An ICU nurse manager told my wife that her Med/surg experience was hurting her!?

Published

We went to a job fair at a new North side hospital today only to learn that all positions (including med/surg) required two years experience. I started up a conversation with the manager of the new ICU, and related how important it was for my wife to get in the ICU. I also told her of my hypothesis that it might be more difficult for a nurse with some nursing experience, but not two years to find an ICU job than a new grad (based upon my observation that several of my wife's classmates had no trouble going straight to the ICU, but that she has had problems trying to transfer after six months).

I was surprised to find that she (the ICU manager) absolutely agreed with me. In fact she said that my wife going to Med/sugical in the first place was a mistake if she had the ambition of going to the ICU, and then becomeing a CRNA. She indicated that Med/surg was in fact making her a worse ICU prospect since it tended to degrade critical thinking skills necessary to the ICU. Personally, I don't see how caring for four to five very sick patients most with multiple IV's, and many with telemetry could degrade the skills of a new nurse! However, in the real world perception is reality and I'm left to wonder is this really what ICU managers think? IF so why would someone become acceptable after two years experience in med/surg? After all if being in med/surg degrades critical thinking skills then one would think that those skills would be significantly more degraded after two years than only after six months.

Unfortunately, it is my impression that to the entent any ICU positions are available in our area for newer grads, that they are of the nighttime variety.

The new grad vs. experienced medsurg experienced candidate: who makes a better ICU trainee? is an age old debate. Personally, I think the calibur of the ICU nurse you get is more a function of that individual's personal attributes than their nursing background, but that's just me.

What does your wife, herself, believe? If she does some soul searching and finds that she believes that a year or two of med-surg will make her a better CRNA in the long run then go for it! If, on the other hand, she feels that she can handle direct entry into an ICU well then go for that!

The key, ultimately, is to find a hospital that embodies her belief system.

More than the new grad vs. m/s nurse issue, I have found one factor that contributed to poorer one year evals... night shift. The fellows that went directly to night shift after their training did disproportionately more poorly on their one year evals than those that stuck to days. On days you get to go on more roadtrips, attend rounds, assist with more procedures, be around for more consults, etc. This phenomenon was so pronounced on my unit that the new batch of fellows this summer are actually not allowed to transfer to nights for a year. I have first hand experience with this because I was one of the top fellows out of the fellowship but fell behind after I transferred to nights way too soon. Since I've gone back to days, I am getting all kinds of kudos from my managers, peers and attendings at how much I am growing and excelling (read they felt I had a lot of growing to do...)

Up Vote Up Vote ×

I was told med/surg was a good foundation to go to any department because you learned more about alot of different illnesses and patho. I can really tell that I have learned alot in my 7months med/surg.

melissa

Up Vote Up Vote ×

I've said this before here, but nurses seeking a move to ICU really need to find a good Critical Care Internship program and an education dept that supports them and gets them the right combination of education and experience.

I've worked in ICU's where nurses were brought in and trained 'on the job' and while I did this myself many years ago, most ICU environments today are not conducive to OJT,and won't support most novice's needs. Dedicated internship programs are the way to go IMHO ! :)

Up Vote Up Vote ×

I have been working in NE ohio for the last 18 mos. Everyone who has gotten into CRNA school lately has been very young and just out of school with about 1yr icu exp. The schools want youngins with no responsibilities or kids, etc. who will easily complete the program. The schools have only one thing on their minds: board pass rate.

Up Vote Up Vote ×
Specializes in Med Surg, Hospice, Home Health.
We went to a job fair at a new North side hospital today only to learn that all positions (including med/surg) required two years experience. I started up a conversation with the manager of the new ICU, and related how important it was for my wife to get in the ICU. I also told her of my hypothesis that it might be more difficult for a nurse with some nursing experience, but not two years to find an ICU job than a new grad (based upon my observation that several of my wife's classmates had no trouble going straight to the ICU, but that she has had problems trying to transfer after six months).

I was surprised to find that she (the ICU manager) absolutely agreed with me. In fact she said that my wife going to Med/sugical in the first place was a mistake if she had the ambition of going to the ICU, and then becomeing a CRNA. She indicated that Med/surg was in fact making her a worse ICU prospect since it tended to degrade critical thinking skills necessary to the ICU. Personally, I don't see how caring for four to five very sick patients most with multiple IV's, and many with telemetry could degrade the skills of a new nurse! However, in the real world perception is reality and I'm left to wonder is this really what ICU managers think? IF so why would someone become acceptable after two years experience in med/surg? After all if being in med/surg degrades critical thinking skills then one would think that those skills would be significantly more degraded after two years than only after six months.

Medical / Surgical experience used to be the stepping stone to ICU, MICU and other specialty units... I think the ICU manager has been stuck in an office too long. I can rememeber a time when you COULDN'T walk out of school and into an ICU position BECAUSE you didn't have med/surg experience...

atlantarn

Up Vote Up Vote ×
Unfortunately, it is my impression that to the entent any ICU positions are available in our area for newer grads, that they are of the nighttime variety.

Roland, how far along are you in school?

Up Vote Up Vote ×

I graduted a year ago, and have spent this past year on a floor that gets ortho/neuro and general surgery as well as overflow medical pts. I am transferring to the ICU next week. Our hospital has only one ICU for all the critical pts, peds are transferred out asap. My reasoning for wanting to go to ICU is that I am usually so busy on my floor, doing shift assessments, given meds and charting, that I rarely have the time to see the "big picture" of what is going on with my pts. When, and if I get any downtime, I can be found reading progress notes, op reports, h&ps and looking at labs. Our charge nurses usually end up monitoring labs and calling docs. The sad truth is that I don't have the time to sit by the phone waiting for a doc to return my page. I feel that if I spendtoo much longer on my current unit, with the same pt load (7-8 on nights) that my critical thinking skills will go down the drain due to under use. Also, I want to do more direct care ie turning and baths because I have never been very comfortable with being accountable for tasks that I don't do myself or at least get to observe being done.

I do think that my year of experience will allow me to get off to a better start in the unit than a brand new grad. At the very least, i have definately honed my tame management and organizational skills.

I will get 6-8 weeks of precepted orientation. (New grads get 12) I'll also spend 4 hours per week completing an online learning module that will help me refresh A&P, patho and pharm.

I am beyond excited. My long term goal, since I am married to the military, is to move to a hospital that has sicker pts and does more advanced procedures. I've always been into the science/ high tech stuff.

Up Vote Up Vote ×

IN THE DEFENCE OF THE NURSE MANAGER OF THE ICU THAT YOU SPOKE WITH, SHE IS RIGHT. I HAVE WORKED IN AN ICU FOR OVER 4 YEARS AND FOR THE MOST PART, NURSES WHO GIVE REPORT FROM THE FLOOR HAVE LITTLE TO NO CRITICAL THINKING SKILLS WHAT SO EVER. THEY JUST THINK

"SENT THEM TO ICU." MY OPINION IS IT IS BECAUSE THEY ARE TO OVERWHELMED WITH PT. LOADS. THEY HAVEN'T THE TIME TO STOP AND THINK ABOUT MUCH. HONESTLY I WOULD BE SCARED FOR MY LICENCE IF I HAD TO RESPONSIBLE FOR AS MANY AS 7-9 PT. AT ONE TIME. SO IF YOUR WIFE WANTS HER CRNA, I WOULD JUST GO STRAIGHT TO THE ICU.

We went to a job fair at a new North side hospital today only to learn that all positions (including med/surg) required two years experience. I started up a conversation with the manager of the new ICU, and related how important it was for my wife to get in the ICU. I also told her of my hypothesis that it might be more difficult for a nurse with some nursing experience, but not two years to find an ICU job than a new grad (based upon my observation that several of my wife's classmates had no trouble going straight to the ICU, but that she has had problems trying to transfer after six months).

I was surprised to find that she (the ICU manager) absolutely agreed with me. In fact she said that my wife going to Med/sugical in the first place was a mistake if she had the ambition of going to the ICU, and then becomeing a CRNA. She indicated that Med/surg was in fact making her a worse ICU prospect since it tended to degrade critical thinking skills necessary to the ICU. Personally, I don't see how caring for four to five very sick patients most with multiple IV's, and many with telemetry could degrade the skills of a new nurse! However, in the real world perception is reality and I'm left to wonder is this really what ICU managers think? IF so why would someone become acceptable after two years experience in med/surg? After all if being in med/surg degrades critical thinking skills then one would think that those skills would be significantly more degraded after two years than only after six months.

Up Vote Up Vote ×
Specializes in ACNP-BC.

Hi everyone. I'm a new grad RN & I thought you all might like to hear my perspective on this topic. I've been working on a med/surg/tele floor for three weeks now (I have 9 more weeks of orientation to go) & really love it. I have been considering working in an ICU setting in the future. However, the idea of being a brand new grad in the ICU is scary to me! I'm still right now trying to get organized, work on prioritizing my care, still trying to get comfortable working with physicians, etc. that if I were to just jump right into an ICU I would be so overwhelmed. I think the only major thing I don't like about med surg is having to take care of so many patients-that is scary too. Right now I'm up to taking care of only 3 patients, but even 3 patients keep me so busy with assessments, meds, treatments, charting, & of course all the phone calls & other interuptions. I like to have time to actually spend quality time with my patients to talk to them, listen to them & comfort them if they're worried about their upcoming surgery, answer their questions on their meds, etc. I know it's going to be hard to spend time with my patients when I'm up to taking care of anywhere from 5-10 of them. Anyways, my point is I still think med surg is a good starting place to learn how to be a nurse first, before thinking about going over to critical care settings.

-Christine

Up Vote Up Vote ×
Specializes in ICU, Education.

I have been nursing for 20 years. I spent 3 years as a med/surge RN before i took a critical care course and transfeerred to ICU. It took me 3 years because i was scared to death. After 17 years in ICU, I've seen all kinds of "nurse to ICU" transitions.

I really can't stand to hear the ICU nurses knocking the floor nurses(especially that nurse who has only worked for 4 years and NEVER worked the floor) At least when I came to ICU, I already knew & had experience in basic assessment, starting iv's, passing medications, calling docs, placing NG'S and foleys, understanding lab values, hanging blood & TPN, chest tubes, assisting physicians in procedures, etc., and I had awesome organizational skills. My ICU preceptors could then focus on my critical thinking & subtle assessment, help me to learn ventilators, hemodynamics, ecg, assertiveness, troubleshooting, crisis management, etc. No internship around gives you the fundamentals that acutal med /surge work experience does. And I challenge that "4 year ICU nurse" to do a med/surg nurse's job as well as some of them do.

I am not knocking the new grad with an internship either, but I truly think the med/surg nurse has more sound fundamentals. I have precepted both, and it is diffiuclt to be teaching basic nursing, when you know this new nurse will be taking a patient with MSOF, sepsis, on PC ventilation and maxed out pressors (with another patient) on thier own in 3 months, and they can't even make a bed roll, or they have to look up every med they're giving.

The most important thing, however, in my book is attitude. That fear that kept me out of ICU for 3 years is important. I carried that fear for a long time after i worked in ICU, and sometimes I'm still scared. These are real people we are taking care of. You must never stop caring for them the way you would your brother or mother. It is not just a job. you need to ask, you need to read up, and ask ask ask. You need to care.

Up Vote Up Vote ×

More than the new grad vs. m/s nurse issue, I have found one factor that contributed to poorer one year evals... night shift. The fellows that went directly to night shift after their training did disproportionately more poorly on their one year evals than those that stuck to days. On days you get to go on more roadtrips, attend rounds, assist with more procedures, be around for more consults, etc.

This is an excellent post. I am now 3 months on an ICU as a new grad, and am in the "night orientation" phase now. I do feel that I am missing a lot, because most of the knowledgeable experienced nurses are on days, who I can't touch base with anymore. I also miss rounds, road trips, etc. When I am done with orientation, of course, I will go to nights, and rotate to days, but it will be like 6 weeks of nights, 3 weeks of days. The nurses on nights are fine, but don't have the 30 years of experience that some of the day nurses have.

I do think that it is probably better to have new grads on days a little longer.

Oldiebutgoodie

Up Vote Up Vote ×
Specializes in critical care.

:nono:

I was a med surg nurse for 10 years before I went to the unit. 10 years of very fine assesment skills came with me . It is not that they lack skills what they lack is resources and SUPPORT!!!!!!!!!!!!!!And attitudes like yours do not help. These nurses think on their feet and on the go they make quick assesments and are tuned to subtle changes with out the aid of moniters, probes, lines ,or what not! If any thing I have lost most of that ability so I would never be able to return to med surg. Critical patients have no business on a med surg floor. It is not that "they just think send them to the unit ".These nurses know "get them out of here ,NOW. period. Med surg is a skill and an art just like any other speciality. geez

IN THE DEFENCE OF THE NURSE MANAGER OF THE ICU THAT YOU SPOKE WITH, SHE IS RIGHT. I HAVE WORKED IN AN ICU FOR OVER 4 YEARS AND FOR THE MOST PART, NURSES WHO GIVE REPORT FROM THE FLOOR HAVE LITTLE TO NO CRITICAL THINKING SKILLS WHAT SO EVER. THEY JUST THINK

"SENT THEM TO ICU." MY OPINION IS IT IS BECAUSE THEY ARE TO OVERWHELMED WITH PT. LOADS. THEY HAVEN'T THE TIME TO STOP AND THINK ABOUT MUCH. HONESTLY I WOULD BE SCARED FOR MY LICENCE IF I HAD TO RESPONSIBLE FOR AS MANY AS 7-9 PT. AT ONE TIME. SO IF YOUR WIFE WANTS HER CRNA, I WOULD JUST GO STRAIGHT TO THE ICU.

Up Vote Up Vote ×
+ Join the Discussion