New Grad in ICU?

Magpye58 · May 21, 2010

I graduated in 2007 and went directly to ICU. It was difficult at first, but now I can't imagine working on any other kind of unit. It's better than starting in the ER!

pinkynbd_99 · May 21, 2010

well I got the job in the ICU!! Im very excited about it!! after talking to the nurse manager, the versant program is 22 weeks of training, plus an additional 4-6weeks from the ICU. Then after that I start the night shift. Im glad I pushed to start in the ICU as a new grad! I think if you're going to be a nurse, be happy nurse at what you do!

netglow, ASN, RN · May 21, 2010

Funny thing the only new grad positions opening in my area now are critical care and er. I am torn. I took great advice from allnurses not to begin this way. There have been absolutely no m/s or tele jobs open anywhere! I might have to apply due to no choice. These hospitals in particular I am sure do not offer such an extensive orientation as you have been offered.

suanna · May 21, 2010

When I got out of school (a long time ago) I knew my clinical facts, A&P, drugs... What I lacked was time management skills and priority setting. I worked a couple of years on Tele to gain a more practical prespective before attempting critical care. That said- it can be done. My hospital hires new grads in ICU. They are the cream of the crop and must have precepted in critical care in school. They have to have a recommendation from the insrtuctor that teaches critical care, and they have a fairly long probationary period. My advice- look for a "step down" or progressive critical care unit to gain some hands on skills. You will be a better nurse in the long run and your patients will be better served when you do move to ICU. Ask yourself- If a patient came through the door crashing- could I start a line, mix the drips and titrate them to theraputic effect with a first year medical resident calling out random instructions.? If you can say "most likely" you may be up to critical care. If not- give it a little time before you jump in.

netglow, ASN, RN · May 21, 2010

Sigh... I know, that is what is troubling to me!

I did my management/preceptorship in ICU. I do have a ref from my instructor MS, OCN, ANP-BC.

Funny you should say medical resident distraction, one of these offerings is at a hospital with residents.

I remember one clinical at such a hospital where I did a wicked groin to toe dressing change with my RN as a student, 80% bone/hardware exposed. A new admit dump, refused back at original trauma center, came to us from SNF, was obvious to me bone was highly compromised, pt had to be septic or on his way. The resident backed against the wall and turned white. I was very surprised as I looked down at what I was doing, and happy too it hadn't occurred to me to pass out.

PMFB-RN, RN · May 22, 2010

Ask yourself- If a patient came through the door crashing- could I start a line, mix the drips and titrate them to theraputic effect with a first year medical resident calling out random instructions.? If you can say "most likely" you may be up to critical care. If not- give it a little time before you jump in.

*** Who pays any attention to first year medical residents? I have two rules in my room with a crashing patient:

1. The number of physicians can never exceed the number of registered nurses.

2. "Sure doc (intern) we can do whatever you want to do, as long as I think it's a good idea".

Chisca, RN · May 23, 2010

Ask yourself- If a patient came through the door crashing- could I start a line, mix the drips and titrate them to theraputic effect with a first year medical resident calling out random instructions.?

Or an attending who commented to me more than once "don't let the house staff kill my patients".

Magpye59 · May 25, 2010

Time management skills are very important in ICU. I started nursing school at age 46, and had worked as a professional and manager for 28 years in the government. I thought my time managment skills were excellent. But for the first year and 1/2 in ICU, I got to work 1/2 hours early and left 1.5 hours late - couldn't figure out why. When a co-worker mentioned my lack of time-management skills I was appalled! Now I realize that the difficulty was the learning curve for simple things, like drawing up meds quickly, starting IV lines, etc. Fortunately, my co-workers were ALWAYS there for me and helped me if they saw things getting out of hand, not that they were necessarily happy about it....was I in charge of codes, even for my own patient - NO! The crucial thing is to know when you need help and practice safe nursing, and you just have to suck it up when people complain about new grads in the ICU, because it's probably true. If your peers and managers find you are unacceptably slow and unqualified, believe me, you will get fired.......but for now, YOU were given the job, and YOUR manager thinks you can do it - don't let people get you down, stick it out - it's YOUR job not anyone else's.

netglow, ASN, RN · May 25, 2010

I hear all of you. ICU is a place I aspire to as well as the OP. I find it troubling that managers will hire new grads to ICUs when the fully know they do not offer a residency of any kind. I think that there are few facilities that can support new grads in ICU at all. Is this horrifically poor judgement on management's part? I think, it's a little lazy to pawn if off on the new grad,/new hire in some instances.

What is dangerous is knowing that ICU positions are higher paying than other floor positions often because they require top talent and the fact that management wants to make more money and reduce that overhead somehow. Management might just be really pushing the line and endangering patients by hiring people who they can pay much, much less.

I did my preceptorship/management in one facility that was staffed with very young nurses, many of them imports. I didn't see nurses with the years ICU experience of those posting on this thread. I am also older, and wise to this fact that you cannot learn if you do not have mentors, and a facility that has a REAL process in place. As I've mentioned before, in my area there are several new grad ICU/ER positions open. Only one hospital that I know for sure has a residency that pretty much guarantees a new grad with the wherewithal can become an excellent nurse. This with no tele or ms jobs available.

Magpye59 · May 25, 2010

I think it is quite possible that hiring new grads to the ICU is a way to save money. I have heard this theory before from experienced ICU nurses. I also believe that once the new nurse is there, it is in everyone's best interest (especially the patient's) to help that nurse achieve the skills necessary to become a good ICU nurse. Maybe they will not be as great as an experienced nurse, but everyone retires, and no one is indispensable and maybe they will be great someday.To do anything else is like throwing the baby out with the bathwater...

Again, I am an older nurse new to nursing and ICU. But I have to say that not every experienced nurse even wants to be there anymore... so what is the difference between having an apathetic nurse or a new nurse? Not much!

Alvindudley · Jun 6, 2010

Magpye, your point about time management is so well taken--that is such a huge issue for me. I am the same age as you and I just graduated nursing school. I love critical care and I am lucky enough to be doing an immersion in it. Although I am learning so much, I am so new at the basics, that I may not be ready yet to do patient care effectively for such critically ill people. I actually went looking on these boards today to see if there was some kind of a chart or sort of tickler file that nurses use to keep themselves on track with duties during their shifts. :eek:

EMSnut45, BSN, RN, EMT-P · Jun 7, 2010

Alvindudley,

I posted a Report Sheet as an attachment in a reply in this thread: RN Shift Report Sheets - New Grad. As a new grad, I found that my time management got much better once I developed a good "brain" (What I call my Report Sheet).

EMSnut45