New Grad in ICU feeling terrible...,

[janelicurn]

I just began a job in the MICU in a large teaching hospital as a new grad 7 weeks ago. My orientation is 12 weeks long, which includes 7 weeks of working 2 days a week with preceptor and doing ecco course 1 day, 5 weeks doing three day weeks with preceptor. During my interview, the management was pretty hesitant about letting a new grad work in their unit. I left the interview feeling like there was no way I would get the job, but then I did! I feel so lucky to be in my dream position right out of school, but although I feel like I am a "cream of the crop" new grad (I graduated first in my class w/ BSN, did an externship in a level 1 trauma center ED, etc), I am still A NEW GRAD.

Long story short, I alternate between 4 preceptors (which is a problem in itself) and one of them really thinks its unacceptable that they must teach me "basic nursing" rather then only the critical care component. I was told all along in school, you really learn how to be a nurse in your first job in a new grad program. Well, my program wasn't designed for new grads, it is the same program "New to the ICU" nurses go through (that's what all my documents state--new to the icu RN).

Regardless, I am meeting the minimum goals for each week. I am, however, still slower then most nurses at many things. I am still learning to organize and time manage. I feel like they don't understand that my 6 month externship does not bring me up to the same starting level as an RN who worked years in tele or medsurg.

I am just wondering, are there expectations of me unrealistic?

Is a new grad RN supposed to be learning basic nursing things (by this I mean becoming comfortable with giving report, talking to doctors, organizing your day)?

If I am the one who is wrong, I would like to know, because in that case maybe I am truly NOT ready for icu yet...

[ProgressiveActivist, BSN, RN]

HGB Na CL BUN gluc

WBC PLT gap

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[ProgressiveActivist, BSN, RN]

Sorry, I just can't get it to post with the spaces where I want them

[ProgressiveActivist, BSN, RN]

Shorthand for laboratory values:

CHEM-7 (SMA-7):

CBC:

Attention: Some people switch WBC with platelets

Liver Enzymes:

ABGs

[jjjoy, LPN]

To go on a tangent... why in the heck isn't it standard to teach such standard notation in nursing school? I'm sure some do, though even then, I imagine those students who were explicitly instructed on such things just had the good luck of being with an especially good clinical instructor. Goodness knows, the lectures at my school were all about rushing through textbook content with no time for questions or elaboration or even to really have any of it sink in! I'm not sure what the point was except that when half the class got an obscure question wrong on a test, the instructors could say "you should've got that, it was covered in lecture!"

To become familiar with an everyday notation *and* what it means... why cover that in school when you'll learn it on-the-job? Why bother with school at all? *Everything* theoretically could be learned on-the-job, couldn't it? Ugh!

Vent over, back to the topic at hand...

[turnforthenurse, MSN, NP]

As a new grad, you will be slow. It takes time to develop time management skills, so don't worry about that! ICU is also a whole new bear of nursing, too, with a very steep learning curve (well, any type of nursing is!). You can't be expected to be a full-fledged ICU nurse overnight.

Some supplemental texts I suggest:

Critical Care Nursing Made Incredibly Easy.

Great resource and very easy to understand. I think they just came out with a new edition, too!

Hemodynamic Monitoring Made Incredibly Visual.

Understanding hemodynamics is such an important part of ICU nursing. If you are a visual learner like me this will really help.

Handbook of Critical Care Nursing.

Contains nursing diagnoses and interventions along with information on everything you will see in the ICU. Very informative. This book is easy to carry in your work bag or to keep in your locker.

Get in there and learn, and ASK QUESTIONS! And study! On your free time, look up things you don't understand...or if you don't necessarily have the time, do it on your time off. You will learn more that way. Good luck to you!

[Carrig RN]

Also, High Acuity Nursing is a great textbook/reference. It was my Meg/Surg 2 book in nursing school and we used it as a reference in my New Grad ICU program. Easy to read and full of information!

[ProgressiveActivist, BSN, RN]

jjjoy said:

To go on a tangent... why in the heck isn't it standard to teach such standard notation in nursing school? I'm sure some do, though even then, I imagine those students who were explicitly instructed on such things just had the good luck of being with an especially good clinical instructor. Goodness knows, the lectures at my school were all about rushing through textbook content with no time for questions or elaboration or even to really have any of it sink in! I'm not sure what the point was except that when half the class got an obscure question wrong on a test, the instructors could say "you should've got that, it was covered in lecture!"

To become familiar with an everyday notation *and* what it means... why cover that in school when you'll learn it on-the-job? Why bother with school at all? *Everything* theoretically could be learned on-the-job, couldn't it? Ugh!

Vent over, back to the topic at hand...

I couldn't agree more. Even basic Med Surg skills such as IV insertion, NGT placement, chest tubes, injections, accessing a port, CBI, telemetry and catheter insertion aren't being taught. Two six hour clinicals a week and not being able to provide hands on nursing care is just to me a big charade. A new grad doesn't even know what they don't know. ,And it might sound uncharitable but some grads have no appreciation for all the time and effort that we invest in helping them be successful. Precepting is draining, you have to be on your game every minute and be a good role model.

So if you are lucky enough to be taught critical care nursing by a competent and caring person - even a grumpy one, try to show appreciation somehow, a card or donuts, a gift card, cookies, a bottle of Jack, some little something will mean a lot to the person who is sharing many years of hard earned knowledge and experience.

[RNDance]

Is there anyone who will admit to the fact that they really do believe that new grads should not be hired directly into ICU?

It is such a horribly steep learning curve, from dealing with physicians and families to handling tremendously technical tasks quickly and efficiently.

Take the time to learn the basics in a slower-paced environment. Learn to put in NGT's, PIV's, foley catheters, etc and become proficient at it and come on board with more than a "oh I did that in school" level of skill. Learn how to react in a code (through experience, not online tutorials) and learn how to deal with idiot residents who give dangerous orders (this skill may save your patient someday). Yes, it MATTERS.

Sorry, I know this is not a popular opinion these days but what I see going on now (less so lately, since there is no longer a nursing shortage) is downright scary.

[CCRNDiva, BSN, RN]

No, I don't agree with you, RNDance. I started in the ICU as a new grad and I excelled. The majority of our RNs started in the ICU as a new grad and have several years of ICU experience now. The ICU is not for everyone. We have had RNs come to our unit after several years of the traditional med/surg experience and they have not been successful because they are more concerned with the tasks of nursing instead of the critical thinking required of an ICU nurse. I think it is all about the critical thinking and being able to retain and process information quickly.

[ProgressiveActivist, BSN, RN]

It comes down to maturity, and I think there is a world of difference between a new grad age 22 and a new grad who is five years or more older with some life experience. The older ones get it faster and apply themselves 100%.

Last year we had some tele nurses transfer into ICU. They have some bad habits to unlearn and they are stuck in doing the tasks but not interested in learning how to put it all together. It's sad and uncharitable to say but they don't even know what they don't know and are trying to fake it. And before you all freak out I am working on it one shift at a time with no management support.

[CCRNDiva, BSN, RN]

Libbyliberal, I never thought about the age factor. I was 26 went I became a RN and now that I think about it, our older new grads have fared much better in the unit than the 21-23 year old bunch.

We also have those who have came from tele floors that haven't been able to get the whole picture. I think it's because of the way patients are assigned to our tele floors. Cardiac pts go to one floor and they refuse to take HD, neuro and non-cardiac post-op pts (even if they have a cardiac dx as well); the stroke/CHF floor only takes embolic strokes but not if they had TPA and they won't take pts with + Trop or EKG changes. The intermediate floor takes the HD pts but won't take pts with cardiac and neuro issues. How on earth are you supposed to learn to "see" the whole patient when you never take the opportunity to do so? Our CT surgeons are reluctant to transfer their post-op pts to the cardiac floor because they fear they will get into resp. trouble. It is crazy that so many RNs don't know that the renal failure will cause cardiac and resp. failure and that cardiac failure can lead to renal and resp. failure.

[RNDance]

CCRNDiva said:

No, I don't agree with you, RNDance. I started in the ICU as a new grad and I excelled. The majority of our RNs started in the ICU as a new grad and have several years of ICU experience now. The ICU is not for everyone. We have had RNs come to our unit after several years of the traditional med/surg experience and they have not been successful because they are more concerned with the tasks of nursing instead of the critical thinking required of an ICU nurse. I think it is all about the critical thinking and being able to retain and process information quickly.

No one who has started out as a new grad in ICU ever agrees.

Some do well but I am talking about the learning curve. Talking about the beginning, not "several years later." I can't tell you how many times I've had to start IV's, put in "difficult" foleys and NGT's, and countless other "tasks" that, IMHO, are basic and should be second nature to anyone entering the ICU. Need to be "nurturing," of course but I'll tell you, it's gotten mighty old. Frankly it's a pleasure to see the tide turn back to hiring experienced nurses in the ICU again. It's nice to be able to compare notes with experienced nurses, see how they've done things in other places. It adds real life knowledge to our communal data base and benefits us all.

And honestly, having lived through the shortages and the gluts, the truth is that new grads were hired in the ICU because of sheer desperation, not because anyone thought it was a particularly great idea.

No sense going down this road, again. We're all entitled to opinions and I imagine that there's no way some would be open to considering that hiring new grads in ICU might not the best thing.