I honestly feel I can comment from both sides of this argument. I was a new grad in the ICU, was off orientation early, wanted to learn, made myself available whenever a patient was crashing in another room to help intubate, place a line, look at the fancy monitors (SVo2, Swan, etc.). I remember the older nurses being stressed out because there were so many newbies at one time. There were also the new nurses who talk on the phone, surf the internet, take long breaks, one had been there as long as I had and freaked out night because she didn't know how to help a doc insert a central line. I remember thinking to myself "there's a reason you don't know what's going on, there have been plenty of opportunities for you to learn, but you haven't wanted to". It was a stressful time in the unit for all of us (old and new).
Fastforward two years later, and I am just starting charge in my unit, precept a good bit, and I am starting to see the other side of when new nurses come into the unit. I try to be patient, but it's hard now to not want to do everything myself when I am running behind when I orient because I am quicker and more efficient and can do 4 things at one time. I feel the stress when we've got one going bad, we're behind, and we've got the doc on the phone and I'm trying to let the new nurse communicate with the MD what's going on. I'm learning sometimes, it's just best for me to take over, explain what we're doing and why, so that when the new nurse has a similar situation after orientation, they'll have a strong example of what to do. To the OP, when your preceptor snaps at you, it's probably not directed at you personally, probably just her way of blowing off steam. Some situations, it's a time for you to learn, and others it's time to take care of the patient and keep them from coding, and you'll have to stand by and watch and talk about it later. That's the nature of an ICU with sick patients.
Bottom line, I don't think it matters if you're new grad or not coming to the ICU. We've had a couple of med surg nurses lately come into the unit and decide they don't want to do it for a number of different reasons. I've also seen the nurses with telemetry experience come in and struggle as much as a new grad, just in different ways. Truth to tell, our experienced tele nurses sometimes make me more nervous than the new grads do. New nurses are nervous and know they don't know everything, they come double check most everything with you just to make sure they're doing the right things. Some of our expereinced nurses new to ICU take for granted that they know things and in my oppinion have the attitude that just because they're in the unit they can do things now without having to check with MDs. At least once a week, one will do something that is just not acceptable for us to be doing, and telling that to them in a nice way without them thinking you are being condescending is not easy.
I guess the crux of my point is, a new nurse to the ICU is a new nurse period. I agree with Dinith in that yes, you are learning all of nursing as well as the quirks of ICU nursing at once, and it is a big hill to climb when you're starting fresh. I personally think the mindset of new grads needing floor experience is not entirely valid. I think it is a case by case basis, each person if different in what they are willing/able to learn and how quickly. To the OP, just realize you're in a challenging environment with strong personalities, and it takes nothing but time and perserverence and a willing attitude to learn to succeed in the ICU.
down to business. Why do you think new grads are being sent to the units? Is there a reason this is becomming a hot debate? nursing shortage, money, training time?
I think it's more a national shortage of experienced critical care nurses, and critical care nurses in general than it is they want to have new grads because they are cheaper.
Simply put there are positions open and new grads are asking for them and they are getting them because there aren't enough experienced nurses. They have no interest in med-surg, and putting them on med-surg units against their will is pure torture. It's not cost effective to orient them for three months on med-surg, while they are miserable the whole time counting down the days until they get to ICU, then send them to ICU with only one year experience, and then orient them for another 16 weeks. Med-surg managers don't like that idea either.
Experienced nurses that stick their noses up at the new grads should be ashamed of themselves for such petty catty behavior.
Now, in reality, we KNOW that you are only their because management loves what they are paying YOU instead of us. But, that is another form of resentment. Just wait till you get a little experience under you belt and start competing with these nurses for their sacred overtime.
Management will love you. Your co-workers, mmmmmm, not so much.
I can start to see where the resentment is coming from, but still do not agree that it shoud be pointed towards me. BTW i do not make $22.00 an hour maybe I should ask for a raise... JUST KIDDING :)
After having spent a good amount of time as a preceptor for new nurses to ICU, the difference between a new grad and a more experienced nurse who is new to the ICU setting is huge. I feel that nursing school does very little to prepare you for what nursing is really about. As a result, new grads have a huge learning curve - just to become a nurse. Many of the daily tasks and skills have never been done by the new grad. Much of their time is spent learning the "tasky stuff". How can we expect them to even begin to critically think when they are focused on completing tasks, developing basic nursing skills and getting organized??
The nurse who has spent time on the floor not only has their organization and skills developed, but now has time to begin to critically think about what their patients are going through and the pathophysiology involved - only now it is a much less critical/stressful situation. When these nurses come to the ICU, they can pick up the new tasks quickly and spend a lot more time thinking about the "why's", developing the knowledge to become good ICU nurses.
That being said, I truly feel that new grads have no place in the ICU. However, because of the current situation, we seem to be stuck with this. I do believe with the right orientation, preceptorship, mentoring and desire to learn, new grads can be successful in the ICU and it is our job to help them to succeed so we aren't saving their butts or cleaning up after their messes every day.
On a side note of this discussion, I agree that it takes at least a year for a nurse to begin (notice I said begin) to feel comfortable in the ICU. It makes me absolutely ill to see these people with only 2 or 3 years experience, who think they now know it all, training the new grads or taking charge. Is it any wonder that many new grads do not get the training they need from their preceptors?? How can somebody with so little experience in such a demanding field be expected to adequately teach others or actually be the resource person for the entire unit?!
Maybe this is just my experiences with ICU coming into play. When I started, nurses had to be on med/surg for a year before going to a telemetry or step down type unit, where they spent a year before applying to ICU. Typically nurses had to be in ICU for about 4-5 years before they were even considered to be a preceptor and another year before they were placed in charge. If only we had that luxury now.....
note to any new grads reading and researching the topic "new grads in critical care":
once you decide that critical care is where you want to be... make sure to be responsible in chosing your first unit.
ask
how long the unit has been hiring new grads?
what happens to you if it doesn't work out?
are preceptors trained to precept?
are preceptors paid extra for participating in your training?
are preceptors voluntary?
what is the units "new grad" success rate?
by asking these questions in addition to getting detailed info on critical care classes and internship details you can find a unit that is set up to help you become a safe and competent nurse within a welcoming critical care environment.
new grad options are almost limitless. do not be disuaded. my new grad internship in icu/trauma is entering it's 33rd year... good luck!
Just wait till you get a little experience under you belt and start competing with these nurses for their sacred overtime.
Management will love you. Your co-workers, mmmmmm, not so much.
~faith,
Timothy.
Yeah, those same nurses whine about being tripled and not having enough staff when people take a break from signing up for overtime. Yet when they want the overtime they resent having enough staff to where they can't get it. Can't please the old folks. :lol2:
Morning all. Management at my facility does not hire new grads for ICU positions period! At least one year experience on another unit, successful completion of EKG and tele monitoring courses, completion of ACLS, and completing a peer interview are required before you ever get into the ICU. Then comes an intensive orientation process.
Any nurse at our facility is more than welcome to come visit us and get a general ICU orientation. I will welcome you with open arms. If you are truly willing to learn the skills it takes to become a good, competent ICU nurse, then I am more than willing to help you. I will be your preceptor, your mentor, your shoulder to cry on when things get tough. But, remember I do expect things from you. I am not always going to be there to hold your hand, deal with difficult physicians, or upset families. I do NOT bite. I was new to ICU at one time...we all were.
Yeah, those same nurses whine about being tripled and not having enough staff when people take a break from signing up for overtime. Yet when they want the overtime they resent having enough staff to where they can't get it. Can't please the old folks. :lol2:
Yeah, but I walk uphill both ways from my bedside to the nurse's station through blood and puke and I was doing it before you young whippersnappers even knew what a care plan was.
(not you, of course, Tweety).
So, I whine the old fashion way - I earned it.
Look, you got to look out for number one. If you want to be there, and it's allowed, then give it everything and who cares what I or anybody else thinks.
I'm not trying to discourage new ICU nurses. I'm just EXPLAINING WHY there might be some resentment.
Like anything else, it's something to work through.
But it comes down to there are likely two sides to every issue. Is it fair that other nurses take our their 'managerial' complaints on you? NO, it is not. But, you don't have 'the power' and you are there.
And I think it is managment failing you guys, also. Too often, management decrees from on high and that is that. It sets you up to fail.
I'm a huge proponent of setting you up to succeed. Management shouldn't have told your peers to 'deal with it'. They SHOULD have armed you with tools for success including preceptors that are a 'best fit' for you and the fostering of a 'culture of success'.
One of the lectures I attended at this year's critical care conference was on 'best fit' precepting. Drawing up comparisons to young nurses and matching them w/ preceptors that fit - instead of assigning you the next person that HAS to take you - has been proven to increase success by more than 50%.
If I ever get any rest and have a chance, I might look up some articles and cite them from that lecture. I'd have to find my conference book first.
Maybe the older, more experienced nurses are not transfering into ICU because they are not willing to put up with the crappy attitudes that they get from the "experienced" $35/hour ICU nurses. So, let's see - you work short handed because the new grads don't "deserve" to work there (and when they do they aren't worth anything) and the older more experienced nurses from the floor know your ICU personality issues and can work agency and make twice the money. Gosh, I wonder why you get to work so much overtime? You can't have it both ways.
For the new grads reading this: you don't have to take this garbage. Timothy was once a new nurse also, and I am sure that he still makes a mistake or two. Everyone starts somewhere. EVERYONE has something to learn, and everyone has something to teach. There are plenty of jobs out there. Pick the one YOU want, not the one that other people think you should take. Don't listen to the nurses who $itch about new grads .... if they weren't gripping about us, they would be gripping about other departments, the docs, their nurse manager, the President, the weather, the patients, the patient families, the toilet paper in the bathrooms, or maybe even other "wonder-nurses" who make $35.50 her hour.
On a side note of this discussion, I agree that it takes at least a year for a nurse to begin (notice I said begin) to feel comfortable in the ICU. It makes me absolutely ill to see these people with only 2 or 3 years experience, who think they now know it all, training the new grads or taking charge. Is it any wonder that many new grads do not get the training they need from their preceptors?? How can somebody with so little experience in such a demanding field be expected to adequately teach others or actually be the resource person for the entire unit?!
Maybe this is just my experiences with ICU coming into play. When I started, nurses had to be on med/surg for a year before going to a telemetry or step down type unit, where they spent a year before applying to ICU. Typically nurses had to be in ICU for about 4-5 years before they were even considered to be a preceptor and another year before they were placed in charge. If only we had that luxury now.....
It is obvious that each of us has experiences with staff in ICUs that cause us to lean one way or the other- ie new grads in ICU or not. However, for those of you who think new grads can't do well in the unit, my experience at my facility proves otherwise, there are too many new grads who started in ICU that are excellent nurses now, and some of them have over 5 years experience now and you'd never know they were new grads when they started in the unit. So, do I think new grads can start out and do well in the ICU? Of course I do. Do I think it's harder for a new grad compared to an experienced med surg nurse? In some ways yes, in other ways, no. New grads tend to be more mallable and not set in their ways. We have some experienced nurses who argue everything with you when you're trying to orient them to the unit. That's been my experience, obviously others have different experiences. I do believe there is a steeper learning curse for new grads starting out, but I absolutely think it is possible to succeed as a new grad in the ICU with the right attitudes of all involved-management, co workers, new nurse, in the right type of supportive environment. When it comes right down to it, the hospital posts openings for the units, the management does not have to take new grads, if there are nurses from other areas who want to transfer into the units, then management can choose to do so, but if no one else applies for the units, why not suck it up and teach the nurses who want to be there all you can? As far as I'm concerned a nurse is a nurse if you're willing to do your part you're welcome in my unit.
I also think that you can't judge someone's abilities based on how long they've been a nurse. I didn't want charge in my unit, I didn't go looking for and tried not to take it. However, in a unit where alot of the night staff goes to days ASAP, we've got a short list of experienced nurses who can take charge. Most of the experienced staff in my unit on nights has 2 years or less. I don't think I know everything, and I'm quite willing to admit when I don't know something and help my co worker find out, or ask others oppinions on what they think if there's a question about the best thing to do. It seems in my units often the older nurses for whatever reason do not want to orient. A new nurse in the unit can tell someone who resents being followed around versus someone who is helpful and enjoys teaching. So, if I had a choice to orient with someone with over 20 years experience that knows a lot and lets you know they know more than you constantly on top of a bad attitude who talks about everyone, or to orient with someone with 2 years of experience that is friendly, works hard to be patient with you, may not know everything but is a great resource, who do you think most new nurses would want to be with?
:lol2:
TennRN2004
239 Posts
I honestly feel I can comment from both sides of this argument. I was a new grad in the ICU, was off orientation early, wanted to learn, made myself available whenever a patient was crashing in another room to help intubate, place a line, look at the fancy monitors (SVo2, Swan, etc.). I remember the older nurses being stressed out because there were so many newbies at one time. There were also the new nurses who talk on the phone, surf the internet, take long breaks, one had been there as long as I had and freaked out night because she didn't know how to help a doc insert a central line. I remember thinking to myself "there's a reason you don't know what's going on, there have been plenty of opportunities for you to learn, but you haven't wanted to". It was a stressful time in the unit for all of us (old and new).
Fastforward two years later, and I am just starting charge in my unit, precept a good bit, and I am starting to see the other side of when new nurses come into the unit. I try to be patient, but it's hard now to not want to do everything myself when I am running behind when I orient because I am quicker and more efficient and can do 4 things at one time. I feel the stress when we've got one going bad, we're behind, and we've got the doc on the phone and I'm trying to let the new nurse communicate with the MD what's going on. I'm learning sometimes, it's just best for me to take over, explain what we're doing and why, so that when the new nurse has a similar situation after orientation, they'll have a strong example of what to do. To the OP, when your preceptor snaps at you, it's probably not directed at you personally, probably just her way of blowing off steam. Some situations, it's a time for you to learn, and others it's time to take care of the patient and keep them from coding, and you'll have to stand by and watch and talk about it later. That's the nature of an ICU with sick patients.
Bottom line, I don't think it matters if you're new grad or not coming to the ICU. We've had a couple of med surg nurses lately come into the unit and decide they don't want to do it for a number of different reasons. I've also seen the nurses with telemetry experience come in and struggle as much as a new grad, just in different ways. Truth to tell, our experienced tele nurses sometimes make me more nervous than the new grads do. New nurses are nervous and know they don't know everything, they come double check most everything with you just to make sure they're doing the right things. Some of our expereinced nurses new to ICU take for granted that they know things and in my oppinion have the attitude that just because they're in the unit they can do things now without having to check with MDs. At least once a week, one will do something that is just not acceptable for us to be doing, and telling that to them in a nice way without them thinking you are being condescending is not easy.
I guess the crux of my point is, a new nurse to the ICU is a new nurse period. I agree with Dinith in that yes, you are learning all of nursing as well as the quirks of ICU nursing at once, and it is a big hill to climb when you're starting fresh. I personally think the mindset of new grads needing floor experience is not entirely valid. I think it is a case by case basis, each person if different in what they are willing/able to learn and how quickly. To the OP, just realize you're in a challenging environment with strong personalities, and it takes nothing but time and perserverence and a willing attitude to learn to succeed in the ICU.