Any new grads that went into the ICU?

20year veteran · Apr 19, 2000

Kim,

I'm not a new grad nor did I go right into the ICU BUT I am a manager who hires new grads. I just wanted to say "Good luck" to you!

FYI:

When other managers ask me why I hire new grads into ICU I say "because they don't come with years of bad habits, and we'll be the ones to mold them into the type of nurses we want." that might come in handy for you.

KR · Apr 21, 2000

Thank you so much I got the job and start May 15th. Very excited and a lil nervous. But none the less very looking forward to it. I really appreciate the reply and the thoughts. Keep in touch. Kim

TRN · Jun 2, 2000

KR....I want to go into ICU nursing right from the start also. We should keep in touch so you can share your experiences with me. I will graduate in a year and would love to learn from you. I really want to be an ICU nurse but I'm afraid I don't have the skills. You can teach me as you learn new things! ;-)

KR · Jul 21, 2000

Hi TRN,

My email is [email protected]. Email me and I will email ya back and we can keep in touch. I couldnt find your email in your profile. Best of luck to you! Kimberly Rush

ICUkids · Aug 4, 2000

I was a new grad in a PICU 14 yrs ago. Still there, have been up the ladder to mgr, back to my passion of patient care. I have oriented and hired new grads and with solid support they are doing fine. Key ideas are support, orientation programs and recognition that proper assignments build confidence. Not always easy but certainly something to strive for. Good Luck, it is possible.

ratchit · Sep 21, 2000

A bit of a change in subject here...

As someone who is not in favor of new grads in ICU's due to lack of clinical judgement, experience, and ability to know when they are missing something, I am curious about how other hospitals new grads are faring.

The two in my hospital (not orienting on my shift, not being precepted by me, not aware of my opinions, so not my fault ) are doing poorly. Mostly, they are overwhelmed by the pace and are frustrated with other people getting frustrated with them (e.g. 4 calls to an attending to clarify an order that had to be re-clarified by me later.) With one there is a "weak preceptor" factor that is being addressed, but the other, while bright and well intentioned, is being sent to another unit for some seasoning first.

I love to precept and mentor students and think all new grads should get a solid and comforting preceptor to lead them and back them up. But the place for this, IMHO, is NOT the ICU's. Any impressions? Anyone's new grads doing well or poorly? I am currently in a community/Level 2 trauma hospital- any smaller or larger hospitals having a different experience?

hollykate · Sep 22, 2000

Hi Nurse Ratchit,

I am a new Grad in one of my hospital's 10 critical care units (NSICU)(Level one trauma center, high acuity). I got off orientation about 3 weeks ago and am doing very well. My first evals were great! In addition, the attendings and residents have all told me they are happy to see me in the unit (they know me from my techie days in the ED). Several RN's on staff have also given me good feedback. I know several other new grads at the same hospital who had to extend their orientation, so I totally agree with you, the ICU is not for every new grad- BUT, it is for some.

I knew I wanted to do ICU before I started school. SO while in school, I prepared. I went to continuing ed classes: I took several on ventilators, and vent troubleshooting. I was certified in EKG interpretation. I was certified in ACLS. I had about 100 CE hours before I ever graduated school.I also worked as an ED tech where I took EKG's, did phlebotomy and casting as well as assisting with trauma codes and procedures (i guess the new catch word for that is multi tasking). I joined AACN and read lots of journal articles. While reading is nothing like hands on, it helped me to learn the vocabulary and grasp some concepts about critical care. In my last rotation in school, I went to an ICU 40 hrs a week and worked one on one with an RN preceptor- sort of an mini orientation. This RN taught me a lot of technical stuff (ICP, PAWP, ventric's, ABG's) but she also taught me some skills like piggybacking a non-urgent call (can I advance the diet in the am?) with another RN's call to avoid paging the MD 6 times. SO, I felt ready to go to the unit when I did, as a new grad. I generally get my work done, give report and get out on time with out complaints. The settling in to the unit was tough, as they had never had new grads before, but now things seem to be going well. I don't get frustrated often, and very few complaints have been trown at myself or my manager. I do think, however, that it was the extra time I invested (CE classes, etc) that helped me to be successful at this- and I should add, I take a vented pair, on drips, with swans, but I do not take very unstable trauma, I help with those and learn (it takes years of experience to develop the gut instinct, I know! I know my limits and I ask lots of questions. So, I feel I am doing well, and my evals seem to indicate it, but without all that extra stuff, I would probably be floundering like the pair you describe. I am impressed at your compassion for these GN's. Most ICU RN's who feel new nurses should not be in the unit are generally quite cruel. Anyway, just my 2 cents Not for everyone, but yes for some.

ratchit · Sep 23, 2000

THanks for the time and thought you put into your message- I was expecting to get deluged. Also,

congratulations and keep up the good work!

But (and there always is one...) a couple points to consider: most new grads do not have your background (The CE classes, ED tech background, understanding how a unit flows and how to prioritize, to name a few.) How much of your ICU comfort level comes from skills you acquired on your own? How much more than your classmates did you get out of your orientation because you knew what questions to ask? You are not a typical new grad and we can't evaluate a typical new grad based on your accomplishments. Most new grads are not ready to assimilate textbook with clinical information and act in a critical care setting.

I graduated when nurses were being laid off. I had the chance to move right into ICU even then, but realized that while I had done well in class and in clinical, real life nursing was different. I did some M/S, stepdown, then got my training in a 28 bed level one ICU. Even with a solid background and being com- fortable working with pat- ients, docs, and families, it was oftem terrifying. Now I am an ICU traveller and feel comfortable walk- ing into a lot of different situations. (BTW, I get great feedback and eval- uations, too.. )

Missing something can kill a patient in any setting, but the risk is so much higher in ICU, and the time you have to act is so much shorter. You certainly have gone out of your way to learn, and deserve credit for that. With the extra background, you might well be able to function under the pressure and frustration of critical care nursing without time to become comfortable with yourself as a nurse first. But most new grads just aren't able to do it. They can be excellent new nurses with tons of potential, but the risk to patients is too high to offer ICU nursing as an option to new grads in general when most (IMHO) won't be ready for it yet.

I'm glad you have the personal wherewithal to ask questions when you're uncertain. I'm glad you have extra skills that make you more solid in your practice. But it is your outside background that made you a solid ICU candidate- not your nursing school background alone.

In my opinion, new grads need to learn how to be nurses before trying to perform in such a high-risk siutation, both for patient safety and for their own mental health. But I wish you luck. As for my compassion for new grads, well, what little I have learned I love to share, and I remember how horrible veteran ICU nurses can be to youngins. While I love to precept students, I decline to precept new grads. I don't think it's fair to them and I don't want the liability.

Would you mind posting updates on your new grad experience? It's interes- ting to see your view. And I'd be interested in how you and your classmates do over time.

Good luck!

ccnurse · Sep 23, 2000

I agree with you that the background has a lot to do with the success of a new grad in the icu setting. I worked as a medic for 10 years before going back to school for my RN. I went straight into MICU and now work in CCU. I believe that already having the necessary critical thinking skills from my medic experience helped me be successful. Even with my past medical experience I felt overwhelmed at times. The hardest thing for me was time management. I made myself a schedule and followed it which helped me out.

I am lucky. I work at a 300 bed hospital in Northern AR and the nurses are great with new grads. They do not "eat their young" at this facility and most of the nurses are great mentors. They try to put you with someone who will teach willingly.

Now, I did graduate school with a younger girl (fresh out of high school) that works at our facility also. She went straight into MICU and is doing great. I think a lot of it is the personality. Some people are not made to work in critical care; period. I love the critical care world. A lot of it depends on the attitudes of the people being trained, their ability to learn, and the attitudes of those training. But, occassionally you do find those that are untrainable.

I am for hiring new grads into ICU, but I thik the nurse manager needs to evaluate carefully who she hires into these positions.

Overland1, RN · Oct 27, 2000

Maybe bringing new nurses right into the ICU from graduation is a better way. The new ones I have seen are doing very well. They come in without preconceived notions (and without any bad habits).

Large CPA firms have done this for years with new grads and it has worked well for them, too.

That option was not available to me; I worked as a float and then went into ICU/Telemetry (one big unit), then went to ER. I will be starting a new job at a new (to me) hospital in a week, and it will be in the ICU. I guess I just couldn't stay away from it, and knew I would be back.

Go for it!

Jerry

ccunite · Oct 29, 2000

Over 8 years ago, with zero hospital experience, I graduated nursing school & went right into the ICU/CCU. After 6 months orientation (pre-arranged before hire) to open-heart surgery patients, vents & IABPs, I was a walking STRESS bomb. I don't know which was worse, waking up so early for the day-shift or dealing with the aggressive personalities of the day-nurses; it was way too confusing. Even though I graduated near the top of nursing-school, it was definitely a sink-or-swim experience. Took me about a half-year to get used to 12-hr nights, but I love the slower, more emphathetic pace where my colleagues are more apt to help with muscle or ideas, than criticize. My opinion for new grads: make sure you have a good orientation experience & can bond with your preceptor. Think of "boot camp" - you have to learn & think fast, be prepared to do the dirty work (take unpleasant, low-priority assignments) to earn your stripes in the eyes of other nurses, and do more listening than speaking - until you really know what you're talking about. If the other areas of your life is already stressful & unstable, I would not recommend diving straight to ICU/CCU; I couldn't have done it without my husband "nursing" me all these years! As hard as the experience was, or maybe because of it, I really appreciate where I am now. I've started precepting some "newbies" and can empathize with their deer-caught-in-the-headlights look! ICU-CCU is a tough area, but very rewarding