Go to ICU without MedSurg Experience?

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I hear it all the time from experienced nurses when I say that I want to work in critical care, "You need at least a year of med-surg experience because you will get to see and learn sooooo much". It worries me.

Right now, I am a nursing tech at two separate hospitals....one in ICU, the other in Med-Surg. I thoroughly enjoy my ICU job and enjoy each day I get to go to work. I dread my med-surg job and feel like I am wasting valuable experience that I could be getting from my other position. However, I am cautious not to throw out more experienced opinions about the needed med-surg experience. I want to be the best nurse I can be.

Do you think that it is wise to go straight into ICU after graduating, without first having worked a med-surg floor?

Specializes in geriatric, hospice, med/surg.

Do what it is that makes you happy. Don't beat yourself up over maybe not getting the medical/surgical experiences...you'll be saturated in knowledge from your experiences in the intensive care unit. Go for it!

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Specializes in tele, ICU.
The options are there to go straight to ICU. But, let me give one caveat:

If you choose to learn to drive on the nascar circuit, don't be surprised when some of the drivers run you down. It happens. It happens, alot.

I'm not saying don't do it. But, it IS a choice that YOU are making. As a result, you really can't complain about being 'eaten' when there are obstacles and attitudes to overcome based on your choice.

can you give an example of being "run down"? do you mean getting taken advantage of for being the new kid on the block?

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The options are there to go straight to ICU. But, let me give one caveat:

If you choose to learn to drive on the nascar circuit, don't be surprised when some of the drivers run you down. It happens. It happens, alot.

I'm not saying don't do it. But, it IS a choice that YOU are making. As a result, you really can't complain about being 'eaten' when there are obstacles and attitudes to overcome based on your choice.

I'm an advocate of a year on med surg. I had 3 before moving to ICU 10 yrs ago. Did it stop me from being run over by assertive nurses there? Oh, no, not at all. My first year in ICU was far from certain and mostly due to a few key personalities.

Sorry to be the 'keep it in perspective' voice. I wish you well.

~faith,

Timothy.

I agree with many of the things Timothy has said here. I went straight into the ICU, and for me, it was a disaster. First of all, I did not work as a tech in nursing school, so I did not have any familiarity with the day to day functions of a hospital floor.

My nursing school was one of the "respected" BSN schools that were pretty light on skills training. If we complained, the instructors just blew us off and said we would learn it our first year of practice. So, coming out of school, I had NEVER started an IV (except in a rubber arm!) I could barely prime a bag of saline. It wasn't pretty.

For various reasons (toxic co-workers, limited experiences,etc) I ended up transferring to a med-surg floor after 1 1/2 years. I did this on my own volition--no one told me to do it. This move has been met with puzzlement on the part of many nurses, who I guess figure the ICU is mecca.

I have been able to see much more working in Med-Surg, and have had many more varied experiences. Let's face it--if you have 6 patients, not 2 patients, you will see 3 times as many situations. The old ICU I was in was basically vent patients with sepsis, or drunks going through withdrawal. Definitely a limited experience.

I have also found that I like working with families of patients who are dying, and I may go into hospice nursing at a later date.

SOOO, if you have a good orientation, good preceptors, a unit that is not hostile, and you have some tech experience under your belt, going to an ICU as a new grad is probably fine. But a year of Med-Surg at least gives you lots of experiences.

I will say that one advantage of the ICU is that the "heavy patients" (G-tubes, traches, etc etc...) don't bother me at all.

Good luck with whatever you decide.

Oldiebutgoodie

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Specializes in Critical Care.
can you give an example of being "run down"? do you mean getting taken advantage of for being the new kid on the block?

No, not 'taken advantage of'.

I mean many critical care nurses consider putting your time on med/surg to be 'paying your dues' and by NOT doing so, it makes you 'uppity'. So, BECAUSE you are labeled as 'uppity' by a minority of nurses, those nurses will expend lots of energy 'putting you in your place'.

That can mean preceptors that set you up to fail.

Fellow nurses that WON'T answer your questions, "I don't have time for this. . ."

Placing you in unfair/unsafe assignments not based on your skill sets. There is a current thread about a new LPN in critical care being given a patient on a balloon pump with no training. . .

Putting you down, "You won't make it here. . . "

Writing you up for silly and endless things.

Excluding you from 'cliques' and trying to make you feel like an outsider.

Whisper campaigns, both to your fellow nurses, and to the doctors, casting your competency into doubt.

Being very judgemental of you, both to your face and to your peers.

Taking over a situation where you ask a legitimate question (such as titrating a drug) and then complaining about having to 'rescue' your patient from your incompetence.

Ensuring that you get bad schedules. Stepping in front of you and claiming seniority in taking any overtime you have planned from you.

Forcing you to float often and out of turn. "The skill set requires that more senior nurses must stay in the unit this shift, so YOU have to float, yet again."

These things happen. In the end, when you make it an adminstrative issue, your boss has to weigh the relative value of the persons making their cases: what's more important - keeping an experienced nurse in place, or a 'newby'? In addition, it's a slam dunk that the more experienced nurses know much more about the administrative culture and how to play the game. Many times, your unit manager has been a 'peer' with these nurses for YEARS. THEY are well-known quantities: who are YOU?

Besides, it's simply YOUR word against THEIRS that their motives are suspect.

MOST of the nurses you work with will NOT play such games. But, it only takes 1 or 2 in a busy unit to make your life very difficult. And really, while EVERYBODY in the unit knows who they are, that does not mean that anybody is willing to throw down the gauntlet of their careers to save yours.

It's not that I'm trying to scare you, but these things DO happen. What it requires from YOU is the ability to stand your ground. Critical care is KNOWN for attracting very, shall we say, 'assertive' personalities. (Many times, that's a 'good' thing. Critical care does NOT need nurses too timid to stand up for not just thier patients, but their OWN ability to make critical decisions and command attention to those decisions.) If you aren't the type of person to rise to the challenge and become assertive yourself, you will quite possibly be 'run over'.

Critical care is the nascar circuit. There IS no 'slow' lane. You must be prepared to drive at 200 mph. That applies in terms of the skills and care you need to give. But at least as important, it applies in terms of the personalities you might be forced to deal with.

So the CRITICAL question to ask of yourself: can you stand your ground? Just how assertive are you? There are many horror stories of nurses 4-6 months into CCU complaining about 'being eaten'. While that MIGHT be true, it's simply a fact that this is more likely in specialty areas out of school. YOU make the choice to be there, and so, YOU are at least part of the equation that is being created. So, the crucial question remains: do you have the fortitude to 'stick it out' and stand your ground? Ultimately, even the most persistent harrassing nurse will grow tired of crashing into a brick wall if YOU are that brick wall.

For me, it took sticking it out for over a year, and THEN, changing jobs so that I came into a fresh unit as an 'experienced critical care nurse'. And THAT was with having 3 yrs of med/surg and some knowledge of the administrative culture of the hospital with which to watch my own back and survive that year plus. Simply put, I would not have made it directly out of school. And I consider myself to be quite assertive (many here at allnurses would attest to that.)

I don't regret for one minute being in critical care. It's simply where I want to be. BUT, that doesn't mean that it didn't take a very long time before I really felt like I 'fit' in. And, that doesn't mean that I didn't fight lots of battles to get where I am today. In retrospect, I'm quite proud of myself for sticking it out and standing my ground. I'm proud of myself because being where I am today was well-earned.

~faith,

Timothy.

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Wow, Timothy must have been at the ICUs I worked in!

Oldiebutgoodie

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Specializes in Occ health, Med/surg, ER.

Oldiebutgoodie,

Wow, in your BSN program you NEVER started an IV? :uhoh21: Crazy!

Timothy,

I appreciate your opinion and advice.

Well, I worked 6 months in a rural hospital as an LVN on a Medical/Surgical floor and ER. I also work now as an Occupational nurse (LVN). However, I dont think that counts as the "year of Med/Surg experience" especially as an RN. So, I dare to dig deeper.... Can you (or Timothy) explain WHAT sort of things on Med/Surg made you more prepared? Im curious just because I want to determine the value of my prior experience.

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Specializes in ICU, ER, Hemodialysis.

I say...evaluate YOUR abilities/personality and then IF you believe that you can handle it...GO FOR IT!!!

As far as the new grads that do not make it...Well maybe they would not have made it on the floor either, maybe they over estimated THEIR abilities! Who knows? I believe that a new grad will fall into one of these catagories....

1. Never will be able to handle critical care nursing.

2. Needs to ease into nursing, get exp. in Med/Surg first then go to ICU.

3. Has the ability to learn the ICU and will thrive there.

Which one are you? I bet that the ones that "did not make it" were in catagories 1 or 2. However, if you are a 3, then you will not suffer their fate. Let's not forget that time management and critical thinking are not just skills acquired in nursing. I was a soldier in the Army, worked as a warehouse manager, CNA, medical assistant, unit clerk, cardiac monitor tech, among many other things! As a CNA, I have learned to prioritize basic nursing care on 14 or more pts at a time. I know that nurses have other priorities, but knowing which call light to answer first is also VERY important and critical to pt safety. If you are a 3, then you WILL be able to keep up. Some people will never be able to make the transition and some will need a slower transition.

That being said, I DO see some value in going to the floor first, but this does NOT mean that there is not any value to going straight to the ICU. For example, You may not have any "bad habits" from the floor to unlearn. Also, if you are miserable on the floor, as so many seem to be, how effective can your year really be? If you are happy in the ICU, you are bound to get more out of the training and orientation. You are more likely to go home and study what you have learned that day or study about procedures on your own time. I love critical care, and although I am still in nursing school, I still read their journals, websites, and tutorials. Why? Because it is INTERESTING to me. I just interviewed for a med/surg ICU externship. I hope to get it and, if so, begin my career in ICU. Good luck to everyone else. Again, evaluate YOURSELF and decide if critical care is something that you can handle.

Sincerely,

Jay

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Specializes in cardiac/education.
No, not 'taken advantage of'.

I mean many critical care nurses consider putting your time on med/surg to be 'paying your dues' and by NOT doing so, it makes you 'uppity'. So, BECAUSE you are labeled as 'uppity' by a minority of nurses, those nurses will expend lots of energy 'putting you in your place'.

That can mean preceptors that set you up to fail.

Fellow nurses that WON'T answer your questions, "I don't have time for this. . ."

Placing you in unfair/unsafe assignments not based on your skill sets. There is a current thread about a new LPN in critical care being given a patient on a balloon pump with no training. . .

Putting you down, "You won't make it here. . . "

Writing you up for silly and endless things.

Excluding you from 'cliques' and trying to make you feel like an outsider.

Whisper campaigns, both to your fellow nurses, and to the doctors, casting your competency into doubt.

Being very judgemental of you, both to your face and to your peers.

Taking over a situation where you ask a legitimate question (such as titrating a drug) and then complaining about having to 'rescue' your patient from your incompetence.

Ensuring that you get bad schedules. Stepping in front of you and claiming seniority in taking any overtime you have planned from you.

Forcing you to float often and out of turn. "The skill set requires that more senior nurses must stay in the unit this shift, so YOU have to float, yet again."

These things happen. In the end, when you make it an adminstrative issue, your boss has to weigh the relative value of the persons making their cases: what's more important - keeping an experienced nurse in place, or a 'newby'? In addition, it's a slam dunk that the more experienced nurses know much more about the administrative culture and how to play the game. Many times, your unit manager has been a 'peer' with these nurses for YEARS. THEY are well-known quantities: who are YOU?

Besides, it's simply YOUR word against THEIRS that their motives are suspect.

MOST of the nurses you work with will NOT play such games. But, it only takes 1 or 2 in a busy unit to make your life very difficult. And really, while EVERYBODY in the unit knows who they are, that does not mean that anybody is willing to throw down the gauntlet of their careers to save yours.

It's not that I'm trying to scare you, but these things DO happen. What it requires from YOU is the ability to stand your ground. Critical care is KNOWN for attracting very, shall we say, 'assertive' personalities. (Many times, that's a 'good' thing. Critical care does NOT need nurses too timid to stand up for not just thier patients, but their OWN ability to make critical decisions and command attention to those decisions.) If you aren't the type of person to rise to the challenge and become assertive yourself, you will quite possibly be 'run over'.

Critical care is the nascar circuit. There IS no 'slow' lane. You must be prepared to drive at 200 mph. That applies in terms of the skills and care you need to give. But at least as important, it applies in terms of the personalities you might be forced to deal with.

So the CRITICAL question to ask of yourself: can you stand your ground? Just how assertive are you? There are many horror stories of nurses 4-6 months into CCU complaining about 'being eaten'. While that MIGHT be true, it's simply a fact that this is more likely in specialty areas out of school. YOU make the choice to be there, and so, YOU are at least part of the equation that is being created. So, the crucial question remains: do you have the fortitude to 'stick it out' and stand your ground? Ultimately, even the most persistent harrassing nurse will grow tired of crashing into a brick wall if YOU are that brick wall.

For me, it took sticking it out for over a year, and THEN, changing jobs so that I came into a fresh unit as an 'experienced critical care nurse'. And THAT was with having 3 yrs of med/surg and some knowledge of the administrative culture of the hospital with which to watch my own back and survive that year plus. Simply put, I would not have made it directly out of school. And I consider myself to be quite assertive (many here at allnurses would attest to that.)

I don't regret for one minute being in critical care. It's simply where I want to be. BUT, that doesn't mean that it didn't take a very long time before I really felt like I 'fit' in. And, that doesn't mean that I didn't fight lots of battles to get where I am today. In retrospect, I'm quite proud of myself for sticking it out and standing my ground. I'm proud of myself because being where I am today was well-earned.

~faith,

Timothy.

Isn't this every floor? I mean, to some extent?? Sounds like every floor I have done my clinicals on, lol:rotfl: Super depressing, if you ask me. Sad that nursing has to be so political and "cliquey". It's like being back in high school, but not.:rolleyes: Oh well, time to get used to it, right?:bluecry1:

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