I'm starting to get a bit "scared" about my position as new grad in ICU

[email protected] · Apr 30, 2005

I will be beginning my 3 week (yes, you read that right, 3 week) orientation in the ICU on June 6. We actually will be doing a week of didactic/computer and meetings, then 3 weeks of working with our preceptors. I'm starting to get really nervous about my new job.
Here's some background: I started working in the ICU in December 2003. For the first 6 months, I was a Tech/Apprentice Nurse I. My duties were stocking, ensuring equipment was available, setting up rooms, helping with patient turns, etc. I also asked a LOT of questions and went to many, many different procedures, admits, and helped with transfers so I can familiarize myself with how the unit and nurse operates.
Then, in June of 2004, I began working as an Apprentice Nurse II. I was paired with a mentor and worked side by side with her through the 12 hour shifts, assessing, documenting, starting IV, dropping NG, foleys, etc. The only thing I couldn't do was give IV medications. I was responsible for all the responsibilities for one patient until December of this year, then my preceptor decided it was time for me to start "taking" 2 patients. I have seen and experienced a lot, gotten down the charting (one of the areas where I was most hesitant), and have become very comfortable in the ICU environment (comfortable, but still "scared", which I think is a good thing....to have some level of fear in such an environment).
My concern is this: after reading the board here, it seems as though everyone thinks I should be starting off in a med-surg environment with a 12 week or longer preceptorship. So even though I was feeling good about the experience I've received in the past 1 1/2 years in my unit, I am now feeling scared. I have to sign my contract for the 2 year internship on June 6 and if I don't fulfill the contract, I will have to pay back $2500. There really are no other units I would like to work, with the exception of maybe Neuro or CIC (I LOVED my rotation there). I am currently doing a rotation on Med-Nephrology where they have 7 patients, sometimes 8 and the chaos in that environment stresses the hell out of me. I don't like having CNA's doing my baths, vitals, etc. and would rather be responsible for total patient care. That's one of the many things I love about the ICU. I really enjoy my shifts in the ICU....in fact, I love the unit I'm in. The people are great (extremely helpful), the supervisors are terrific, I love taking care of the patients who are so acutely ill (I work in a Trauma/Med/Surg ICU) and I just plain love going to work.
So does my prior experience count for anything? The students that will be starting as new grads along with me will be getting a 5 week orientation because they started in January of this year as Apprentice Nurse II's. I feel as though they are even worse off then me because they have only had a few months of "real" experience in the ICU and are only getting 2 weeks longer that I am. Any advice, thoughts, opinions, etc. are greatly appreciated!!
Melanie
Graduation May 24, 2005!!!

You sound like you've had a lot of great experiences already in the ICU setting and the additional weeks will just pull everything together. I know that many RN's feel you must have a med/surg background first to be successful but I don't find that to be true. I started myself as a graduate nurse in the unit and stayed in that specialty for 15 years until just recently when I transferred to informatics

Med/Surg is really a specialty in of itself because of the time management issues and variety of patients you get. I found that I was undoing many habits picked up by med surg nurses that they had developed to survive with 8 or more patients

If critical care is what you love stick with it it is very rewarding

Good Luck

fergus51 · Apr 30, 2005

I think your prior experience does count. You don't need a year in med-surg anymore. Most hospitals I have worked at take new grads into specialty areas and with your experience in the NICU as a nursing student, I can't imagine you wouldn't be snapped up to work there. If you feel unprepared at the end of your orientation, could you extend it? If so, I don't see a problem.

PJMommy · Apr 30, 2005

I agree with previous posters. You sound committed to learning and it sounds like you'll do fine. You've spent a great deal of time there and just need to pull it all together and work out any kinks.

Good luck!

zambezi, BSN, RN · May 1, 2005

I agree with the previous posters as well. I too started out in a position similar to yours. I have 6 months of working as a student nurse along side a preceptor (40 hours a week) before I graduated. I did have a longer orientation with more preceptorship after i graduated about 12 weeks. I felt pretty good when I graduated...like you, still scared but at least familiar with the environment. See if you can push to have the orientation extended if you feel like you need it...At the very least make sure that you have a "buddy" on each and every shift that you can turn to if you are feeling unsure or have a very unstable patient. If your unit is supportive, I think that you will do fine..if you have an unsupportive environment, I would ask for a longer orientation for sure-> support is crucial in this early phase of your new career...I think that you sound like you have gotten a good base and would do okay after a shortened orientation, but once you graudate and have the RN behind your name a longer orientation to your new role (title and all) never hurts! If you like ICU, I think that you should stay there...I too think that the floor work is craziness and have not alot of desire to be there (thank goodness there are people that love it...it just stresses me out...i need to be able to see my patient all the time and I too don't like delegating vitals/baths, etc to the CNAs- even the good ones...I guess its that control freak in me...)

Good luck in you decisions!

TJNurse · May 1, 2005

Melanie,

Are you from northern Nevada or Las Vegas? As a new grad in the PICU at our hospital you get about 12 weeks orientation with a preceptor, more if you are not comfortable yet. I was also a nurse apprentice for a year and a half and did 4 months on a gen peds floor before transfering. I think if I was thrown out on my own after three weeks I wouldn't feel very safe. There are so many things I have yet to learn!! Good luck to you, and don't forget to ask for help! Talk with your nurse manager too, they may be able to stretch it out for you if need be.

Tracy

dino56 · May 1, 2005

I think you're good to go! Back in the early 80s when I was a new grad it was not at all uncommon for new grads to join ICUs. Having had an internship in one, I was readily hired into one and spent several content years there. I don't think being a new grad is a handicap. If you are motivated, have some experience, and want to work in an environment that requires you to think and make decisions 8 hours a day, ICU is for you. Best regards, and welcome to Nursing!

Graduation May 24, 2005!!!

lady_jezebel · May 1, 2005

My advice to anyone who asks is to do med-surg first UNLESS your passion lies elsewhere. For nurses like yourself, who have a love in a specific area of nursing, GO FOR IT! You'll become a competent nurse with either choice, so why not choose your favorite option?

One strength of new grad nurses (though you have much more to offer than a typical new grad) is that all the theory is fresh -- it helps to have an intellectual understanding of the pathophysiology, in addition to skills. But for someone like me, who started out in med-surg, the basic skills are there but the knowledge has started to fade...

Maine Critical Care · Sep 26, 2006

You are the kind of nurse who can actually start in ICU.

You have support. You have gradually layered experiences there.

You know enough to actually be frightened. This is crucial, because it will keep you humble and safe. You won't go off half cocked or not ask questions when something is wrong.

Good luck and go for it!

Aristotle said the older he got the more he knew what he didn't know. Knowing you don't know means you know more than you think you do.

Trauma Columnist · Sep 26, 2006

I see no reason NOT to go into ICU. However, I sincerely question the 3 week orientation. Your experience does count. However, you were not getting RN experience, you were getting TECH experience. Once you get done with THREE weeks orientation - you're on your own!??

That is a big issue just waiting to happen.

SanFranSRNA · Sep 26, 2006

I'm working at the same hospital but in a different unit. I have a total of 12 weeks orientation for CVICU and CCU. For the first two weeks, part of the day was on computer class called ECCO and the other part was on the unit with the preceptor. For the remainder of the 10 weeks, I was on the unit working with my preceptor. Two months into orientation, We got ACLS certified. I felt that my orientation experience was adequate. The nurse educator really tailored to my learning style.