Floor nursing to ICU? or New grad to ICU?

Ruby Vee, BSN · Aug 12, 2007

how difficult is it to get into nicu or icu in general after becoming a regular floor nurse? do they always prefer new grads over floor nurses? i've heard that because the idea is that its easier to train than to retrain. please let me know your thoughts.

i know a lot of the younger/newer nurses will disagree vehemently with me, but i think "floor" experience before entering the icu is essential. it helps to be able to concentrate on learning the new skills rather than having to start from scratch learning how to take off orders, talk to families, when and how to talk to a physician, how to take a blood pressure, etc. i think some floor experience first makes a better icu nurse, and it certainly makes for an icu nurse with more longevity! nurses who've worked the floor first are less prone to "burn-out." i know that's not cut and dried, but over all, i think floor experience first is the best.

CarVsTree · Aug 12, 2007

I agree with Ruby Vee. I will have 2 years experience on Trauma Step-down/med-surg when I start the Critical Care Course at my hospital. I love my job, but don't love having too many patients. When a med-surg pt. goes bad you now have an ICU patient and 5 others. Or your tech comes up to you and tells you your patients sao2 is 69%. Then a tech covering another pt. tells you their sat is 84% (and its only 8pm and you haven't even laid eyes on them yet. Meanwhile you have 4 other to take care of.

Teaches you good assessment skills (no machines to tell you what's going on), time management, yes ICU nurses are busy, but CC nurses that have never worked the floor are totally lost when they're pulled here (and they're only given 4 patients).

One other thing, when I get a report for a CC nurse that never worked outside of the unit, they often don't understand they're patient or ramifications for their actions. They understand on a technical level, but they don't know their patients. They know their vitals, but not them. Don't know if that makes sense or not.

I just know that I have a lot to offer my patients in CC now that I have 2 years of knowledge, calling docs, asking, begging, demanding, and finally calling the attending to get a CT scan for my pt. with all the signs of a PE. Having a pt. vomit 2 units of blood and calling the trauma resident who says, "I'm in a trauma." There is no other doc there. Then calling the attending and getting him up to the floor in 2 minutes.

There is just so much that I've learned. Now when I go, I can as Ruby so wisely said, focus on learning new skills. I already get how to deal with patients, their families (and very dysfunctional ones at that), residents, attendings, etc.

I also know I love trauma not just think I do. I KNOW I want to go to Trauma ICU because I LOVE trauma, I love our attendings, and I like the challenge of dealing with trauma patients and their families. I had no idea what I loved, hated, or was indifferent about 2 years ago.

That's my 65 cents!

Take care!

Sue Z

AdelaideChic · Aug 12, 2007

As a graduate RN (in Australia mind, but still) I would recommend working on the floor first. In my grad program, i have been given specialties, 2 of which are critical care units. I feel that my prior experience as an undergraduate nurse has helped me immensely.

A new grad has more potential to struggle, as they dont have a grasp on the kind of things Ruby Vee mentioned.

As a grad who has gone pretty much straight into critical care (though never asking for this!) with a fair amount of acute nursing experience, i recommend working the floor before jumping into the ICU environment.

I personally do not intend on staying in the critical care environment at the end of my grad program, as i want at least a year on the floor first, if ever i return to the crit care environment.

NursingAgainstdaOdds · Aug 12, 2007

[edited to add : I'm a GN.] 95% of the CC nurses I've discussed this with roooooooooooooooollllllllll their eyes when they learn of GNs entering the ED or ICU. Personally, I feel it is with good reason - 99% of the time my pts are pretty predictable, and if they do start circling the drain I have time to react, time to call a clinical assessment team, time to get an MD on the floor ... it just seems to make sense to me. Of course, I'm just a newbie with zero CC experience, but logic to me dictates a GN head for an area w/ pts who are generally more stable.

And, now that I think about it ... if it were me or my family member in the ICU, I'd want a seasoned nurse by their side, not a GN. *ducks tomatoes being hurled in her general direction*:sofahider(please don't hurt me. :lol2: )

Lainee · Aug 12, 2007

I think EVERY nurse should do a year of med/surg. It is a shame that with the shortage people go straight into specialties.

llg, PhD, RN · Aug 12, 2007

If you are interested in Neonatal ICU, adult med-surg experience is not helpful and may even hurt your chances of being successful. The transition from adults to neonates is so dramatic that many people have trouble making that switch. With 14 years of experience running orientation programs in several NICU's, I have monitored that phenomena for years. I have also talked with educators in other children's hospitals who have said the same thing: the adult med-surg nurses are the ones who have the hardest time switching to NICU and who have the worst chance of making it through the first year in a NICU. The success rate for new grads is much higher.

After a year or two in adult med-surg, a nurse begins to feel competent, confident, and comfortable in her role. She trusts her judgment. When she then swtitches to NICU where the judgments are so different and few of the lessons she learned apply to her new work environment, she feels as if the rug has been pulled out from under her. Feelining uncomfortable and insecure, many retreat back to adult med-surg where they feel competent and comfortable. I can't tell you how many nurses I have seen do this and say to me, "I'm so disappointed. I always wanted to work in NICU, but I'm just too afraid I am going to hurt one of these little babies if I work here."

New grads don't expect to feel comfortable right away and haven't developed that feeling of competence and confidence that usually develops about a year or so after graduation. So ... they stick out that first year of transition and develop that comfort in a NICU environment. I hope that explanation makes sense.

Also ... a good NICU will be quite used to hiring new grads and will have an orientation program that is geared toward helping them succeed. If your local NICU does NOT often hire new grads and does not have such a program, then I wouldn't start there as a new grad ... but if they do, then go for it if it what you want.

Finally ... if you feel that you are not ready for the NICU's intense environment and would like to get some nursing experience before becoming a NICU nurse, then that's OK. But I strongly recommend that the experience you get be something that is relevant to NICU -- don't choose adult med-surg that will give you experience that you will have to "un-do" to work in NICU. Level II nursery experience is the best choice. Mother/baby, general peds, etc. are all better choices than adult med-surg. Work somewhere will you will be working with babies and/or small children.

Now ... if you are wanting to work in an adult ICU, then that's a whole different story. For that type of career goal, adult med-surg experience can be very helpful.

Lainee · Aug 12, 2007

On the flip side, I have lost 3 nurses in the past 5 years from medsurg to NICU and they are all still there and love it!

PMFB-RN, RN · Aug 12, 2007

I think EVERY nurse should do a year of med/surg. It is a shame that with the shortage people go straight into specialties.

*** I disagree and am happy that nursing leaders also disagree (at least at my hospital). I entered a large level I trauma hospital's SICU as a new grad and have been very successful. My hospital has a very comprehensive, nine month long, training program for new grads. Of the 8 new grads in the program with me only two had no health care experience before going to nursing school.

I knew exactly what I wanted to do and it isn't med/surg. If I had been forced to spend a year doing med/surg it's very likely I wouldn't have even gone to nursing school to get my RN. I know at least a couple of people in the CC training program felt the same way.

All that said, I have plenty of respect for the floor nurses and though I occasionally float to med/surg (my choice, CC nurses are not required to float to med/surg in my hospital) it's not for me.

AngBthatsme · Aug 12, 2007

I think it's foolishness to put a new grad in a CCU or ICU. Ahhh just my 2cents........I really liked Sue's 65 cents worth

SarasotaRN2b · Aug 13, 2007

The hospital in which I work now requires a year of acute care nursing (i.e. med/surg/telemetry, etc) before working in units such as ICU and the ER. While there are some new grads that could jump right in, I think that a year of acute care nursing before will better prepare a new nurse.

Kris

deeDawntee, RN · Aug 13, 2007

I really think it depends on you, how quickly you learn, and how able you are to deal with nurses who feel you should absolutely not be a new grad in the ICU.

In my mind, there is absolutely no reason that a bright new grad with the commitment to make it work, can't succeed on the ICU. Especially if they are given an extended orientation which would allow them to learn to function in the hospital environment in general along with ICU specifics. I have personally been in the ICU for about 1 1/2 years and 2 new grads started a little after I did. 1 of the 2 has done extremely well, while the other is still struggling. I have talked to both of them and they both say that absolutely the hardest part about starting out in the ICU is the attitude of some of the experienced nurses have towards them.

Personally, the most essential background I had was telemetry before I started ICU. I had experience in codes, knew heart rhythms, was already ACLS trained, felt comfortable managing chest pain etc. It made the ICU course easier for me and my stress was much reduced compared to others in my class. My personal recommendation would be to get a year of telemetry, preferably a unit that pulls sheaths and you will transition easily into ICU.

If I were a manager, I would very carefully hire new grads into the ICU. They would have to demonstrate some pretty specific traits. Extended clinical or internship in the ICU environment in nursing school or past experience in a related field like EMT or RT. They would have to be a strong individual but not a "know it all". I don't know, I am not a manager, but if you are truly committed to going straight to the ICU, be prepared for some difficulty from fellow staff members who will believe you have no business being there.