How difficult is it to move from med-surg to ICU???

detroitdano · Aug 18, 2009

I started off on med-surg as a nurse extern/tech. Did assessments, basic tasks (NGT's, Foley's), admits, discharges, transfers, blood draws, etc. Basically everything a nurse does besides licensed tasks. I did that for 2 years and it definitely helped in my assessment and prioritization skills. I applied for an internship in our MICU and got the job and I've been at that for 3 months, and I am now an RN as of 2 weeks ago.

In the ICU your assessment will be a lot more intense, your medications require closer monitoring and a lot more knowledge about how/when they work, etc. For me the move to the ICU was wonderful because understanding all the physiology behind your patient's illnesses is highly encouraged, if not expected, and you keep a much sharper eye out for drug mechanisms and actions. That's something you don't get to spend a lot of time doing on a GPU with 5+ patients, and I enjoy all that nerdy stuff, so it was an enjoyable change for me.

If you have a hard time with lots of tasks in med-surg it will follow you to the ICU. If that's a problem for you, do a year or two on a GPU before transitioning into the ICU and work on that. I was always finding myself tasks on my med-surg floor so having a patient that requires ten things being done at once and knowing I've got the same for my patient in the next room over is no biggie.

Don't be afraid to make the move, but you should most definitely have lots of experience on a general floor beforehand, that is key. I was doing 24-40 hours/week of extern work while in school for the entire 2 years on my old floor which prepared me well for my move to the ICU.

geekgolightly, BSN, RN · Aug 18, 2009

I think you only really need a year or two. After that it's redundant. I did learn more taking my time (six years) on various floors before making the move, but I realize now that all of what I learned could have been picked up in ICU in a much shorter time frame.

If you want to be constantly challenged, then ICU is for you. You will be challenged in ICU no matter how much time you spend on a general or specialty floor.

I walked in knowing my heart sounds, and all nuances of assessment down pat because of my varied experiences (progressive care, tele, orthotrauma and started out neurotrauma and neuroscience), and lots of nurses in my unit do not have the assessment skills I have, which is about all I can say about my floor time. I learned everything on my own time, though. I searched doctors notes and read what they had heard and then went and listened for myself. I taught myself heart sounds this way.

RNDave · Aug 20, 2009

I'm new, 4th week of orientation, to ICU. I spent 2 1/2 years on an oncology/medsurg floor including 6 months as nurse tech. In my opinion, I needed at least that much time before moving to ICU. I just think it's fair to patients to get some chops down as a nurse before moving on to ICU. I never knew 2 patients could keep you so busy! I know people go right into ICU from school, but I wouldn't recommend it. (There's also stepdown which is a good prep for ICU).

geekgolightly, BSN, RN · Aug 23, 2009

I'm new, 4th week of orientation, to ICU. I spent 2 1/2 years on an oncology/medsurg floor including 6 months as nurse tech. In my opinion, I needed at least that much time before moving to ICU. I just think it's fair to patients to get some chops down as a nurse before moving on to ICU. I never knew 2 patients could keep you so busy! I know people go right into ICU from school, but I wouldn't recommend it. (There's also stepdown which is a good prep for ICU).

I've seen people do exceptionally well in the unit right out of school. It just takes the right person.

Mrs.Rollins, ASN, RN · Aug 26, 2009

I'm one of those people. To be honest, ICU is a different world from med-surg. While they both utilize many of the same basic nursing skills they are applied in VASTLY different ways, each with a very different focus. I personally would find it harder to learn to juggle 5-7 different patients with wildly different needs on med-surg than to manage my 2 critically-ill patients in ICU/CVICU. But that's just me. Like much in nursing, it really depends on your perspective, your ability, and what you bring to the table in attitude and aptitude.

I figure this first year is all about learning, learning, learning and learning some more. Why not do that learning in a field I already know I'm passionate about and start applying that new knowledge now, instead of suffering through something I (personally) know I hate when I'm just going to have to learn and adapt to a whole new culture (the ICU) when I'm done anyway? If you're a self-starter and quick on the draw I say you can make it in ICU.

WindwardOahuRN, RN · Aug 27, 2009

Detroitdano wrote:

>>I started off on med-surg as a nurse extern/tech. Did assessments, basic tasks (NGT's, Foley's), admits, discharges, transfers, blood draws, etc. Basically everything a nurse does besides licensed tasks. I did that for 2 years and it definitely helped in my assessment and prioritization skills.

And this is exactly why many experienced ICU nurses advocate getting a bit of med-surg experience under your belt before heading to the ICU.

Yes, new grads are being accepted into the ICU and yes, many of them eventually do just great.

But there is a huge learning curve and the stuff that the new grad should be learning on a general med/surg floor (dealing with doctors, families, prioritizing, putting in NG tubes and foleys, starting IV's, etc) should be second-nature when starting to work in the intense atmosphere of the ICU.

Until it does become second-nature it is often up to the seasoned ICU nurses to pick up the slack for the new grads.

And boy....does that become real old after a while.

Yes, we love our new grads and realize that they have to learn somewhere but please....pick up the basics in areas that are less intense. When an ICU is crazy and stuff is hitting the fan we need backup and resource. Get the basics and then move on over.

You often see the repetitive assertion of "I started in the ICU and I did just fine." Okay....sure....but it often comes from those who are praising themselves.

No offense meant but maybe if we polled the nurses they worked with they would have the comment of "yes, she was very enthusiastic, willing to learn, great person..." which is all wonderful of course. But then there is that..."BUT..."

I've been in this long enough to see new hires from both ends of the spectrum and IMHO the ones who have the basics down pat are miles ahead of those who don't. And I am not talking "school experience." Real floor experience, where you are the only one accountable for your actions.

I really do believe that one should follow one's dreams and go for the area that one is drawn to but I also think that one should be realistic about the skills that should be in place before going to a critical-care area.

:: DUCKING:::

geekgolightly, BSN, RN · Aug 27, 2009

There is one (one!) new grad who was hired just before me in ICU and I think she's probably a better critical care nurse than I am. We have been there a year now. There is still lots of stuff she doesn't know and I am surprised at times by that (like being able to differentiate pepcid from protonix and which is the stronger medicine), but in terms of critical care thinking and guts, she's got it down. She took an IABP before me because she felt she was ready, and I felt I just wasn't. I admire her confidence and drive.

GucciRN22 · Sep 1, 2009

i was lucky cause our med/surg unit is also a mixed tele unit so we were all acls certified soon after orientation. i also floated to oncology a lot (honestly, i was there more than my own floor, i liked it so much!!). i was there for about 13 months before i transfered to the icu and now i've been there a year in november.

honestly, i still am nervous going to work (not the pleasant nervous, either) and even more so if i've had a bad shift or something, but it's getting a lot better. some of my friends haven't had that problem at all, but i personally am not a person who adjusts to things quickly (for better or for worse) so it's taking me longer.

i like it so far and i'd say my floor experience really helped me out. i still float to other floors when i can (it's a nice break!) too so i don't forget how to do things out there with more than 2 patients. plus, it's a good way to meet other people you may be transferring patients to/from in the future! :nurse:

MainenurseRN · Sep 16, 2009

I did 2 years of med-surg/tele before moving into ICU. I am really glad I had 2 years under my belt before making the move into a specialty. I work with several nurses who went right into ICU out of college and they are great nurses, but personally I believe it's better to have the med-surg experience. One of those nurses has been in ICU for 5+ years right out of college and she can't start an IV to save her life, for example. Yes, a lot of pts have CVCs but just as many don't, or what about when we need to d/c the line but need a peripheral before we can do it? Also, having that experience is nice in the ICU because we don't get THAT many post op joint replacements, for example, so having a few years of taking care of the healthy ones all the time, helps me immensely now, and helps me be a resource to my colleagues. Like someone said earlier, it seems getting your basic skills perfected in a less intense environment is the way to go. Just my opinion!

silentRN · Sep 17, 2009

Moving from a step down surgical-trauma unit to a surgical-trauma ICU was a humbling experience. I spent a year and a half on the IMC unit before transferring to ICU. I am very glad I made the change and I really do enjoy my job now. The Residents really treat you with respect unlike before when working on the floor. I love the orders so much more because they're within parameters and I love being able to titrate drugs without having to call the MD for every single little move you do. Basically in the ICU you have to use your brain, on the floor you don't and you can cruz all shift on automatic.

I am one of those nurses who also believes that a new grad shouldn't start on ICU. It is so intense at times and to come strait out of school I don't know how you could do it. I would be pretty scared. On the floor I learned a lot of basic nursing skills and time management. I had to handle 5 patients every night and sometimes more if there were discharges and transfers.

Now my debate I'm having with myself is, after a few more years in ICU should I transfer to the ER and experience that or stay in the ICU. I really like my ICU and it's really hard to get into. I was lucky to be able to transfer there because positions don't open up to frequently. We have a lot of nurses who've been there for 10-25 years, unlike floor nursing I think the longest someone was on my IMC unit was 3 years then they left. HA! So I guess it's a very covenanted position. Tough decisions.

vastudent09 · Sep 21, 2009

This topic has been debated before, but I feel as a new grad in the ICU I need to state my opinion.

I worked in the same ICU as a tech for 2 years prior to becomeing an RN in that same unit. I don't think it's as cut and dry as "yes or no " in regards to whether a new grad should start in the ICU. I feel like i am learning better critical thinking skills in the ICU than I would be on a floor. The expereinces I get every shift at work taking care of 2 critically ill pts are irreplacable. I have a great team of nurses around me that provide support and encouragement. Also I have to constantly be thinking and learnign in order to continue to do well in that environemtn, but I am aware fo that, and I think that is why it is going well for me. I only got 7 weeks of orientation because they took me off early b/c my preceptor said I was ready. So, neways I can't imagine working anywhere else. I tried to take every opportunity available to prepare myself to be s good nurse in the ICu out of school. I did 2 summer externships in that ICU and then my final school 120 hour preceptorship while alos continueing my tech position.

So basically, I think the ICu can be a good fit for soem new grads but others are not ready. I think it really depends on the person. But it get old ( no offense) hearing a lot of veteran nurses saying I don't belong where I am working, and that I am not ready.

JMHO