New grad ICU residency tips?

Ruby Vee, BSN · Aug 13, 2018

Hi all! In a few weeks I'll be starting as a new grad in a residency program in a large ICU. I've been brushing up on my med, ABG, vent knowledge etc to try to come in as prepared as I can, but I'm still pretty nervous. After reading on this site pretty regularly, I guess I'm a little worried since I seem to see so many stories of trouble with preceptors, safety, staffing, and making mistakes as a new nurse. I'd love any encouragement or tips from more experienced nurses on how to make it through the first few months as a baby nurse without becoming too overwhelmed, and especially how you've dealt with difficult situations that stand out in your memory.
Thank you! I really appreciate any guidance- as intimidating as this is, I am so excited to dive into nursing!

Congratulations on your new job, and welcome to the ICU.

As an experienced preceptor, I really don't expect you to come to work knowing ANYTHING on your first day. I know you graduated and passed your licensing exam, but the license is just a license to learn. I'd rather you spent your few weeks before starting your job seeing friends, seeing movies and relaxing. Once you start your job, you're going to be studying at home. ABGs make a lot more sense in the context of a clinical situation. Why are we drawing these ABGs? Why are we drawing them now? What to we expect to see? Why?

On your first day on the unit, you'll learn where to hang your coat and leave your bag, where to eat your lunch, the name of your manager, your preceptor and the charge nurse (maybe) and how to find the employee bathroom. If you learn something else along the way, that's a bonus.

Most preceptors mean well . . . we want our new nurses to survive, thrive and become awesome nurses and awesome colleagues. But here's the thing: preceptors are human, too. We worry that you won't like us, that we won't be able to teach as well as we'd like, that we'll miss teaching you some vitally important thing that will be the one thing that will save your patient two years from now . . . .

Not everyone is cut out to teach, not everyone wants to be a preceptor and unfortunately, most people don't get a choice to NOT precept. If you have a pulse and a license that has ever been renewed, you will be tasked with precepting, and often you find out about it when you're introduced to the orientee. Having an orientee slows us down -- a task that could take us 90 seconds takes 20 minutes or more to teach. Orientees don't understand what it is like to carry a full assignment while trying to teach someone how to do the job, they don't understand that even great preceptors have bad days and in general, they expect the preceptor to cut them plenty of slack while not expecting to EVER cut the preceptor any slack. At least, that seems to be the gist of many of the problem preceptor stories we read on here.

The difference between an orientee who is successful and one who isn't:

The successful orientee isn't overconfident. Nothing scares an experienced nurse more than a new grad who thinks she knows everything.

The successful orientee goes home and looks stuff up. The unsuccessful orientee announces that she's through with school and isn't going to study anymore.

The successful orientee is a good employee -- if there's a dress code, stick to it. Know the attendance policy and don't push the limits. Accept your schedule unless you're scheduled to work on your wedding day (or your sister's.) Introduce yourself to everyone you meet, and do it as many times as it takes for them to remember your name (and for you to remember theirs.) Chit chat for 30 seconds with everyone the first time you encounter them that day. (Well not if someone is doing CPR, but you get the drift.) An orientee who is warm and friendly will be liked, and an orientee who is liked gets the best assignments, experiences and is forgiven the most (and the worst) errors.

The successful orientee cuts the preceptor some slack. No one is perfect, not even a preceptor.

Good luck with your new job. I hope you get the preceptor who is perfect for you.

agalm · Aug 20, 2018

I agree with the above post.

Realize that you know absolutely nothing (but you will learn so much). Ask questions. Acknowledge your mistakes and LEARN FROM THEM.

Work hard. Offer to help your co-workers and ask to observe/participate if you have completed all of your assigned tasks.

If you have more than one preceptor, you will likely hear/see more than one way to do something at some point. Know how to access unit and hospital policies.

Even on the toughest/saddest days (and you will have them, it's inevitable), remember that your hard work and diligence helps people in an extremely vulnerable time in their lives. If something about your patient doesn't look/sound right (you'll get better at picking up on these things with time), speak up! They depend on you.

And even when you're in the middle of orientation and feel like you are drowning, know that it gets easier.

One day you will get to work and actually feel like you know what you're doing, and it. is. awesome.

Nursing (healthcare in general, really) is a career of lifelong learning. Enjoy it.

cakeandcrown, BSN, RN · Aug 21, 2018

I agree with what has already been stated above.

Also, say "yes" to any learning opportunity your preceptor finds for you. I had a great preceptor, and I told her I wasn't confident in my Foley/NG/IV starts because I had relatively no experience doing them in clinical. She sought out opportunities for me to do those skills, and I'm grateful for gaining some experience with those skills while having someone by my side.

I highly recommend bringing a little notebook with you to work and jotting down procedures/surgeries/medications you're unfamiliar with, and if you have time to look them up at work, definitely do, but also look them up after work/on your day off. I am still a new nurse (1.5 years), but I told myself from the beginning of my nursing career that I'd make it a point to learn something new every day, even if it was something small.

Don't be afraid to ask questions! And if something doesn't look right, ask your preceptor. Even the most experienced nurses on my unit aren't afraid to grab a second set of eyes to look at something that seems "off" to them.

Be a sponge, take it all in, and learn as much as you can. Welcome to the ICU! :)

coffee&scrubs, BSN, RN · Aug 21, 2018

Thank you! This is all so helpful- "the license is just a license to learn" is such a great way to think about it and a way I hadn't thought of before :)