Worried about the future of ICU nursing

Specialties Critical

Published

I just recently started a new job as an ICU nurse at a large facility in California and some trends I've noticed over the years have stuck out to me. It worries me when I walk into a new facility, especially in the ICU and see all new and inexperienced nurses. Every new grad I meet wants to be a CRNA or an NP. And after 8 years, I found myself in the same boat. But I started to wonder what it's going to be like in the future if no one stays and gains experience? It's great that people want to advance their educations, but I feel that we've done a disservice in some way by not encouraging people to stay at the bedside. In part I blame hospitals for crappy ratios, caps in pay and lack of ancillary support.

This is just a random thought in my head that I felt like getting out there. What do you guys think?

Specializes in SICU, trauma, neuro.

PMFB-RN!!!!* One of my AN nurse-crushes... good to see you.* :laugh:

OP I agree completely.* I have been an ICU nurse for years... and I still don't feel like an expert (largely due to part-time work).* There are SOME yearlings who are stand-out self starters... but they are not the norm and even they shouldn't be the highest level of staff.

A psychiatrist I know outside of work says he was taught in med school that the ICU nurses are the Navy SEALs of the hospital.

Anyway yeah... the thought of few to no true experts in the ICU is terrifying.

0 Votes
Specializes in Adult Internal Medicine.
I think it starts in nursing school. A lot of my professors would say things like "when you go to graduate school" or "get some experience and then become an NP", as if being an RN was a stepping stone. This may be a good thing for RNs though, hopefully the salary will increase for us as the demand increases especially for experienced RNs.

I do think nursing school has a role in this, peddling this notion that there is a linear progression from student RN to novice RN to expert RN to student APN to novice APN to expert APN. Nursing has pushed for decades to develop "lifelong learners", which is good for the profession overall, but it is misplaced to think that continued learning and the pathway to expertise for RNs has to be tied to anything APN. I think nurses also help this a long at times with the argument about the "advanced" part of APN.

0 Votes

I agree. I've been open about how NP program standards are horrible and that it's made way too easy for people to advance (essentially NO standards). It was just a random thought I had on my orientation. I have a total of 9 years behind me and I look around and most people have less than two years. I just know that in my early days of ICU, the people that guided me and taught me were the experienced nurses. Like I said, It's good to want to advance yourself, but I feel as tho nurses feel that the only way to advance is by becoming an ARNP .

0 Votes
Specializes in Adult Internal Medicine.
I agree. I've been open about how NP program standards are horrible and that it's made way too easy for people to advance (essentially NO standards). It was just a random thought I had on my orientation. I have a total of 9 years behind me and I look around and most people have less than two years. I just know that in my early days of ICU, the people that guided me and taught me were the experienced nurses. Like I said, It's good to want to advance yourself, but I feel as tho nurses feel that the only way to advance is by becoming an ARNP .

Not all NP programs have horrible/no standards, actually only a small percentage do, and the quality programs have acceptance rates that are less then medical school. The poor quality programs to make it easier for less competitive candidates to move into advanced practice, however, as I said earlier we need to be very careful with this wording, because the APN role is not the way for RNs to advance their practice. RNs can advance without anything to do with APN.

0 Votes
Specializes in Critical care.

We're seeing a similar situation this side of the pond in the UK. Skill mix on the unit is becoming increasingly junior, staff turn over is getting higher. Some nurses are using critical care as a short term experience to accelerate their career progression into senior roles on the wards or into some advanced practice roles.

When I was a student, critical care nurses were seen as the experts of nursing care in the hospital (I love the navy seals of nursing comment made in a previous post, I'll be using that in the future), it's why I aspired to be a critical care nurse. To those outside of ICU even a short period of working on the unit (6 months to a year) is seen as highly desirable when employing nurses into senior positions, even though it's an incredibly short time in practice as an ICU nurse. In my current place of work, nurses who've been there for two years are seen as experienced, when I'd been on the unit for that long, I was considered as still wet behind the ears.

I guess there's a number of factors at play, it does seem that these days, no one wants to be a staff nurse anymore, but then conditions aren't great for nurses so why would they want to be? I've no problem with people wanting career progression, but it's immensely frustrating to put lots of work into supporting someone to become a competent critical care nurse just for them to leave after a year.

0 Votes
Hate to break it to you, but this is like any other profession. In the day, if you had a high school degree, you could find a steady profession. Then, more and more professions wanted a four year degree. When I finished my first four degree I was young and dumb thinking I was set for life. Reality set in and realized that a four year degree was the new high school diploma, if I wanted to go anywhere, I needed a masters, doctorate etc.

Now, nursing is catching up to that, but it has a lot more flexibility than a standard job. If you want to be a grunt and stay in the trenches (where I am and love to be) you can. If you want to broaden your scope of practice, or look for something outside of bedside nursing, you have to go to school and get that advanced degree.

There will always be those that love getting dirty and fighting in the trenches, but again, nursing has become a profession like any other professions. There will be those that get their RN and then go for CRNA or NP or DNP. Power to them, but there will always be the backbone of those of us, that just enjoy being RN's.

I understand your point, but in reality, the number of ARNPs is set to outpace the need for them (in primary care). NP programs have pitifully low standards and many have subpar educational standards. I personally am weary of going to a primary NP who went to one of these fly by night colleges to get their "advanced degree" Now, ACNP and CRNA programs are in a different category. CRNA school, while not terribly difficult to get into is a huge personal sacrifice and a very difficult program with actual standards. I would allow a CRNA to treat me any day of the week because I know their training process.

With all that being said, there is a new trend for nurses to go straight to advanced practice without "doing their time". What do you really know after a year of practice? I was still lost at times. It wasn't until the 3 year mark that I felt like I really had a grasp on it. Secondly, with this culture, we are undervaluing the expertise of a competent bedside nurse. Especially in speciality units and ICU. My first ICU was filled with new graduates and the more experienced and seasoned staff were the ones that kept things going and knew what was going on and often saved lives by recognizing things before stuff hits the fan.

I know people are going to bash me for talking about NPs like this, but lets be real here. The training is subpar for being a provider (in many of these schools NOT all). Having to beg strangers for clinical placement, no mandatory visits to campus, no entrance standards....seriously?

0 Votes
We're seeing a similar situation this side of the pond in the UK. Skill mix on the unit is becoming increasingly junior, staff turn over is getting higher. Some nurses are using critical care as a short term experience to accelerate their career progression into senior roles on the wards or into some advanced practice roles.

When I was a student, critical care nurses were seen as the experts of nursing care in the hospital (I love the navy seals of nursing comment made in a previous post, I'll be using that in the future), it's why I aspired to be a critical care nurse. To those outside of ICU even a short period of working on the unit (6 months to a year) is seen as highly desirable when employing nurses into senior positions, even though it's an incredibly short time in practice as an ICU nurse. In my current place of work, nurses who've been there for two years are seen as experienced, when I'd been on the unit for that long, I was considered as still wet behind the ears.

I guess there's a number of factors at play, it does seem that these days, no one wants to be a staff nurse anymore, but then conditions aren't great for nurses so why would they want to be? I've no problem with people wanting career progression, but it's immensely frustrating to put lots of work into supporting someone to become a competent critical care nurse just for them to leave after a year.

I agree. Here in California, staff nursing is not a bad gig and you have the potential to earn a great salary. The pay difference between advanced providers and RNs isn't that much. I've worked in other states where I don't blame people for running for the hills. Some places suck to work at.

0 Votes

Which NP "quality programs" have acceptance rates that are less than medical school?

0 Votes

The need for NPs will continue to grow as they are a lower-cost replacement for doctors. Comparing NP programs to med schools is apples to bananas. Med school is an overly long, overly expensive, hoop-jumping "institution" that could be greatly streamlined. As in every school from Paramedic to RN to CRNA, etc., the bulk of your knowledge is gained in the hands-on clinical experience you get. The didactic portion is pretty much the same.

0 Votes

I realize not all new nurses with their sights set on advanced practice are like this, but true story.... I was working with an RN who had gone straight into a NP program. A BP needed to be taken. He asked me "can you go and check that BP, I don't know how". I said, "Oh, then come with me and I'll show you", and he said that "No thanks, I don't need to know how to do that". I myself was one of the first people in the US who was admitted to what was then a brand new program that was a combination accelerated 2nd Bachelor's and NP program (I stopped after I got my BSN). So, I don't have a negative bias, but I was just shocked. Just could not believe my ears at the attitude.

0 Votes
The need for NPs will continue to grow as they are a lower-cost replacement for doctors. Comparing NP programs to med schools is apples to bananas. Med school is an overly long, overly expensive, hoop-jumping "institution" that could be greatly streamlined. As in every school from Paramedic to RN to CRNA, etc., the bulk of your knowledge is gained in the hands-on clinical experience you get. The didactic portion is pretty much the same.

The need depends on where you live. I have tracked the nurse practitioner jobs posted in my area over the last 4 months and I noticed s common theme. Very few jobs are out here and the ones that are want a minimum of 2 years experience as a nurse practitioner or more. In 4 months I may have seen one company willing to hire a new grad. The market for nurse practitioners is flooded in this part of California. New grads need not even try to break this market anytime soon.

0 Votes

I can say it has to do with the hours, working conditions and pay. So many schools are around and continue to pump out new RNs. Plus in the south you can work 10 years and still not break 30 a hour. people dont want to give up nights, weekends, holidays and break down their bodies for low pay, the abuse and lack of respect. You must admit that at some point these things get to all of us and i think its why people are so fast to want to leave the floor or ICU. Heck some even decide to leave nursing all together. Just stating what other nurses have told me.

0 Votes
+ Add a Comment