New Grad in the ICU

vastudent09 · Apr 26, 2009

I could really use some guidance!! PLEASEEEEE

Ruby Vee, BSN · Apr 27, 2009

i'm not a big fan of new grads in the icu. i'm sure that's not what you wanted to hear, but you did ask! i believe that some med-surg experience helps enormously. if you already know how to throw in an ng, iv and foley while assessing your patient and fielding questions from the family, md and charge nurse, the transition to icu won't be nearly as stressful. learning to be a nurse is hard enough without having to learn icu at the same time. but you've chosen to begin your career in the icu -- please be aware that many experienced icu nurses may not be as "nurturing" as you might expect. we're hear to take care of the patients first, and your orientation comes second.

as a preceptor, i expect that an orientee will make the effort to look things up on her/his own time. if you run into a new disease, surgery, medication or treatment ask me about it if you have to know right now. (for instance, your patient is crashing and you need to give the med now!) otherwise you learn better, retain the information longer and impress your preceptors more by making the effort to look things up on your own. there's a wealth of information available on the internet now, you don't have to drag drug books, pathophysiology texts and taber's around.

i expect that an orientee will work the schedule given without undue whining and complaining about the necessity to work nights, weekends and holidays. if you or your sister are getting married by all means, ask for the time off. and we'll do our best to accomodate you. but it makes you look really bad (and makes the rest of us reluctant to work with you) when you request every weekend off all summer long because all of your college friends and sororoity sisters are getting married, each on a different weekend, and you cannot miss any of the festivities. ditto asking for thanksgiving, christmas eve, christmas, new year's eve and new year's day off because you have longstanding plans and traditions -- and by the way, you're jewish so you need the jewish holidays off as well. and since your husband is a member of the buddhist faith, you also need off . . . . you catch my drift.

i expect that you'll make the effort to work with the preceptor assigned to you even if you don't like her or him, that you'll make the effort to communicate with your preceptor, and that you won't complain about "being eaten" every time you have a bad interaction with someone.

all of that being said, i wish you luck in your new job.

vastudent09 · Apr 27, 2009

Thanks so much for the great information. I appreciate your opinions and knowledge. I expect that I will meet resistance about starting in the ICU, but I feel like i have done everything I can to prepare myself- and i feel like knowing the staff and having worked with them both in my role as a tech and a student nurse, that I might have an easier transition... Hopefully anyway. Thanks again though for taking the time.

TemperStripe · Apr 29, 2009

I'm a new grad in an ICU, too. I graduated in December, got my license in February, but had a big knee surgery so wasn't able to work until April. I did an internship on the unit last summer and stuck around (mostly stocking carts) until I graduated. So, I'm basically familiar with a lot of the daily happenings of the place, anyway. As a new nurse, I find having this previous knowledge is absolutely invaluable. I have enough to learn without trying to figure everyone's names, phone numbers, who to ask, who not to ask, etc, etc. So, to the OP, I think your previous experience on the unit will serve you very well.

My take on asking questions is slightly different than the other respondant to this post. I do frequently look things up when I have some down time (ha!) but I also make sure I'm asking the nurses tons and tons and TONS of questions. The nurses I work with are happy to teach (we are a teaching hospital, after all, but I think they enjoy it beyond that). They always add in knowledge that might not be as obvious in a textbook, as well as tips on how to handle situations more efficiently. And personally, I learn better when the information is applied to real situations, which is easier for me to do when I'm talking to someone, rather than reading. Of course, I usually read up on things after the fact, to solidify the information. Also, I think the nurses feel more comfortable with me when they know I WILL ask questions when I need to. I also have a bunch of applications on my iPod Touch that stays in my pocket all day, and I reference them constantly, too.

I think the most important thing for a new graduate is the level of support on the unit. I have been extremely lucky in that I have met no resistance for starting in the ICU right out of school. If there are those who disagree, they have never approached me directly. However, I make an extreme effort to work diligently, not complain, use my down-time wisely, and solicit suggestions on how I can improve. I work hard to make sure none of the nurses on my unit will regret hiring a new grad, at least because of me. It is not easy, but I do enjoy my work and I look forward to the day when I can "pay it forward" to the next batch of new grads.

nursingpower · Apr 29, 2009

:redbeatheHELLOO! well I know this topic has been discussed before but..
I have been a tech in the ICu for 2 years, did a 5 week preceptorship over the summer in that ICU, and a 120 hour preceptorship for school in that same ICU... and now i am about to start working there as an RN !
well NEWAYS- I am really nervous now becasue I knwo the staff and I feel like I am expected to "know everything" becasue I have been there for a while.
I was jsut kinda looking for opinions/ feelings about working with new grads in the ICU, and kinda what your expectations of them are?

I think that a lot of older ICU nurses get upset to see that new grads are able to now work in ICU right out of school. These type of nurses had to "work their way up" (some taking 1-3 or more yrs) to work ICU from meg/surg or SDU's so maybe it's hard for them to envision a new grad doing well in ICU right out of school.

At the same time many hospitals have created great orientation programs to help new grads make easier transitions into the ICU. That was not available in the past. I am a Dec 2008 grad and I started in the ICU. Our orientation program is designed to help non-ICU nurses as well as new grads. They give classes on hemodynamics, ECG interpretation, ICU equipment, they conduct mock codes, review policies and nursing forms, etc.

I have a preceptor that is very positive and willing to teach. She knows that I am a new grad and doesn't expect me to know the world. She does expect me to have basic nursing knowledge (i.e full pt assessments, simple drug interactions, giving meds, hanging IV's, etc.) or know how to access information (i.e. normal lab values, drug dosages) needed for pt care. It is my job to absorb what she teaches me. That is why I carry my Palm and a small notepad. I try to make it so that she doesn't have to repeat the same simple stuff over and over again. I go home and study. I take flowsheets and forms home with me. I print policies and take them home. I continue to research things throught all available resources. I have numerous friends that are nurses that are available to me if I need them.

I think new grads do as well as their preceptor is great. Meaning if you have a preceptor that is an overall great person, openminded, helpful, positive, and compassionate about nursing you may tend to have that same type of attitude. If you have a preceptor that compares every new grad to the previous ones or complain about having an orient or not happy with their job that attitude most likely will transfer over to a new nurse and you can understand how tha would make it such a dreaded experience.

My preceptor doesn't believe in "eating the young". Now I understand that some people are not motivated, inspired, timely or compassionate enough to work in the ICU and they may not do well. But I also know that there were people who would have done well in the ICU had they had more support from the staff and their preceptor.

That's my experience. I don't think I could work for the exact same floor I worked on before becoming a nurse. I know many of my friends that have done that and are doing great. Like I said it depends on the staff and how well they receive you.

vastudent09 · Apr 29, 2009

Thanks everyone for your replies. I am graduating in 9 days, so i am starting to get nervous. I appreciate your words of wisdom!

nimchimpskii · May 7, 2009

otherwise you learn better, retain the information longer and impress your preceptors more by making the effort to look things up on your own.

c'mon we all know that differen't people have differen't learning styles. i prefer to see something done / have a hands on approach / be able to ask questions, than read a book any day.

i don't think i'd like a preceptor who wasn't approachable.

Ruby Vee, BSN · May 7, 2009

c'mon we all know that differen't people have differen't learning styles. i prefer to see something done / have a hands on approach / be able to ask questions, than read a book any day.
i don't think i'd like a preceptor who wasn't approachable.

while everyone has different learning styles, you still need to be able to look things up on your own. about the third time in your orientation that i have to tell you what lasix is and does, (or clonidine or metoprolol or any other drug used commonly in our patient population) i'll start to wonder what's wrong with you that you neither seem to retain information or find it on your own. after all, the job of a preceptor is not to spoon feed you information, but to prepare you to be able to practice independently on your own. and that means being able to find the information you need.

nimchimpskii · May 8, 2009

about the third time in your orientation that i have to tell you what lasix is and does, (or clonidine or metoprolol or any other drug used commonly in our patient population) i'll start to wonder what's wrong with you that you neither seem to retain information or find it on your own.

okay, i agree that there is something wrong if they have to be repeatedly told stuff.

i would hope that after 3-4 years of nursing school the student would be able to take charge / responsibility for their own learning. it's also the responsibility of the nursing school to ensure their graduates are competent and capable of self-instigated learning.

ruby do you remember what it was like when you first graduated?

Ruby Vee, BSN · May 8, 2009

ruby do you remember what it was like when you first graduated?

yes, i remember. i'm only 53, not 103!

MamaRN00 · May 8, 2009

:redbeatheHELLOO! well I know this topic has been discussed before but..
I have been a tech in the ICu for 2 years, did a 5 week preceptorship over the summer in that ICU, and a 120 hour preceptorship for school in that same ICU... and now i am about to start working there as an RN !
well NEWAYS- I am really nervous now becasue I knwo the staff and I feel like I am expected to "know everything" becasue I have been there for a while.
I was jsut kinda looking for opinions/ feelings about working with new grads in the ICU, and kinda what your expectations of them are?

You will do GREAT! Don't let ANYONE make you feel like you can't be a good ICU nurse :redbeathe