If I speak, I am condemned. If I stay silent...

[TU RN, DNP, CRNA]

Was hired on a very busy SDU with very high RN turnover in an urban hospital pretty quickly after passing boards. Ideally I would've gotten a job in the ICU since that is my dream, builds awesome experience for career expansion, and this institution's ICU hires new grads. I was offered interviews for 2 separate floors (neither ICUs) and accepted the first one who offered to me - no way I was gonna turn a full time job away as a new grad RN, regardless of the floor.

I've been working here for a couple months, one on my own after orientation. It's hard on me day in and day out, I stress about everything, I feel like I'm missing something, I dread going to work some days, and all the other stuff that comes with being a new grad. Yeah my floor is extremely busy and the pt acuity is much higher than it used to be (according to other seasoned staff), but I feel like these emotions are expected in new grads regardless of acuity.

Anyway I was talking to a friend from nursing school who got hired in the same hospitals ICU as a new grad after passing boards and she says the unit still has staff leaving, and positions opening up. Half of me wants to talk to the manager and see if I can put in for a transfer, but the other part tells me that's a pretty crappy thing to do to my managers/the staff on my current floor. It's not like I physically signed on for a predetermined amount of time, but a question they asked was if I saw myself working there for a year or longer. At the time the answer was (well had to be for the job) "yes."

My plan was to work for a year and gain experience then see if I could transfer. This floor has put so much into orienting and developing me as a new grad RN, I feel terrible pondering this deceit towards them. However I f this opportunity presents itself to me now, how stupid would I feel after a year's time when the position is filled? According to most RNs, you aren't fully experienced/competent as a nurse until about 5 years experience. Yet my coworkers also tell me to go back to school as soon as possible while "the student in me" is still practiced. Why should I wait until I'm approaching 30 to step out of my comfort zone and reach for my career goals? I want to get married and I want a house and a family, but to get where I want to be I have to have ICU experience first. Why wait and gain SDU experience which is inconsequential to my career, when the opportunity to get the experience I need is right there?

May the AN community, whose moral compass ever points north, weigh into my dilemma :)

TU RN

[HouTx, BSN, MSN, EdD]

Why would you feel that SDU experience is "inconsequential"? You describe this unit as a place that is providing a good transition (form student to practicing nurse) experience for you... and you have made a commitment to work there at least a year. Your word should mean something; integrity is not a contextual phenomena that changes depending upon your mood or circumstance. Keep your commitment. If that ICU is experiencing significant turnover, it is NOT a great place to work - particularly for a newbie. Chances are, the turnover will continue so you can transfer at the end of your year.

I'm a Critical Care nurse so I can say this.... although about half of all new RN grads (according to NSNA) say they want to work in ICU, it is not a great environment unless you are very assertive, clinically proficient (not just competent), a very quick learner, easily adapt to change, can make quick decisions, very comfortable working independently, and not afraid to deal with conflict on a regular basis. For most nurses, this means you need some experience and confidence before making the leap. ICU nurses are not known for patience and nurturing, particularly if you are not a good fit, personality-wise.

[TU RN, DNP, CRNA]

Thanks for the response, HouTx. There's no better advice than that from an experienced nurse! Maybe all I needed was another person telling me not to do it to ultimately decide, but after considering how it would stain my integrity, I couldn't agree with that point more. Others I've talked to agree as well. I must keep my word and honor my commitment.

The reason I described this experience as "inconsequential" is because it does not directly fill the experience requirement for the graduate program I would like to eventually pursue, not because it isn't contributing to my clinical and professional development. I am such a stronger nurse, professional, and person because of my floor. I'm not sure if the turnover in this particular ICU is due to low staff morale or due to older staff moving on to less physically demanding arenas of nursing care. The last time I worked there (as a PCA/CNA), there were two RNs finishing school and moving to nursing administration. As an aside: even if this turnover was due to low moral/staff dissatisfaction, bucking up and succeeding in such an environment would only speak more to the quality staff who joined despite it all, braved through the hardships, and made it a better place - that's just my perspective on that.

Your second paragraph strikes a negative chord with me. It has been thrown at me ad nauseam from critical care nurses both online and in person since I was pre-nursing. Unfortunately you're only contestant #999, next caller to tell me new grads can't handle the ICU gets an all expenses paid trip to Dover, Delaware! I bought into it in nursing school and it only served to discourage and diminish me. I conceded to it in accepting my current position after a beloved aunt/critical care RN also encouraged me not to go ICU right out of school. It's true that the ICU is an intense environment and if you can't handle rapidly changing conditions with quick responses you'll easily become overwhelmed and it could be detrimental to the patient. I have never worked there as an RN (only as a PCA), so my opinion is limited to nothing.

/rant I can say this though "as a stepdown nurse"... not sure how it is at yours, but my institution seems to often employ this "let's see how they do on stepdown first" mentality that often gets us hit with ICU patients. That is, patients we struggle with for hours (additional PIVs, Foley, bolusing, NGT insert, central line assist, on monitor to CT, starting multiple gtts, sedating, ET intubation, and my favorite chasing the doctors down to make sure the orders are actually in the computer) before an ICU bed opens up, all the while we take care of 2 other patients - then off they go, stabilized by stepdown RNs (the unsung), so some critical care nurse can blow his/her head up about how 50% of new grads can't handle the ICU. Some of them act like they are the only person who's ever lived that can handle the ICU. As a matter of fact, the unit in reference has several new grad RNs, who I personally know as they were in my same graduating BSN class. I am aware of their capabilities as college-prepared students and PCAs and they seem to be experiencing the very same new grad emotions and discouragement as me. Who exactly do you have to be assertive with in the ICU? Your vent patient who is snowed under propofol, versed? What kind of conflict do you handle? Your patient starts breathing against the vent? From what I've heard, the majority of conflict in our ICUs seems to be between the overly-cliquey staff. In my limited experience, the ICU nurses I've seen pulled to my floor have struggled with the 3 patient assignment. Their palpable misery during handoff when they get pulled, their overall rundown appearance the next morning, and of course the much improved demeanor during report because they're finally finished their pull. /end_rant

Sorry for the length. Again, thanks for the response HouTx.

TU RN

[tcvnurse, BSN, RN]

Ok, I'll field this one. You have to be assertive with the MDs for one thing, who very well might be on a one month rotation and prone to doing stupid things like trying to pull v wires while on a heparin drip. You might be dealing with two patients, one of which is dying yet has three or four pressers, insulin and heparin, on CRRT or worse, ECMO. The other patient might have just been extubated and it's up to you to make sure he does his IS work so he doesn't have to get RETUBED. Oh, and you will probably have to have that awful conversation with the family of patient #1 about how there are worse things than death, and would grandpa or grandma REALLY want to live this way?

Then you have to give report to a ICU nurse with fifteen plus years of experience who is watching you like a hawk to make sure you haven't inadvertently made someone worse by forgetting something crucial.

The reason why those critical care nurses struggle when they get pulled to step-down is that they probably NEVER worked outside of an ICU. I assure you, those of us who started on an acute care floor, and moved up to an intermediate unit, and THEN to an ICU have few problems working in step down for a day. I can survive anything for 12 hours.

Now. Some new grads will thrive in the ICU, some won't. Depends on how you handle pressure and the ability to focus and recall when a patient goes really really bad. Hopefully you will continue to thrive in whatever environment you are in.

[SamMo]

Hello TU RN, I know this is an old thread but I am a new grad considering taking a PCU job and it is a 1:4 ratio. May I ask how long your orientation was?

[seconddegreebsn]

HouTx, your post is very enlightening - I never thought of it that way. Realizing critical care is probably not for me, I'm not the most assertive person. Thanks for sharing that.

[~Shrek~]

I know this is an old thread. But here is my input; you wrote this in November 2012. Let's say you switched to the ICU and worked there Starting December 2012. In Fall of 2013 you start applying to grad schools. Spring of 2014 you get into the program you want. You start school fall of 2014. Right now you would be a nurse with 1.5 years of ICU experience and enrolled in the graduate program you want.

Yeah ideally we would have sooo much experience but I want to get as much of my education done as possible when I am young, childless, healthy, and single. I am not going to wait until I have a husband and 2 kids to worry about to finish my schooling.

[~Shrek~]

Literally no one says "I wish I waited a year to take my dream job because I felt bad about leaving my boss" nobody says this at all!

also nobody ever says "I wish I waited 10 years instead of 1-3 years to go to graduate school"

[Nola009]

I understand your dilemma. I think that having this conversation with your unit manager could help. I am a big believer in open communication-- cuts down on the 'what ifs' and the anxiety that goes along with keeping thin g s bottled up. You deserve to pursue peace.. happiness.