know how you are doing.:typing
  8. by   Imgettingthere
    Wow...interesting...I don't mean to make any generalizations here, but I have found in my limited experience that without the history of habit and repetition, I have in fact, pointed out some potential errors/false information that I gleaned in nursing school. It's not like I can save the world being a new grad, but there are some advantages of a recent/current education that can be an asset to a critical care team. I agree it is not for everyone. Managing the care of one or two patients that are so complex that you look forward to having to go to the supply room to take a breath can be overwhelming. But also exhilarating. Thanks for your thoughts.
  9. by   AJ BSN 2008
    Hi again. Just wanted to give you an update. I had my interview for the Neuro ICU on Wed and the very next day the hospital contacted me and offered me the position . I told the HR person that I need some time to think this over but, I think I am going to go ahead and take the job. Overall, I got a very good vibe from this is a very prestigious, magnet teaching facility and is new grad and nurse friendly. I know if I don't take this job I will regret it and always wonder what could have been. Anyway, thanks for all the advice. Imgettingthere, let me know how things are going for you....
  10. by   samcnl
    I am also a new grad starting in a Neuro ICU in Feb. I had the chance to precept there for my last semester of nursing school, and fell in love with it. I can't wait to start!!
  11. by   AJ BSN 2008
    Hey samcnl, thats great to hear that you will be starting out as a new grad on a neuro icu. You are so fortunate to have had the opportunity to have actually precepted on that unit while you were still in nursing school. I will also be starting in the neuro icu as a new grad but, I don't start until the beginning of April. Anyway, please let me know how things go for you.
  12. by   allnb324
    Hello, I did actually start out as a new grad in a Neuro ICU unit. I have been there for a little over three months now. I am going to be honest with you, it's VERY difficult. You come out of school knowing the basics, enough to keep you safe. But trust me...........we know nothing essentially. I have never felt so totally ignorant as I did the day that I stepped out onto the unit for the first time. There is so much to learn, so many meds to manage, and then the patient acuity to consider as well. I love working my job, but it's very stressful at this point because I personally feel so out of my element or comfort zone. I have been told numerous times that I needed to be patient because it takes new nurses at least a year to a year and a half to feel comfortable in ICU. If you have already started , let me know how it's going. I'd love to hear from you.
  13. by   the sparrow
    jobs in the neuro ICU when you graduate?? Where the hell do you guys live?? I just graduated in May and I couldn't get a housekeeping job in an ICU around here right now...
    Consider yourselves extremely fortunate.
  14. by   Butterfly3001
    Any updates??? I will be graduating soon and I am also interested in Neuro ICU, but of course shaking in my boots because it seems so challenging.