new grad starting in critical care

Nurses General Nursing

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Would anyone reccomend starting out as an ER nurse or ICU nurse. I want to get started on nurse anesthesia and I've heard that this is what I need to do. What do you guys think. I graduate in May.

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.

Haha, no, i wasn't really directing that comment towards you, I'm glad you didn't seem to take it that way. The reasons you laid out to go through med-surg first are good points and when presented in an informative, non-discouraging way, are helpful.

I personally experienced several nurses that tried to discourage me from going ICU right away, and unlike you, they were blunt and condescending. It is intimidating enough as it is to take a big step like that, and having people discourage you for their own selfish reasons doesn't help any (I'm sure those discouraging nurses are the same type who "eat their young", its a symptom of the same mentality). I just wanted the OP to be aware and not let it affect her.

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Specializes in Critical care, Hospice.

I graduated in August and went into CC:nurse:

It was the best decision I could have made because I know I dont EVER want to do med-surg. However, it has taken time to gain the respect of my co-workers, learn the ropes of the ICU and I have been lucky to not make any mistakes to harm a pt. I have asked more questions in my 3 mon on the floor than I ever did in school. If you know that you want to be a NA then dont waste your time in med-surg. I work with several nurses who are working in CC so they can get into NA school. However, IT IS REALLY STRESSFUL!!! So, make sure you can handle your stress.!

Good Luck

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Hello,

I Went Straight Into The Icu On My Interim Permit! If You Want Anesthesia Go For It. It Is What You Need. There Is No Need To The Afraid. You Will Be Trained And You Will Have Support. I Work In An Er Now And I Really Do Believe That A Nurse Should Have Icu Experience Prior To Working In An E.d., This Is Not A Popular View, But It's One I Feel Very Stongly About. We Are Getting A Lot Of Nurses Who Are Way Over Their Heads In Our Unit. I Feel For Them, But I Feel For The Rest Of Us Having To Increase Our Loads To Babysit More. I Have Nothing Against Mentoring And Teaching But When You Are Understaffed And Overwhelmed In An E.d.--it's Neither The Time Or Place. You Have To Be Very Autonomous In A Busy E.d., In An Icu There Always Seems To Be Good Staffing Because Of--lets Face It--ratios. In The E.d. You Take Whatever Comes Thru That Door And You Handle It. Just A Side Note. When I Was In Icu We Were Floated To "the Floor" On Occasion. I Thought It Was The Hardest Work I'd Ever Done. It's One Of The Reasons I Went To Er; We Can't Be Floated. Also, I Too Am Applying To Crna Programs--my Icu Experience Was About 10 Years Ago And I Am Looking At Having To Freshen That A Bit Because--check This Out--the E.d. In Many Cases Isn't Considered Critical Care! It Sounds To Me Like The Icu Is For You:) Good Luck

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Specializes in ICU, psych, corrections.

The route I took has been a great learning experience for me and I feel has prepared me well for my specialty. I started in the ICU after my first semester of school as a Critical Care Tech/Apprentice Nurse I. I was responsible for stocking carts, ensuring that the nurses had all the available equipment they needed, setting up rooms, helping transport from ER, to MRI/CT scan and other places patients needed to go, and helped with bed baths, turning, and was able to see many varied procedures from chest tube insertion to bolts and swans being put in.

Then, after my second semester of school, I was "promoted" to Apprentice Nurse II, where I was paired up with my preceptor and worked the 12 hour shift as a RN, except for giving meds and one or two other things that are BON does not allow. I did that from June 2004 until graduation of June 2005. I worked full time during the summer between my first and second year of nursing school, so by the time school was back in, I really felt like I had learned a great deal. By that time, I was taking 2 patients in the ICU, doing all assessments, all charting, calling docs, etc. I just could not give meds.

I started as a GN in this unit around August, was given a 6 week orientation, 4 of which were clinical weeks (the other were didatic). Yes, it was scary and yes, it's still scary. I suspect it will be several more years before I don't have that "gnawing feeling" in the pit of my stomach. There is so much I don't know, yet working here for the 2 years prior to my becoming a GN, and finally an RN, has helped a great deal. I am familiar with the unit, know all the policies and procedures, became close with the staff and the doctors all know my face/name. I know where everything is because of the time I spent as a tech (which is REALLY helpful...I am able to tell some of the RN's who have been here for years where items are located or how to order them).

I did my clinical time up on the regular floors I have to say....god bless those nurses. I could NEVER do their job. I don't know how on earth any M/S nurse does what she/he does, but I admire and respect them. I am an insanely organized person who likes very structured environments. I like knowing that every 2 hours, there is something that is expected of me, whether it be assessments, charting, etc. I enjoy knowing everything there is to know about my patients. The ICU environment is a good fit for me and at this time, I can't imagine being anywhere else.

I still get scared quite a bit and nervous with some patients. I've learned over the past 2 years in this unit that even the most stable appearing patient can turn sour in the blink of an eye. I've had 2 patients die already and that was very difficult. I've learned not to take anything in this unit lightly and am learning to trust my instincts. If I suspect a patient needs to be tubed, I'm more than likely right. I've learned when to call the doc and when to consult with my charge.

Go for it.....especially if you are interested in NA school. That was my reason for choosing the ICU, although I no longer wish to be a Nurse Anesthetist. I will probably be here for another 5-7 years and then onto to some other specialty.

Melanie = )

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I just don't understand the mentality of how 5-10 "easy" patients prepares you for ICU. I feel more like my ICU preceptorship in nursing school prepared me for M/S. Being able to concentrate on 1-2 patients helped me learn to prioritize for when I got to the floor and couldn't concentrate on just 2. Sure, it's hard to handle all those drips, but it's on 1 or 2 patients. While you're in M/S, concentrating just on the heparin drip in one patient's room for too long and you could have a patient falling out of bed and breaking a hip or worse down the hall. Sure, M/S experience will make the initial days in ICU easier. But ICU experience will make the initial days in M/S easier. Experience at all is going to make everything about nursing easier.

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Specializes in tele, stepdown/PCU, med/surg.
I just don't understand the mentality of how 5-10 "easy" patients prepares you for ICU. I feel more like my ICU preceptorship in nursing school prepared me for M/S. Being able to concentrate on 1-2 patients helped me learn to prioritize for when I got to the floor and couldn't concentrate on just 2. Sure, it's hard to handle all those drips, but it's on 1 or 2 patients. While you're in M/S, concentrating just on the heparin drip in one patient's room for too long and you could have a patient falling out of bed and breaking a hip or worse down the hall. Sure, M/S experience will make the initial days in ICU easier. But ICU experience will make the initial days in M/S easier. Experience at all is going to make everything about nursing easier.

I see your point wooh but I would like to mention one thing. I've seen critical care nurses start working on the floor and get VERY stressed while caring for 5-6 patients and it's very noticeable. So I while you may be able to change from 1-2 critical to 5-6 floor patients, it's not a given for everyone.

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Go for it. My husband went straight into the ICU, no problems at all. He had a few month preceptorship and doesn't regret it at all.

I'm in nursing school now, and the school I attend has an NP who is our "school nurse" for dispensing tylenol or whatever else she does. Her husband was a classmate of my husband when they were in nursing school. I had to go to the school nurse to get an absence excused and she asked how my husband was doing, I told her he started in ICU right after graduation. She went on a five minute mini-rant about how that was a HUGE mistake. She said he would NEVER learn to develop any instincts and that it was WAY too much responsibility for a new grad and that he's going to burn out in a year. I was pretty peeved at this for several reasons:

1. If I had gone to her for advice on my husbands career (as if), I could understand her heavy handed response.

2. Even if she truly believes what she said, what possible good can come out that sort of reaction? Now that he's already in the ICU, what possible good can come out of insisting that he's made a huge mistake?

3. I really don't get how you render yourself unable to develop instincts because you work in the ICU as a new grad.

Bottom line, if you want to do the work and the job is offered to you...go for it. You're gonna need a few years of critical care experience for CRNA school anyhow. Some schools don't consider the ER to be critical care experience, so keep that in mind.

Adri

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I just don't understand the mentality of how 5-10 "easy" patients prepares you for ICU. I feel more like my ICU preceptorship in nursing school prepared me for M/S. Being able to concentrate on 1-2 patients helped me learn to prioritize for when I got to the floor and couldn't concentrate on just 2. Sure, it's hard to handle all those drips, but it's on 1 or 2 patients. While you're in M/S, concentrating just on the heparin drip in one patient's room for too long and you could have a patient falling out of bed and breaking a hip or worse down the hall. Sure, M/S experience will make the initial days in ICU easier. But ICU experience will make the initial days in M/S easier. Experience at all is going to make everything about nursing easier.

All good points indeed. I think I agree with you. Any experience is good experience. I only said that M/S was difficult because it was for me. It's just not my mind/set, skill/set. I started in ICU and when I was floated to M/S it was very overwhelming; not saying I can't do it, just saying I don't prefer it:). ANYWAY--DON'T YOU GUYS FEEL THAT M/S IS THE ICU OF 10 YEARS AGO. GEEZ THOSE NURSES ARE SLAMMED-- IN MY HUMBLE OPINION. I JUST CAN'T SEE WORKING THAT HARD AND I AM NOT A LAZY PERSON! My advice for new nurses coming up is to do what you want to do. Forget the loyalty to extraneous things. You will be better for it, and your work will be better. Never stay in an area you don't like just because you think they need you, trained you, etc.. It's taken me a lot of years to get the whole (To thine own self be true) thing down. Enjoy your work. That's the key. A lot of hospitals need to get a clue and figure out how to keep nurses in nursing. It's the hardest job you'll NEVER love if you don't find your niche.

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Start where you want to start; the old belief that you need med-surg to be a good nurse isn't the "golden rule" anymore; I started in ACCU almost a year ago as a new grad, and I am so glad that I did; I can not imagine doing M/S now. What you need to make sure of is that you are in a progressive, research-based practice, supportive unit. You have to make sure that you are somewhere where there is a solid orientation and a group of good preceptors. Not that you should be babied the whole way, because you shouldn't be-you have to be able to practice safely, not be a burden to your co-workers, be positive and learn, learn and learn some more. But you do need to be in an environment that supports you as a new nurse; these places are out there, I found one. Don't be dissuaded to not follow your dreams; pick where you want to go, but be willing to work hard to be sucessful and as safe as possible. Good lUck!

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Well I graduated in May 2005 and went right into an ICU program. We had 3 months of didactic training then 3.5 months on the floor.......for me it was just to much. I could not get organized enough, could not give/get report well enough, and was making mistakes by the time i got to 3 patients (Progessive care Unit......one notch down from ICU....they had to move me there to see if it would help).

So I believe everyone is different, and all programs are different. For me this program didn't work, maybe another one might have, but at this point I took my shot and have move in a different direction.

And just as an aside, once you don't make it in your first job at you graduate it can be somewhat tough getting that next job. YOu're inbetween hiring points (i parted in Dec and I"m still looking now) and you're not THAT experienced that you don't need training but are considered somewhat experience so some feel you're more advanced and don't need the orientation as much......so you wind up in a sort of limbo......

Would I do it again that way if I knew now what i know? Yes and no......we all went through and obtained alot of info from the ECCO program we studied and I still have it as a reference, but being in limbo job wise is NO fun.....

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Well I graduated in May 2005 and went right into an ICU program. We had 3 months of didactic training then 3.5 months on the floor.......for me it was just to much. I could not get organized enough, could not give/get report well enough, and was making mistakes by the time i got to 3 patients (Progessive care Unit......one notch down from ICU....they had to move me there to see if it would help).

So I believe everyone is different, and all programs are different. For me this program didn't work, maybe another one might have, but at this point I took my shot and have move in a different direction.

And just as an aside, once you don't make it in your first job at you graduate it can be somewhat tough getting that next job. YOu're inbetween hiring points (i parted in Dec and I"m still looking now) and you're not THAT experienced that you don't need training but are considered somewhat experience so some feel you're more advanced and don't need the orientation as much......so you wind up in a sort of limbo......

Would I do it again that way if I knew now what i know? Yes and no......we all went through and obtained alot of info from the ECCO program we studied and I still have it as a reference, but being in limbo job wise is NO fun.....

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I work in ICU as an LVN and have seen too many new grads start off in the ICU and end up leaving the unit for lower level of care units due to "too much stress" and the fact that they do not have the basic training. I started off as a telemetry nurse and worked my way to the ICU and love it. I would reccomend starting off in telemetry and not MS. You get a better understanding of the cardiac patient on the telemetry floor and not a MS floor. The telemetry units would give you the foundation to carry to the ICU should you choose to transfer to the ICU.:mad:

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