IS MICU/SICU too much for New Grad?

amzyRN · Sep 21, 2014

It is my personal opinion that new grads should go to a lower acuity specialty first like MS or tele. Or, they have a long orientation program, like 6 months. The reason being is usually a good orientation for a high acuity specialty like ICU, NICU, or ED is 12 weeks (3 months) for an experienced nurse. So an extra 3 months might be very beneficial to a new grad. That being said some new grads are able to make the transition with less.

The reason why I think most often 1 year (at least) before going on to a specialty is because clinical enough intuition is often formed with the first year of practice to be successful in a higher acuity specialty (sometimes more time is required). To go into a high acuity specialty and have no clinical intuition or confidence can be very challenging. Not that it can't be done, but I think not all new grads can do this. If someone can't survive, their confidence may suffer, which is tough.

For me personally, I did a residency at the end of nursing school in the ED and I knew that I needed at least 1 year of floor experience before. I just didn't have the intuition and confidence I needed as a prerequisite. Plus, I would have only received 8 weeks on top of the 6 weeks of residency. Knowing that I might not be successful, I chose to get floor experience (tele/step down). Now that I have confidence and a solid experience base, I feel that I could make it in the ED.

I know everyone is different, but I do think in most cases it is best for new grads to get experience first. Many units won't let new grads into ICU, NICU, ED. Many even want 2 years experience. What ever you decide, you know yourself best. Good luck!

Mama_Cashew, ASN, RN · Sep 22, 2014

I am a new grad in an MICU. Not sure why everyone thinks new grads don't get into ICU, because I am one of three hired into my area. We all get 6 months orientation with a preceptor. If it's where you want to be and you get an offer I say go for it.

llg, PhD, RN · Sep 22, 2014

I know it is not the answer you want to hear, but in reality ... "It depends." It depends on a lot of things, such as:

1. How accustomed to hiring new grads in the unit? Are there expectations of a new grad realistic?

2. Is their orientation appropriate for a new grad? Do they offer the type of support that a new grad needs -- both during and after orientation?

3. What is their success rate with orienting and integrating new grads into their staff? How many new grads succeed in their orientation and are still working in that unit after 1 year? 2 years?

Some ICU's are very prepared to integrate new grads into their staffs. They have great orientation programs and provide the support new grads need for many months after orientation has ended. Other ICU's are not good places for new grads. You have to assess each unit individually. What is true of one may not be true of another.

It also depends on the particular new grad:

4. How much experience in ICU did you get in school? For example, did you do a capstone experience or preceptorship?

5. How tough are you?

6. How well do you handle stress?

7. How much do you want it? Are you the type of person who will "stick it out" if it turns out to be VERY difficult for the whole first year? Or are you the type of person who will cry every night and quit after a couple of months?

Just as every unit is different, every new grad is different. It can work if you are a good fit for that unit. It will not work if you are not a good fit for that unit. Be BRUTALLY honest with yourself and assess whether this unit is really a good fit for you at this time. If it is, it's OK to "go for it." But if it is not, it would be foolish to start your career off with a high-risk job.

DogLover17 · Sep 23, 2014

One question I'd encourage you to ask is the turnover rate on the unit. Right now on night shift we typically have 2-3 new grads (who are extremely capable), a few new to ICU nurses but not new nurses, and one person with more experience. It's really tough and anxiety provoking if there's a lot of stuff going on that night. If you'll be on orientation only 3ish months and you'll be working with mostly new people, I might think twice about it.

Guests · Sep 23, 2014

I generally advocate having self-confidence and seizing opportunities when they present themselves because they may never do so again.

When I graduate nursing school, the only job I could get was a (usually) low acuity med-surg gig. Within the year, I was offered an ED position where I was the *only* nurse... one year out of school and with very limited experience. I decided to take the chance and hope for the best. It all worked out in the end though there were some very trying times.

When opportunity knocks, people are generally wise to open the door.

Natural510 · Sep 28, 2014

I started in ICU, but I was also a nursing assistant for 2 years in the same unit beforehand. Other new grads from my class who got hired there included an ED NA, a step-down NA, and someone with no medical experience at all. The latter has taken the longest to "come around", but she also has done the most studying of meds, diagnoses, procedures, etc in her off-time to catch up.

In the end, ICU is all about ambition and attention to detail. If you're the type who is aggressive and likes to take initiative (rather than being told what to do, or doing 'just enough' to get through the shift), then you can handle critical care as a new nurse.

CardiacKittyRN · Sep 28, 2014

I'm a new grad myself and have been at my job on a Cardiac Progressive Unit for about 7 months now. We take all drips except Levophed & sedation drips and no vents, but often have critical pts on bipap. I will say it has been tough because there is so much to learn! I know ICU would have even more and it is overwhelmed. There are so protocols and critical decisions to be made on the spot that a lot of the time I am not confident in my decision and often have to ask a senior nurse for help in tough situations. I love my job and I have learned sooooo much, but sometimes I do wish I would have taken a medsurg position so I could get comfortable with protocols, developing plans of care, and common nursing problems & care.

Just think long and hard over it! If you're committed to doing the extra studying/learning required to excellent in such an intense area then I would say go for it!

IndiCRNA · Sep 28, 2014

So there are lots and lots of people out there who are not up on their EBP and believe that new grads must work their way up to ICU. It's not true. Evidence has shown that new grads can excel in ICU, if they are properly trained and supported. Most of the better hospital hire new grads into ICU as a matter of routine.

It very much depends on the investment the hospital is willing to make in training and supporting you. If they don't offer the kind of training and support required to turn new nurses into ICU nurses then you are better off to work your way up.

Ask if the unit has a history of training new grads into ICU and understands what is required.

My hospital offers a 9 month critical care residency for new grads going into ICU. We are actually too small to support the training so grads are trained at the much larger flag ship hospital in the system then go to work in our smaller hospital.

VANurse2010 · Sep 28, 2014

So there are lots and lots of people out there who are not up on their EBP and believe that new grads must work their way up to ICU. It's not true. Evidence has shown that new grads can excel in ICU, if they are properly trained and supported. Most of the better hospital hire new grads into ICU as a matter of routine.
It very much depends on the investment the hospital is willing to make in training and supporting you. If they don't offer the kind of training and support required to turn new nurses into ICU nurses then you are better off to work your way up.
Ask if the unit has a history of training new grads into ICU and understands what is required.
My hospital offers a 9 month critical care residency for new grads going into ICU. We are actually too small to support the training so grads are trained at the much larger flag ship hospital in the system then go to work in our smaller hospital.

I don't think they can't be successful in the ICU - I just think only doing ICU gives an extremely distorted view of how nursing works outside the ICU.

IndiCRNA · Sep 29, 2014

I don't think they can't be successful in the ICU - I just think only doing ICU gives an extremely distorted view of how nursing works outside the ICU.

Any good ICU training program for new grads is going to strat them off on a busy med-surg floor with a preceptor. For a few months anyway. I would question any program that didn't.

jamisaurus · Sep 29, 2014

I'm in MCSICU as a new grad. I only got 12 weeks of orientation, wish it would have been more but I seem to be doing ok. It's important to remember you're never really alone and to ask for help when you need it and to go home and study. I could never go out and do floor nursing after this- we have so much autonomy with physicians and I don't think I could handle more than 2 patients. I plan to transfer to L&D after another year or so, hoping this ICU experience makes me marketable.