How do all the experienced ICU nurses feel about....

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How do you feel about a New Grad starting in the ICU? Is it safe for a New Grad? Do you recommend Med-Surg first? Thank you in advance for your feedback.

:heartbeat

Specializes in CT ICU, OR, Orthopedic.
The post wasn't about you. I'm now on 3 years nursing, now considered an expert.:nurse: But, by example, I know an OR nurse going for a Masters in teaching, and she is scrambling to find some med surg experience because she was advised she needs it. One of our own ICU nurses is going for a nurse pract, and she had to take a job in the neuro unit because she needed it for her requirements.

And from past experience, I don't know how many 4.0 students we had that sucked on the floor. So, you many sing your own praises, I'm wondering if your coworkers do............

agree that an OR nurse needs med surg! Or is a whole different animal. The skills needed there are completely different than the skills needed anywhere else. I could see needins some neuro experience I guess, but obviously they meant neuro ICU. But I don't think a MSN program is going to telll an ICU nurse that they need to do med surg in order to admit them. That seems ridiculous!

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Specializes in CT ICU, OR, Orthopedic.
Ok, forget everything I said about Med surg vs ICU. Here is the best reason to work med surg, and this is going to make all the ICU nurses who went straight to ICU mad, but I don't care. I know in my hospital, ICU nurses have a certain reputation for being mean b's who think they run the hospital. Do you know the ones with that attitude? The ones who never worked med surg and saw how completely swamped and busy they can be. I'v seen many ICU nurse talk down to the floor nurses, Shame on you! I, having worked Med Surg have tremendous respect for those nurses, and if they tell me they can't take report right now, then I understand. I treat them as my equals, not someone below me. Don't email me saying it doesn't happen, I've worked in three hospitals, and it happens in everone. So, work where you want, there is positive sides to both, and good luck.

About the meds, shouldn't a grad nurse learn how to do a morphine push before he needs to do a adenosine push? Shouldn't they learn some basic skills before they come into a high stress unit that expects them to come off of orientation knowing what they need to know? Remember, these are grad nurses who as we all know, most of the learning comes on the job, not in school. I vote for all grad nurses doing a year in medsurg before moving on to any field.:yeah:

every one deserves respect regardless of their role. Of course we know the ones you are referring to... But there are some in every group. I have had med surg nurses treat me like crap. I have had aides, transporters house keepers etc. Be mean. Everyone should be treated as equals. We all need eachother in order to get our jobs done.

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Specializes in ICU.
I do agree that a n ICU nurse has to be very well rounded in all aspects of patient care, as well as posses great critical thinking skills and know how to think outside of the box. In the unit, a patient is usually more complicated than onthe floor..they may have multiple problems that may or may not relate, and may or may not even be diagnosed yet. The nurse is the one with the patient all day, sees what is going on, and steps inwhen needed. I say this from the standpoint of a new nurse, and the only ICU experience i have really had is from my preceptorship, which was only 90 hours (or 8 days)..i started monday with orientation and will be in MICU starting next week, as a new grad. My director knows i have no real background in ICU, but yet i was hired on the spot, over several experienced ICU nurses, because i was told i had the right attitude, and the dediction to get in there and learn. I dont now how much that will matter once i get in there, but I am determined to make them proud, and leave them no room to doubt their decision to hire me. However, i have to admit i am scared to death, because next week, my first week on the unit....Joint Commission will be there!! I expected them to ask me to not work that week ( i have seen other places do this), because of that, but no..they want me there front and center, and a honest as i can be about my knowledge or lack thereof...sugestions on that??

Mommy of three,

Know where your policy manual is or where they are on your facility intranet. You don't have to have all the answers, just know how to find them. You can always reply, " I am not sure. This is my first week, but I know that SoandSo could help us find the answer." Or you can direct them to your policies and procedures. Start thinking about what you do in your unit as you begin that contributes to meeting JC 2009 Nat'l Patient Safety Goals. This is always something they will address. For instance, recognizing and responding to changes in patient condition is an 09 safety goal. If you guys have a RRT, then that is a policy in place that helps meet that safety goal. Hope this helps!

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Specializes in CT ICU, OR, Orthopedic.

I started as a new grad in the ICU. My previous experience was in the OR, which is a whole different ball game, but that experience still helped. I will say that it was terrifying and very overwhelming! I would drive home from work and call my husband and tell him I couldn't do it!! When I left I'd thank God that my patients were still alive! It was very stressful. I had nightmares. It did help that there were other new grads that started with me. We could cent and share our mistakes etc.

But I stuck it out. It takes about 6 months to not be terrified, and about a year to feel comfortable. My advice? Don't think of yourself as out of school. You will need all those text books etc. I bought ECG books, and "critical care made incredibly easy" that was helpful. I have been doing it for three tears, and still consider myself a new grad LOL! They have to remind me that I'm not!

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Specializes in Emergency Dept, ICU.
Ok, forget everything I said about Med surg vs ICU. Here is the best reason to work med surg, and this is going to make all the ICU nurses who went straight to ICU mad, but I don't care. I know in my hospital, ICU nurses have a certain reputation for being mean b's who think they run the hospital. Do you know the ones with that attitude?

Hey don't leave us ER nurses out of this, you know the whole hospital says we talk down to all the 'floor' nurses too... and what is this bed bath you speak of???!

Well it's true :smokin:

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Um, for one thing, I don't know many med surg nurses who know how to do an adenosine push. That's not something one would typically be pushing on a med surg floor. In fact, if someone needed adenosine on the floor, it's likely an ICU nurse would be the one responding to the rapid response call, thus being the one to push it. Secondly, simple IVP drugs are something a person should have learned how to do in school or during their preceptorship. If not, it's not like it's something too complicated to learn.

I had absolutely no desire to work in med surg. I don't belittle the nurses who choose to do so. I actually applaud them because I know how bad it can be out there, and they do have to know a lot to do their jobs.

I have always wanted to work in critical care, and I started in the CVICU as a new grad and I have been there a little over a year now. While I know that I'm not the best nurse in the unit, I do know that I am a rising star. I love talking to the veteran nurses and I do go to them for help when I don't know something. Keep in mind, the questions I usually ask them are things a med surg nurse wouldn't know. I jumped right in and was taking high acutiy patients without difficulty after coming off orientation. Other nurses compliment me on how well I am doing. Doctors listen to my suggestions and respect my judgement (well the ones who aren't jerks...), and I listen to theirs. I'm a team player, and I help my fellow nurses when they're in a bind. I have responded to RRTs on med surg floors when the lead was busy with another one. I feel like I was adequately prepared to be an ICU nurse as a new grad, and I have never regretted not starting in med surg.

I think there are a handful of new grads who are adequately prepared to go straight to the ICU if they choose, and there are definitely those who need more experience first... but don't tell me you don't think I can kick it because I can--and do!

I'm sorry but your post seems very puffed up for lack of a better word.. . You seem not only condescending to nurses who don't care to work in ICU but also extremely naive. you say you've been a nures for one year, and that "doctors listen to your suggestions, except for the jerks" (of course!). Of course you are a self proclaimed "rising star!" Is anyone who doesn't automatically a jerk? I would fear any MD who would take advise from a novice nurse in the ICU!

I fear someone needs a reality check-and fast!

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Specializes in CVICU.
I'm sorry but your post seems very puffed up for lack of a better word.. . You seem not only condescending to nurses who don't care to work in ICU but also extremely naive. you say you've been a nures for one year, and that "doctors listen to your suggestions, except for the jerks" (of course!). Of course you are a self proclaimed "rising star!" Is anyone who doesn't automatically a jerk? I would fear any MD who would take advise from a novice nurse in the ICU!

I fear someone needs a reality check-and fast!

Really? I was simply trying to emphasize that it's not necessary to have experience to be a good nurse as a new grad in the ICU.

I'm certainly not condescending to floor nurses, I just recognize the fact that there are differences... I personally don't think I could handle 6 med surg patients without pulling my hair out, but I can handle 2 critically ill patients.

Yes, I do speak to the doctors, and I do ask a lot of questions, especially when I feel that something isn't right, or why something isn't done a different way. A lot of doctors respect my opinion, and I am very interested in their rationales for certain orders. It's all about learning and realizing that nobody knows everything. Every doctor and every nurse can learn from one another. That's why we are a health care team. When I first started as a new nurse, I used to be afraid to call certain docs because of their reputations for yelling at nurses who called them in the middle of the night. This is no different for any new grad, on any floor.

Most of the time when I call a doc, he/she is not mad because I'm calling due to something important/critical I have found in my assessment. They know from working with me that I'm not calling for something petty, or for something that could wait until morning.

We all know the "jerk" docs I am referring to... i.e. some of the brand new July residents who think that they are above nurses just because they have the title MD behind their name. These are the docs whom you've called 3 different times throughout the night because you feel your patient is having a hard time breathing. These are the docs who get mad and refuse to even come see the patient, order ABGs, CXRs, etc. This is when you come back the next night and see that the patient was emergently intubated an hour after your shift ended.

When a certain doc who is notorious for being somewhat crochety and picky calls me on the spur of the moment and asks if I am taking care of his fresh post-op LVAD patient and says "Oh good," it makes me think that I must be a pretty good nurse since the only other time I've heard him say that was to nurses who have been in the ICU for over 10 years.

I am the type of person who will admit when I am wrong. I view everything as a learning experience. My whole point in posting was to encourage people who are considering starting out in ICU. Some of us are better suited to certain areas of nursing. My area is not the floor, and it's not because I think floor nurses lack intelligence or skill. In fact, if someone threw out into med surg, I would probably look like a deer in the headlights because I don't have the types of skills suited to maintaining 6 different patients at once. I'm far too Type A for that. If you look at the personalities of ICU nurses, you will find that a lot of us are. All I'm saying is that it's possible to succeed as a new grad in the ICU.

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Specializes in Cardiac.
. I would fear any MD who would take advise from a novice nurse in the ICU!

I fear someone needs a reality check-and fast!

I think the reality check needs to come to you. And I'm not being rude when I say that. If you fear any MD who takes advice from novice ICU nurses, then you have a LOT of MDs to fear. You saying this tells me that you not only do not work in an ICU, and have no idea the role of an ICU nurse, but you don't know what it's like to work in a teaching hospital.

I was giving advice (correct advice) to MDs within my first year as well. And refusing to follow some of their orders, and following up the chain to the attending...all within my first year. You should see the advice I "give" to them now!

Oh, gotta love July...

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Specializes in Cardiac.
.

We all know the "jerk" docs I am referring to... i.e. some of the brand new July residents who think that they are above nurses just because they have the title MD behind their name..

Oh, but they learn quickly don't they?

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Specializes in Telemetry/ICU/CCU.

The best thing I can say is you had better get into an ICU with a GOOD support network. when I started, there were 5 other nurses starting and they were ALL new grads. I had some floor experience behind me and that helped with organization, internal system knowledge, and 'where things are', but it was a whole new world.

The scariest part was not feeling supported with a good nurse educator, a senior nurse on each shift, or a resource person to go to with questions. Preceptor programs are great, especially if they combine with some classroom time, nurse educators are invaluable. You don't HAVE to have floor experience to work in an ICU but you must have a lot of support for safe learning.

ICU nursing is VERY VERY hard. It's tough mental work. Be prepared. Be safe.

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Specializes in Anesthesia.
I'm sorry but your post seems very puffed up for lack of a better word.. . You seem not only condescending to nurses who don't care to work in ICU but also extremely naive. you say you've been a nures for one year, and that "doctors listen to your suggestions, except for the jerks" (of course!). Of course you are a self proclaimed "rising star!" Is anyone who doesn't automatically a jerk? I would fear any MD who would take advise from a novice nurse in the ICU!

I fear someone needs a reality check-and fast!

Wow, something crawled up yours, huh! I was also "making suggestions" to the docs in my first year as an ICU nurse and they were asking my opinion as well. When you've walked in our shoes what you have to say will actually have merit. As for now, you don't seem to have a clue. It sounds like you're a little bitter; turned down for an ICU position somewhere?

No offense intended! :saint:

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Umm, with all your "experience" have you ever applied for a Masters to Teach? Try it and see.

I work with about 50/50 nurses that have had previously general care experience and those that went straight into critical care. The great majority of nurses who worked on the floor wish they would have started in critical care. I myself was a new grad to the ICU. When I have talked to my fellow classmates- there were some who were dead set on working ICU and some that were dead set on psych, OB, or general care. I think it is more of a way of thinking than it is a progression from general care to ICU. Nurses have different interests just as primary care MDs and Pulmonary/critical care MDs have different preferences in career goals. I even know a colleague who was a new grad to the ICU who wants to go back to school and teach. Is this RN disadvantaged because he/she didn't work in general care?? I highly doubt it! I guess we'll see! P.S. How many of your nursing professors even practiced nursing? I know a great deal of mine went straight to a PHD program right out of their BSN. Its amazing that 'nurses' who have never even practiced in the 'real world' are training the new crop of nursing professionals. That statement is probably for a different posting...

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