Welcome to the ICU

Ruby Vee, BSN

It's January, and the December graduates from nursing school will be taking their NCLEX exams, looking for jobs and starting those jobs (if they're lucky enough to get them!) in the next few months. That means that the ICU is going to have another huge influx of new graduates sometime in the next month or two. It happens every year. Some of them will actually want to work in the ICU, but most will be on "the two year plan," meaning they're here to get their two years of ICU experience before they go on to graduate school. It doesn't take long to identify those on "the two year plan," and as few of them are actually interested in doing the work of a bedside nurse most of us old ICU nurses would rather spend our time and energy on the new grads who are here to stay. This advice is for them.

Welcome to the ICU! We're happy to have you here. Not only are you going to ease our staffing issues, but hopefully you'll be here to take care of me when I need care. I'm looking forward to teaching you what I know, and I'm hoping to learn from you as well. I have never ever had an orientee who failed to teach me something!

If you've gotten a job in the ICU because it's your dream to be an ICU nurse, or because you think you want to be an ICU nurse and want to try it out or if you have ANY plans other than "the two year plan", let us know. We may assume that you're on "the two year plan" unless or until you inform us differently and even then we may be skeptical until you prove differently, but if we think you WANT to be in the ICU, you probably will be treated differently. It's a lot more fun to show my best tips and tricks to nurses I expect to want to be around to work with me in a couple of years when they become competent. Something about knowing a new grad doesn't intend to stick around makes even the best preceptors reluctant to invest a lot of energy and emotion in their orientation.

I understand that I'm going to get flamed by those of you who can't wait to go to anesthesia school or become NPs and think you deserve the very best a preceptor has to offer. Perhaps you do -- but with a constant revolving door of new graduates, we develop "preceptor fatigue."

When someone isn't really interested in the ICU it often shows the very first time you show up on the unit to get your locker key and meet your preceptor. These are the newbies who are clustered around the schedule book and the vacation request book on their very first day, making sure they get their many requests for days off recorded for posterity. Don't spend your first hours on the unit complaining about the nights and weekends on your schedule and whining about the seven weddings you have to attend in the next two months and how can you possibly work weekends when you already have these commitments? If you're committed to your job, you may have to miss a few social outings and you WILL have to work nights, weekends and holidays. Make it clear that you understand the concept of 24/7/365 scheduling from the get-go and you'll get along every so much better with the rest of the staff.

Expect to do some studying on your own time. No one graduates from nursing school knowing everything, and we more or less expect you to graduate and show up on the unit without knowing anything. I don't mind explaining Swan Ganz catheters to you or showing you how to put in a Foley, believe me, I don't. I love to teach. But after six weeks of taking care of patients with Swans and Foleys, I expect you to know what they are, where they go and what information they can give us. If you don't study at home, it's going to take you a lot longer to learn the necessary concepts to do your job.

Don't diss the senior staff. I'll never forget the day I was introduced to a young woman who had just graduated from nursing school at a famous Bible college. She'd been on the unit for less than a day, and I happened to be sitting at the monitors when she sat down next to me. "The male nurses on this unit are all immoral," she said. The male nurses of whom she spoke were my friends and colleagues -- did she expect me to AGREE with her? Sadly, that one interaction colored my opinion of her for the 23 months she remained on our unit.

The Nurse Educator is also a friend of mine. Don't act out in your critical care classes, because believe me, word will get back to your preceptor, your manager and the person who does your evaluations. It never ceases to amaze me how many new employees show up underdressed, late or unprepared. You're a professional now so act like it.

I already know I don't do things the way your nursing instructor showed you . . . that's because I actually work at the bedside full time and she doesn't. I'm sure she demonstrated the very best practice and you're eager to demonstrate to me that you know that method. There's more than one correct way to do most things, however, and my way might be faster or easier than the way you learned in school. Or not. At least give me the courtesy of paying attention and considering my way before you dismiss it out of hand.

We see many posts on allnurses.com from new grads who see an experienced nurse doing something they think is wrong and who want to know if they should "report them" and how to do so. The answer is DON'T. Unless you're absolutely 100% convinced that the patient is in immediate danger AND you can afford to lose your job, develop a "wait and see" attitude. It could be that something you think is wrong is actually the most efficient way to go about things, but if you've run to the manager to report that Hildegard is flushing dialysis catheters incorrectly you've already generated significant ill will -- from Hildegard, her friends, the colleague who taught her out to flush dialysis catheters, your preceptor (who wonders what you're going to "report" her over) and probably from the manager as well. As unfair as it seems, you're the newbie, and everyone else will probably side with their experienced colleague. (Unless THEY'VE already generated significant ill will by being vocal about being uninterested in their job and spending all of their time soliciting recommendations for graduate school. Then it's a toss-up.)

Show up on time in appropriate attire -- business casual for classes and scrubs for clinical days.

If you chew gum, do it with your mouth closed. If I know you're chewing gum, it's not discreet. And please don't ever give gum to your patients -- especially your intubated patients!

Be flexible -- sometimes you won't be with "your" preceptor. It sucks, but it can't be helped. Sometimes you won't be with your preceptor for weeks at a time. Understand that your preceptor has an eye on your progress and your needs anyway, and we're really looking out for you.

Be friendly and introduce yourself to everyone you encounter. If someone is surly to you, don't take it personally -- they may not have meant to be harsh, they may not realize they were harsh -- or you may be overly sensitive.

Make the most of every learning opportunity you're afforded.

Demonstrate a desire to fit in and become a part of our staff . . . chocolate helps! Be ready to show pictures of your family and pets if asked. (And it's a compliment to be asked!) To those of you with non-traditional families -- most of us don't care. If you're gay, straight or bi, we'll still care that your pets are cute, your SO is supportive and you have adorable kids. (Most of us don't care about your sexual orientation, religion or whatever -- and those who do care aren't worth worrying about anyway!)

Scheduling flexibility cannot be overemphasized. Sometimes we may have to move you around in order to get you time with your preceptor, OR time, or some other experience.

Never ever be afraid to ask questions. There is no such thing as a stupid question -- except the one you didn't ask and should have. Nothing scares me as much as an orientee who doesn't ask questions! I can't trust that they won't do something stupid because they're afraid to ask. And it's impossible to teach anything to someone who already thinks they know everything!

If you make a mistake with your schedule and don't show up when you're supposed to, come in late or take a too-long lunch break because you couldn't find your way back from the cafeteria, apologize. Profusely. We all make mistakes, but we'd hate to think you just don'e care.

Don't start off expecting people to "be mean to you." Our providers are really nice people as are most of our colleagues. (The ER and OR charge nurses are the enemy sometimes, but your colleagues are not.) Somehow it seems that if you expect negative interactions, you'll find them. If, despite your best efforts, you do find negative interactions, assume that at least 50% of the fault is yours. If you have many negative interactions, revise your fault estimate upward.

Welcome to the ICU. We hope you find it so interesting and exciting that you want to work here for a long time.

Welcome to the ICU

About Ruby Vee, BSN

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