new grad starting in critical care

tracey2705 · Feb 16, 2006

I don't know about ER, but I think you should get 6 months to a year of general nursing in before moving to ICU. The first 6 months for a new grad can be very stressful in many ways, let alone the stress of an ICU. Also, though I'm not saying you will make a mistake and I'm not saying making a mistake on general med-surg patients si no big deal, but in an ICU you are responsible for many potent IV vasoactive drugs. I think I'd rather get my feet wet a bit before taking on an ICU.

Good Luck!

wooh, BSN, RN · Feb 16, 2006

Also, though I'm not saying you will make a mistake and I'm not saying making a mistake on general med-surg patients si no big deal,

Of course, in med/surg, you can make a mistake on 5-10 patients in a night instead of just on one.hehe

If you want to do ER or ICU, then go straight to it. Med/Surg is it's own specialty with it's own way of thinking. ICU nurses can't stand not knowing every little thing about each patient, and that's just not possible with a large load. I as a M/S nurse really don't want to know every last detail, and prefer knowing a little about a lot of patients. You think differently, you organize things differently. It really is a different skill set.

tracey2705 · Feb 16, 2006

Hello, Wooh,

I agree that it is a very different skill set! My suggestion to start in MS was not because ICU nursing is somehow just more detailed MS nursing. I think a new nurse will have an awful lot to assimilate in his/her first 6 months of practice and beginning nursing with a patient on say 4 drips, ventilated, with an NG tube, an A-line, a PA catheter, and a very complex diagnosis will be that much harder. Also, tho management of 8 patients is very different than management of 1 or 2, you certainly will be employing skills that are first practiced and learned in MS. In other words, the patient care skills, assessment skills, etc, that the MS nurse will learn in the first 6 months will not be wasted.

A lot depends on the orientation, too. A long orientation, say 3 months at least, with ample time to practice basic skills and experience with the least sick patients would help the new nurse hone her basic skills and prepare her for managing very challenging, complex patients.

I've worked both med-surg and ICU, and step down for that matter. I've also worked in staff orientation and preceptoring. Many new nurses really struggle in the beginning just getting their priorities straight.

JMO

Tracey

cvp02 · Feb 16, 2006

I am a new grad myself and I was also thinking of going into ICU, but I decided to do MS first. I am happy with my decision because I have learned how to prioritize, the only down fall is that now I find myself feeling sacared to go to the ICU. Any advice anyone???

tracey2705 · Feb 16, 2006

Don't be afraid to go. Or be afraid but still go. You will gaining skills and insight into physiology and pathophysiology that you won't get in MS. You'll also loilely have a more colleagial relationship with physicians, which is an improvement over how it works on the floor (sorry to say). But do recognize a few things first:

1. The staff doesn't always welcome newbies they way they should. It may be awhile before you're accepted. Don't let that bother you. It isn't personal.

2. Think about which ICU you want to work in--they all have their personalities, at least where I worked they did.

4. Try to learn something about the nurse coordinator. When I worked in SICU we had a nurse coordinator who thrived on chaos. She was very knowledgable and a fun person but after she left we realized it didn't have to be as nuts as it was. Her replacement was much more organized.

3. Be careful about burnout. It can happen anywhere of course, but the high stress of an ICU is tough.

4. Ask a million questions--there's alot to learn.

I'm sure there are other things that I can't think of right now. But I do recommend going. It is exciting and you will be getting experience that is sometimes a prerequisite for other nursing jobs, such post anesthesia care.

Focker, CRNA · Feb 16, 2006

If you want to do anesthesia, I wouldn't waste any time on a med-surg floor (not saying its not valuable experience in general, just not for what she has planned). I was in your position and went straight into ICU after graduation. The ICUs that accept new grads have orientation with preceptors for varying periods, kind of like on the job training. You will work up to the more critically ill patients. No doubt, it can be a lot to soak in, and stressful at times, but you might as well learn from the start the things that will be more applicable to anesthesia. You will hear from a lot of "old school" nurses that think new nurses shouldn't be in ICUs but that is only because thats how it used to be done; not so anymore.

tracey2705 · Feb 16, 2006

Hmmmm...are you calling me "old school" Focker??:chuckle I am definitely not one to say "do this because that's the way we've always done it"! But I do know what you mean.

I agree that anesthesia is different and MS skills are much less important there. I have worked both areas (ICU and MS) and still think it's better to get your feet wet in an area where you're less likely to hurt someone and where you can acquire basic skills at a slower pace. I do not think it HAS to be that way, it's just the way I did it.

For one thing, I lacked the procedural skills I needed in an ICU. Like starting IVs or getting an NGT to function properly. Or putting one in for that matter. I just think it's alot to learn right off the bat. By the time I went to ICU, a few years after graduating, (it isn't necessary at all to stay in MS that long) I felt ready and was very confident in my assessment and procedural skills. I could concentrate alot more on the physiology you're expected to know and the pathophysiology you have to recognize. Plus the meds. Anyway, JMO.

watsondr · Feb 17, 2006

Thanks for the advice, I think I'll just jump right in if at all possible. My brother graduated a few years ago and got right into the ICU and has done fine. He felt pretty scared to go to work for about 6 months but has since become a great nurse and is also getting interested in the CRNA program.

Martibear · Feb 17, 2006

I agree you should jump right in if you feel this is what you really like. I'm a new RN in the ED & I couldn't imagine being anywhere else. A long orientation really does help. I think mine was 12 weeks. We really have great helpful staff, so I'm never left alone or made to feel stupid if there is something major going on. Best of luck to you! :nurse:

nursing 101 · Feb 17, 2006

I think people should go right into what they want to do. As I said many times nursing is too stressful to be in an area you don't like. Yes you will struggle the first few months in ICU but you struggle just the same in Med-Surg. So either way as a new grad you will be struggling the first few months, period.

Maybe I'm not realistic but I don't see how handling 8-10 patients is acquiring organizational skills... To me it's just chaotic! Nurses have been feed that for too long. We can't even get a decent patient to nurse ratio and now we are calling it organizational skills...

Anyway, there are many opportunities out there when it comes to nursing and the new grad just make sure you pick the right orientation program and go for what is best for you.

Good Luck to you!

mom23RN · Feb 17, 2006

I went right into the ED as a new nurse and never regretted my decision. :uhoh3: Loved it htere.