Level 1 too much for new grad?

Dinith88 · May 11, 2006

I graduate in Nov and am really considering working ICU in the hospital I've done most of my clinicals in. The thing is that they have a level 1 trauma unit. I'm not sure if jumping right into a level 1 would be a good thing, but I really love this hospital. The fact that they have a 5 month orientation makes me more confident that I could do this, but I am still very unsure if it's the best decision. I've also heard that starting off on nights might be better, especially in ICU since there's usually less commotion, family, and doctors compared to day shift, perhaps. I'd appreciate anyone who can relate or who has any input.
Thanks!

If you're jumping in to icu, dont fret about a 'level I' designation, that's not going to mean your 'work' will be any different. 'level I' simply means the hospital has surgeons on-site and available 24/7...and has the facilities to see a person through from the er to rehab-type unit. Level I centers are usually bigger and busier (and full of student doctors who will be doing alot of your work)...but dont shy away because you think it might be 'harder'. You're going to care for 1-2 critically sick people wherever you work if in ICU.

Mags4711, RN · May 11, 2006

I would encourage you to give it a shot. I started as a new RN (was an LPN for a number of years) in a Level I Trauma and Burn unit. I am so glad I had that experience. I noticed that you said they are offering a 5 month orientation, that is a wonderful thing!

I don't completely agree with Dinith88 about the students doing alot of your work, in does not happen in my medical center, I find here we are doing alot of teaching ourselves. I work at a major University in Ann Arbor, MI (I think you can figure out who it is :) ).

And the theory that nights is better because of less commotion...think again :) When do people get drunk and get into fights? 3am When do people run from the police when they are drunk? 2-3am When do frat boys get drunk and fall into bonfires? 1-3am When do folks blow themselves up with fireworks? 10pm-2am

Nights in our medical center gets the most trauma and burn admissions of any shift. While that is a good thing on one hand, it is kind of tough because it is usually the intern running the ICU and in July, he or she was just a med student a couple weeks before that, so you are really learning together. I know where I work, most of the interns rely on us and say somthing like, tell me what to write and I will. Or do it and tell me what you did, I'll write it later. That's scary, I know...and JCAHO wouldn't be happy, but it's reality. So I wish you the best of luck and I hope you get some really strong preceptors. I love Trauma and Burns and will tell anyone who is the least bit interested in it, to go for it!

WikkedCat · May 11, 2006

Am a supervisor in a Level 1 Trauma/Neuro ICU, and we hire new grads to our unit. I think that if your facility provides a good internship program, you can definitely be successful, which should include specific time frames to work with your preceptor in the area you are going after. Remember that truama is 24 hours a day, so there isn't any type of predictable down time, nights and days pretty much are same. New nurses in our unit have typically done very well, and when it didn't go well, it tended to be more that they really weren't cut out for that area versus not getting proper introduction and education. I think that if you have the desire to do it, and have the drive to do truama, you should definitely go for it!

GOOD LUCK!

cardiac.cure03 · May 13, 2006

Thanks for the boost in confidence!

suzanne4, RN · May 13, 2006

As long as you are getting a strong orientation like that, you should not have any issues.

japaho41 · May 13, 2006

Go for it, as long as you get a good orientation with experienced,competent nurses. When you get an interview, also interview the unit ask indepth questions on your orientation how long, ask the average years of experience in the unit on nights and days, how many new grads, Typically nights is newer nurses unless they offer an outstanding premium. You don't want to put yourself in a situation where the most experience person has a year or so experience to be your resource because you will need advice. Keep in mind in some cities the difference between Level 1 and 2 is the research that is conducted at the facility, the trauma patients are the same.

japaho41 · May 13, 2006

also try to do some of your clinicals or extern hours in a SICU/trauma this will give you an indication if it is something you will even like doing. Having worked in medical, surgical/trauma and coronary they differ vastly.

RedSoxRN · May 16, 2006

I came to our level 1 trauma ICU with a year and a half floor experience and 4 years of pre-hospital experience. I barely made it off orientation. They have also hired 5 other nurses since I've been there (3 with prior experience) and only 2 have made it off orientation. I would strongly advise against you starting in a trauma ICU fresh out of school. Working elsewhere will provide you with the chance to establish your career in nursing, reorient to your new life with a profession, and develop your basic skills in patient care. You will then be in a much better position to work in an ICU, and you will do better, feel better, and take better care of your patients. Good luck!

WikkedCat · May 16, 2006

I came to our level 1 trauma ICU with a year and a half floor experience and 4 years of pre-hospital experience. I barely made it off orientation. They have also hired 5 other nurses since I've been there (3 with prior experience) and only 2 have made it off orientation. I would strongly advise against you starting in a trauma ICU fresh out of school. Working elsewhere will provide you with the chance to establish your career in nursing, reorient to your new life with a profession, and develop your basic skills in patient care. You will then be in a much better position to work in an ICU, and you will do better, feel better, and take better care of your patients. Good luck!

I would be interested to know what type of facility and orientation you received. Did you have a preceptor and a formal internship program? Just curious.

asylum5w2 · May 28, 2006

We were required to have 6 months telemetry experience before moving into ICU, and I wouldn't trade that for the world. There is something to be said about experience. I have seen many new grads excel in our ICU but have also seen them struggle with things like when to wake up the doctor, what data he/she will be asking for, how to get along with some of the other strong personality types in the medical field... It is never a good feeling to look around and realize you are the most experienced RN on when there is a trauma coming in and they want to put in a ventriculostomy at the bedside or something similar. Good Luck to you and demand every minute of your orientation even if you (and your manager) feel like you are ready to be on your own.

roana · Jun 25, 2006

My first job in the hospital was at a level 1 trauma center in neuro ICU. I'll have to go against most of the opinions here and say that I think you should go for a small hospital ICU first. That way you can get your feet wet and learn the basics before you hit the big leagues. There is a HUGE difference between a trauma center and your garden-variety community hospital ICU. Stress doesn't help the learning process, you know. I just wasn't comfortable taking care of patients with PA caths, jug bulbs, chest tubes - - -and I couldn't even start an IV yet!

HTH

Roana