Desire to transition ICU (novice tele RN)

[music42RN, RN]

I can relocate anywhere, but how do I avoid accepting a position on an ICU floor that doesn't mentor well or has insufficient experience levels for me to grow quickly and practice safely? I would also love a position that had a graduate nursing program nearby.

I am a novice RN (15 months) on my second tele floor. The new grad program & preceptorship was ok. Before I hit my first year I was transferred to a different unit for staffing reasons. The new unit planned to provide me 3-4 weeks working along side my mentor to learn about the different pt conditions and the much higher acuities the unit receives. I only received 2 shifts before my mentor left; everyone else is already assigned a novice. I'm told I'm doing very well and they trust I'll transition fine.

Recently several of the ICU RNs have been on their rotation to our floor and expressed that I am diligent, careful and observant and would make a great ICU RN, but to go somewhere else for my 1st ICU assignment as our ICU is new grad and novice heavy.

I am starving for a mentor that can help me understand things I see during my shift, versus days later after studying on UpToDate (I'd be lost without that resource), and would love access to medical staff (day RNs have learned much more than those of us on nights) . I love to learn, and I love complex problems.

I investigated my first position, it sound good, looked well thought out, it wasn't until it was too late that I learned the preceptors received limited training (1 3 hr meeting) and the remainder was power-points and check boxes w/o time to assimilate the knowledge - and I'm a very fast learner.

I must become an exceptional RN, the kind I'd want my family to have. I have seen the difference it can make when a patient isn't doing well. Surely there is someplace where the floor turnover isn't 40-70% a year?

[Ruby Vee, BSN]

I can relocate anywhere, but how do I avoid accepting a position on an ICU floor that doesn't mentor well or has insufficient experience levels for me to grow quickly and practice safely? I would also love a position that had a graduate nursing program nearby.

I am a novice RN (15 months) on my second tele floor. The new grad program & preceptorship was ok. Before I hit my first year I was transferred to a different unit for staffing reasons. The new unit planned to provide me 3-4 weeks working along side my mentor to learn about the different pt conditions and the much higher acuities the unit receives. I only received 2 shifts before my mentor left; everyone else is already assigned a novice. I'm told I'm doing very well and they trust I'll transition fine.

Recently several of the ICU RNs have been on their rotation to our floor and expressed that I am diligent, careful and observant and would make a great ICU RN, but to go somewhere else for my 1st ICU assignment as our ICU is new grad and novice heavy.

I am starving for a mentor that can help me understand things I see during my shift, versus days later after studying on UpToDate (I'd be lost without that resource), and would love access to medical staff (day RNs have learned much more than those of us on nights) . I love to learn, and I love complex problems.

I investigated my first position, it sound good, looked well thought out, it wasn't until it was too late that I learned the preceptors received limited training (1 3 hr meeting) and the remainder was power-points and check boxes w/o time to assimilate the knowledge - and I'm a very fast learner.

I must become an exceptional RN, the kind I'd want my family to have. I have seen the difference it can make when a patient isn't doing well. Surely there is someplace where the floor turnover isn't 40-70% a year?

Believe it or not, a three hour meeting is above average for preceptor training. Many institutions invest nothing at all in training a preceptor. Power points are all too common for "classroom" learning, and you're expected to apply what you've learned in the power points (probably not all that much) to the patients in front of you with the help of your preceptor.

In general, larger teaching hospitals seem to offer the most in terms of precepting and mentorship. Many are working on implementing precepting programs and have regular meetings between preceptors to discuss issues, teaching tips, mentorship, etc. Ask what kind of a program the hospital offers for orientation. Look for a place that can tell you that orientation is so many classes, so many weeks of orientation at the bedside with a preceptor, that there are X number of exams to pass on Y topics, and that they have a senior nurse or assistant manager coordinating the orientation program.

No matter how careful you are, you may land in a place where the preceptor is the most senior nurse available, regardless of her ability to teach, her interest in teaching or the knowledge she has to impart. You will find preceptors who can teach only in one style, and that may not be your preferred learning style. It's up to you to adapt to the preceptor and learn the most you can. Preceptors aren't really teachers -- usually they didn't take the job to BE teachers, they took the job to BE nurses. So there may be widely varying efforts to teach to your preferred learning style. It's best to have no expectation that your learning style will be accommodated.

A large turnover in ICU is unfortunately very common these days . . . it seems that no one wants to work in the ICU to take care of ICU patients. They all seem to want that ICU experience to look good on a grad school application. My conservative estimate is that 3 out of 4 new hires in the ICU have no intention of staying any longer than the absolute minimum it takes to get them into grad school. Finding an ICU with low turnover will be difficult. If you DO find such an animal, you may find that they haven't put as much thought into their orientation program.

You may also find that the preceptor you are assigned for your orientation may not be the mentor who helps you develop as an ICU nurse once you're off orientation. Do your best to get through the orientation, then learn as much as you can from the senior nurses around you.