Is your ICU staffed with mostly New Grads?

Greenclip · Jan 14, 2016

Yes, we have lots of new grads in our ICU. I think it's OK if they are the best of the best--then they learn quickly and bring critical thinking skills. What they lack is experience. In other words, for the question "your patient's symptoms are x, y, and z, what is the most important next action?" they know what the answer should be BUT they do not recognize those symptoms when they see them. I'm not sure that time on the floor before ICU would help that. In our ICU the nurses with previous floor experience do not generally perform better than the new grads.

What I would like to see is more careful hiring of new grads. Zero attention is paid to recommendation of nursing school clinical instructors and preceptors who have actually seen these people perform. On the other hand the personality test that is required of all new hires is weighted very heavily.

I would also like to see a buddy or mentor system for all new-to-ICU nurses who come off preceptorship. There should be someone on the unit who isn't necessarily monitoring their work but does keep an eye out for them. I think that would help for the first six months or so after preceptorship. After that, they should know how to work the team, by which I mean how to work with their fellow nurses, when to ask charge for help, that sort of thing.

I would not like to see anyone with less than two years of experience precepting.

Dranger · Jan 16, 2016

Yes mostly new grads or new ICU nurses. Most experienced ones retire or go on to grad school.

MYSTICOOKIEBEAR · Jan 16, 2016

We hire new grads into 4 (CCI, SICU, MICU, NICU) of the 5 ICUs at my hospital. However we do not hire new grads into the Cardiac/Transplant ICU, which is the ICU I work in. Let me put it this way, when an experienced RN of 5+ years of experience floats to our unit fom one of the other 4 units and has a difficult time with one of our moderately difficult patients, there is almost no way that a new grad would be able to handle it. YMMV :nailbiting:

Here.I.Stand, BSN, RN · Jan 28, 2016

I'm not completely opposed to hiring new grads, but mostly new grads? Recipe for disaster. Fresh ideas are good, but what you really need is nurses who know what the heck they are doing. Precepting by a nurse with less than a year experience in the ICU is completely inappropriate. They haven't been at it long enough to be fully independently competent themselves, let alone molding new hires into ICU nurses.

Michael McNurse · Jan 28, 2016

Seeing things from the other side as a new grad coming into the ICU, I would prefer to be precepted by a seasoned nurse who is already confident in his or her skill set and clinical judgement. I feel that a seasoned nurse would be better able to critique my clinical performance and critical thinking abilities when he or she is already confident in his or her own. Also, to echo what Greenclip had said, a nurse manager had mentioned that in their experience they didn't see a whole lot of difference between hiring new grads versus floor nurses into the ICU. They needed the same amount of time, training, and support because it is totally a specialized skill set.

bgxyrnf, MSN, RN · Jan 28, 2016

What do you all think of having mostly new grads in your ICU than experienced ICU nurses? Do you see that as a recipe for disaster, or bringing in new creative fresh ideas, etc? Has anyone ever worked in an ICU where there were more New grads than experienced nurses; or maybe even equal amounts? How would you feel being precepted by someone with less than or equal to one year of experience? Just trying to get a consensus here.

I think a preponderance of new grads is a recipe for disaster as well as an indication of a terribly dysfunctional unit as evidenced by their apparent inability to retain experienced staff.

A nurse with fewer than 3 years experience in an ICU has NO BUSINESS precepting.

If this is referring to a real hospital, it's one to which I'd never want to be admitted.