New grads in ICU

Nurses Safety

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Hey nurses - I work in a CT surgery ICU in a big teaching institution. Our surgeons do repairs for aquired heart disease and congenital heart disease, so our patients are both pediatric and adult, neonates to geriatrics, and the acuity is very high. The practice had always been to hire experienced ICU nurses only, but about 5 years ago we started to hire new grads. Our routine has been to orient new nurses to the adult population first, and to the pediatric population after proficiency in adult care has been demonstrated. For experienced nurses that could take a month, for new grads, it could take 2 years. The expectation is that eventually, any nurse will be able to provide care for any of our patients. We're running into problems. The 2 years it takes new grads to get to the peds orientation means less adult/peds nurses available to take care of the peds patients. One complication of this is that when we have new grads orienting, senior nurses are often not available to precept because they are needed to provide pediatric care. So, new people are precepting new people. Do any of you out there work in a mixed population unit? If so, how are you handling your orientation process?

Even in ICU's without mixed pops, are you hiring new grads and how is it working out? Grateful for any help- Denise

OK. Does it really only take 1 month to orient a nurse who's being doing adult ICU for 10 yrs to PICU? Come on.

A former coworker of mine (Clinical Nurse Specialist for critical care services) takes 3 months to transition select motivated medsurg nurses to ICU novice with basic competencies. With that in mind, I don't see a huge problem with a motivated experienced adult critical care nurse cross training to PICU novice within a month's time (or vice versa-- if the will is there)

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OK. Does it really only take 1 month to orient a nurse who's being doing adult ICU for 10 yrs to PICU? Come on.

A former coworker of mine (Clinical Nurse Specialist for critical care services) takes 3 months to transition select motivated medsurg nurses to ICU novice with basic competencies. With that in mind, I don't see a huge problem with a motivated experienced adult critical care nurse cross training to PICU novice within a month's time (or vice versa-- if the will is there)

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Don't get me wrong, I know I don't know anything and I may not make it. But why won't you people even give us a chance?

Bluesky,

I know it's natural to be defensive because there are a lot of people who believe new grads don't belong in the ICU. I just want to encourage you and I know you know but there are many people who were new grads that started in the ICU and are doing fine. Of course everyone has their opinions but thats ok. Follow your heart. True you don't know all there is to know about the ICU but don't go in with the attitude that you don't know anything just build upon the knowledge you have from nursing school and use all the experience around you to grow. I'm glad you found a unit that accepts new grads and hopefully yours will be a positive experience. The first unit i ever worked in (NICU) was not new grad friendly but i stayed for a year, learned all I could learn and moved on to another NICU. I've been doing it for 3 years now and I'm now 6 months away from getting my MSN. So enjoy yourself, learn all you can and it'll be ok. Maybe one day you'll be able to shape and mold a new grad RN in the ICU and you'll always remember that one day you were in their very shoes and you'll be of support to them. Have a great career and stay strong everyone has to start somewhere and if it turns out to be not for you, you have plenty of other options.

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Don't get me wrong, I know I don't know anything and I may not make it. But why won't you people even give us a chance?

Bluesky,

I know it's natural to be defensive because there are a lot of people who believe new grads don't belong in the ICU. I just want to encourage you and I know you know but there are many people who were new grads that started in the ICU and are doing fine. Of course everyone has their opinions but thats ok. Follow your heart. True you don't know all there is to know about the ICU but don't go in with the attitude that you don't know anything just build upon the knowledge you have from nursing school and use all the experience around you to grow. I'm glad you found a unit that accepts new grads and hopefully yours will be a positive experience. The first unit i ever worked in (NICU) was not new grad friendly but i stayed for a year, learned all I could learn and moved on to another NICU. I've been doing it for 3 years now and I'm now 6 months away from getting my MSN. So enjoy yourself, learn all you can and it'll be ok. Maybe one day you'll be able to shape and mold a new grad RN in the ICU and you'll always remember that one day you were in their very shoes and you'll be of support to them. Have a great career and stay strong everyone has to start somewhere and if it turns out to be not for you, you have plenty of other options.

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OK. Does it really only take 1 month to orient a nurse who's being doing adult ICU for 10 yrs to PICU? Come on.

Yes, it really does. I have done it. I worked NICU exclusively and transitioned to adult ICU in about a month - I hated it, but adults were just not for me. I did not experience difficulties in the transition because I already was very comfortable in the critical care environment. I also learned and began working in PICU with, again, about a month of transition. It can be done. You will understand as you gain experience.

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OK. Does it really only take 1 month to orient a nurse who's being doing adult ICU for 10 yrs to PICU? Come on.

Yes, it really does. I have done it. I worked NICU exclusively and transitioned to adult ICU in about a month - I hated it, but adults were just not for me. I did not experience difficulties in the transition because I already was very comfortable in the critical care environment. I also learned and began working in PICU with, again, about a month of transition. It can be done. You will understand as you gain experience.

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Well, I am enjoying the responses I've gotten so far, and I hope they'll keep coming. Let me clarify a few things - especially for Bluesky, who I encourage to reread my original post more carefully. Yes, RN4NICU is correct - I was referring to experienced icu nurses who are soon ready for the peds orientation. If critical thinking already exists, moving into a new area of care, or a new patient population is just a matter of learning a new set of skills. Our new grads have a 16 week precepted program which includes class time and clinical time. They can get more time if they need it. They are mentored. So yes, we do give them a chance. But critical thinking can't be taught. And after they have had a couple of years to develop it, by practicing on adults who have more latitiude than pediatric patients, they get their month of peds orientation. I like the idea fergus51 had of orienting half the new grads to peds, half to adults. Problem with that is that while we do about 1200 adults a year, we only do about 300 kids. So wouldn't always be enough peds patients to keep exclusively peds trained nurses working. However, they could maybe work in PICU (which is almost always short) when the peds CT patients are scarce. Hmm.. I'll bring that idea up. The only generic difference between new grads and experienced nurses is time. But time is what it takes to develop critical thinking. And critical thinking is key when caring for icu patients. Not saying that our adults aren't sick - being a teaching institution we don't see many elective cabg's- but there's a big difference between a 70 kg, re-do cabg/avr/maze patient and a 5 day old, 3 kg hypoplast with an open chest who's just had a Norwood. Or a 14 year old cardiomyopathy kid on a Bivad and multiple gtts who needs to stay alive long enough to get a heart. The two groups of patients really can't be treated the same; it's different skill sets. We are considering the idea of orienting new nurses (new grads as well as experienced nurses) to both populations at the same time. So for instance, if I was precepting Bluesky, she would come with me to whatever my assignment was for the day, adult, peds, charge, etc. What do you experienced nurses think of that idea?

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Well, I am enjoying the responses I've gotten so far, and I hope they'll keep coming. Let me clarify a few things - especially for Bluesky, who I encourage to reread my original post more carefully. Yes, RN4NICU is correct - I was referring to experienced icu nurses who are soon ready for the peds orientation. If critical thinking already exists, moving into a new area of care, or a new patient population is just a matter of learning a new set of skills. Our new grads have a 16 week precepted program which includes class time and clinical time. They can get more time if they need it. They are mentored. So yes, we do give them a chance. But critical thinking can't be taught. And after they have had a couple of years to develop it, by practicing on adults who have more latitiude than pediatric patients, they get their month of peds orientation. I like the idea fergus51 had of orienting half the new grads to peds, half to adults. Problem with that is that while we do about 1200 adults a year, we only do about 300 kids. So wouldn't always be enough peds patients to keep exclusively peds trained nurses working. However, they could maybe work in PICU (which is almost always short) when the peds CT patients are scarce. Hmm.. I'll bring that idea up. The only generic difference between new grads and experienced nurses is time. But time is what it takes to develop critical thinking. And critical thinking is key when caring for icu patients. Not saying that our adults aren't sick - being a teaching institution we don't see many elective cabg's- but there's a big difference between a 70 kg, re-do cabg/avr/maze patient and a 5 day old, 3 kg hypoplast with an open chest who's just had a Norwood. Or a 14 year old cardiomyopathy kid on a Bivad and multiple gtts who needs to stay alive long enough to get a heart. The two groups of patients really can't be treated the same; it's different skill sets. We are considering the idea of orienting new nurses (new grads as well as experienced nurses) to both populations at the same time. So for instance, if I was precepting Bluesky, she would come with me to whatever my assignment was for the day, adult, peds, charge, etc. What do you experienced nurses think of that idea?

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Personally, I think that idea would depend on the new grad. In my experience nurses are scared of smaller patients, so they need to be immersed into that area to feel comfortable. Trying to learn to care for both patient populations at once might be overwhelming for them. It would take a confident new grad to manage both at once, but with a good orientation and a supportive environment, I am sure some could do it. And I am certain the experienced ICU nurses you hire would do fine with an orientation like that.

I think the idea of coming up with some sort of agreement with your PICU is a great idea. Either that or if there are no peds patients when a peds trained new grad is scheduled, that could be a teaching day for the adults since they'll have to do that eventually anyways.

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Personally, I think that idea would depend on the new grad. In my experience nurses are scared of smaller patients, so they need to be immersed into that area to feel comfortable. Trying to learn to care for both patient populations at once might be overwhelming for them. It would take a confident new grad to manage both at once, but with a good orientation and a supportive environment, I am sure some could do it. And I am certain the experienced ICU nurses you hire would do fine with an orientation like that.

I think the idea of coming up with some sort of agreement with your PICU is a great idea. Either that or if there are no peds patients when a peds trained new grad is scheduled, that could be a teaching day for the adults since they'll have to do that eventually anyways.

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Specializes in Critical Care, ER.
Don't get me wrong, I know I don't know anything and I may not make it. But why won't you people even give us a chance?

Bluesky,

I know it's natural to be defensive because there are a lot of people who believe new grads don't belong in the ICU. I just want to encourage you and I know you know but there are many people who were new grads that started in the ICU and are doing fine. Of course everyone has their opinions but thats ok. Follow your heart. True you don't know all there is to know about the ICU but don't go in with the attitude that you don't know anything just build upon the knowledge you have from nursing school and use all the experience around you to grow. I'm glad you found a unit that accepts new grads and hopefully yours will be a positive experience. The first unit i ever worked in (NICU) was not new grad friendly but i stayed for a year, learned all I could learn and moved on to another NICU. I've been doing it for 3 years now and I'm now 6 months away from getting my MSN. So enjoy yourself, learn all you can and it'll be ok. Maybe one day you'll be able to shape and mold a new grad RN in the ICU and you'll always remember that one day you were in their very shoes and you'll be of support to them. Have a great career and stay strong everyone has to start somewhere and if it turns out to be not for you, you have plenty of other options.

Wow. Thank you so much. What a sweet and wonderful response! I assure you that I am going to do everything I can to be as good as I can as quickly as possible. I've already read my husband's CCRN book AND learned to read EKGs with the Dubin book. I truely hope to be of use to my unit before 2 years! I am sorry I am being so defensive. :uhoh21: I know I shouldn't have posted to this thread as it was directed to experienced nurses. Originally, I just wanted to share how my hospital was orienting us- then I digressed into the new grad issue.

Up Vote Up Vote ×
Specializes in Critical Care, ER.
Don't get me wrong, I know I don't know anything and I may not make it. But why won't you people even give us a chance?

Bluesky,

I know it's natural to be defensive because there are a lot of people who believe new grads don't belong in the ICU. I just want to encourage you and I know you know but there are many people who were new grads that started in the ICU and are doing fine. Of course everyone has their opinions but thats ok. Follow your heart. True you don't know all there is to know about the ICU but don't go in with the attitude that you don't know anything just build upon the knowledge you have from nursing school and use all the experience around you to grow. I'm glad you found a unit that accepts new grads and hopefully yours will be a positive experience. The first unit i ever worked in (NICU) was not new grad friendly but i stayed for a year, learned all I could learn and moved on to another NICU. I've been doing it for 3 years now and I'm now 6 months away from getting my MSN. So enjoy yourself, learn all you can and it'll be ok. Maybe one day you'll be able to shape and mold a new grad RN in the ICU and you'll always remember that one day you were in their very shoes and you'll be of support to them. Have a great career and stay strong everyone has to start somewhere and if it turns out to be not for you, you have plenty of other options.

Wow. Thank you so much. What a sweet and wonderful response! I assure you that I am going to do everything I can to be as good as I can as quickly as possible. I've already read my husband's CCRN book AND learned to read EKGs with the Dubin book. I truely hope to be of use to my unit before 2 years! I am sorry I am being so defensive. :uhoh21: I know I shouldn't have posted to this thread as it was directed to experienced nurses. Originally, I just wanted to share how my hospital was orienting us- then I digressed into the new grad issue.

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