New Grad starting off in ICU

[shoegalRN]

Hello all!

I am a brand spanking new Registered Nurse that just passed NCLEX on July 8, 2009. I graduated with my BSN on May 16, 2009. I have been offered (and accepted) a position in the ICU at a Level I Teaching hospital. I am also going to be in their New Grad Residency Program. I start August 3 and I couldnt be more excited!

Now my questions to my fellow ICU nurses, how can I make this the best experience for myself and for my preceptor? Any advice? Also, what book(s) should I read about critical care prior to starting my new job? Any pointers or suggestions for a new grad?

I am excited, scared, anxious, and nervous all wrapped up in one!

[Dreamer-RN]

Hello Ruby Vee,

I'll definitely be one of those new grads who will be studying at home. Thanks for pointing out that thread as a reminder of what can potentially happen if one chooses not to study at all.

Studentinnursing,

I believe you cannot take the CCRN while in nursing school. You'll need to be an RN working with critically ill pts and complete a certain number hours (1750 hrs) in order to qualify to sit for the exam. Do you think your college may be referring to ACLS certification?

I suggest to do an externship in an ICU setting when possible. Another option is completing your senior practicum on an ICU floor. Other things which can strengthen your cover letter/resume is joining American Association of Critical Care Nurses (AACN) as a student member.

[studentinnursing]

Thanks so much! I am hoping for externships and/or internships over the summers while in ADN (either that or I'll be taking classes for BSN--will be doing something over summer). My college offers CCRN completely separate from our ADN/RN or BSN, so I wasn't sure when it would "fit in," so thanks again! One of the hospitals where we do clinicals also offers CCRN for nurse residents, so I'd love to get in there. Looking, learning, and studying.

[CoffeeGeekRN]

I definitely agree about the studying outside of your shift. However, when I go home I am in veg mode so I usually go to Panera or Borders to study. In fact I won't start on my unit until the 2nd week of August so I have been taking the advice here and reading some of those books at the library or Borders.

[shoegalRN, RN]

I am so encouraged! I am applying in Spring for RN, have an awesome GPA, hoping for ADN acceptance in Fall 2010, and I want to go straight into ICU as a new grad; I just read a thread of about 30 nurses in my state who could not get jobs at all, let alone ICU! So I am so glad to see these posts and that they are recent; and I'm persistent, have already talked to my county's only trauma center ICU recruiter even though I am pre-nursing. She was very nice, called me first thing Monday morning after I emailed on the weekend. But I am determined, smart, and I am going to volunteer for every single thing they let me do while in clinicals; I too am studying for my next semester while on break (month between Summer and Fall 2009)--I don't stop, can't get enough; I might even buy a Saunders review just for fun. Anyhow, I am so happy for all of you; for RNs who want to be in ICU, it's nice to know that perserverence pays off; I'll be "job hunting" during clinicals if I can do it without being pushy. Any advice on the best way to go about getting straight in? Where you previous LPNs or CNAs or techs while in nursing school or really straight in after graduation with no previous experience? I am doing BSN as well, so hoping to get a nursing residency program, and I will gladly give them 2 years if I can get into ICU. Any pointers other than great GPA and being very persistent, without being a pest? My college also offers CCRN certificate; I will talk to an advisor when the time comes, but did any of you do that before, during, after your RN--sorry, I'm pre-nursing and don't know how/when CCRN falls into place. What I do know: I want to be in critical care; life-threatening things happen every day, so I might as well be the one to take care of them since I crave a challenge constantly and truly want to take care of patients at the worst times of their lives and their families as best I can.

Before I went to nursing school, I had my heart set on being an OR nurse. This was because I spent countless hours watching Discovery Health, and was fasincated by surgery. I went all throughout nursing school taking every opportunity to "shadow" in the OR when I could, since nobody else wanted to. That should have been my first clue. I went as far as to get my Capstone in the OR. After 3 weeks in the OR, I knew it wasnt for me. I requested to be transferred to the PACU for the rest of my Capstone so I could actually have some hands on learning. And this is when I discovered I had a love for critical care that I've never known before.

When I got to the PACU, things started to "click" like they never did before. I was fascinated with the monitors, and since I worked as a Nurse Intern on a Telemetry floor, I was able to read certain heart rhythms, such as A-fib or Sinus Bradycardia. Then when a couple of the patients started crashing, I was in awe at how fast and calm the nurses were. I had my first code in the PACU, and a nurse told me to jump in and do compressions. That was it for me.

So, I started reading up on critical care and trying to learn as much as I could. When I did my ICU rotation during my junior year in nursing school, I was alittle intimidated by all the drips and the vents. The rotation wasnt a very pleasant one. However, it was just THAT facility. Also, my preceptor for the OR told me I would do good in the ICU because I pay close attention to detail and I ask alot of questions and have a desire to learn. I am also a structured person so that helps as well. I had a few nurses I used to work with on the Tele unit tell me the same thing because they would see me looking things up and asking them alot of questions. Not to mention, I like to "critically think" and find challenge in putting the pieces together.

I do have plans to stay in the ICU and eventually get my CCRN. I just so happen lucked up and got this opportunity to be part of a new ICU unit (opening in December) and it's a teaching Level I trauma hospital. The experience I will gain will be invaluable! I'm so excited! Also, one reason why I got the job (according to the nurse recruiter) is because I showed a compassion for critical care and a great desire to learn. Not to mention I had a couple letters of reference from my previous clinical instructors. When I was asked questions about what I would do in a certain patient situation, I made sure I let the manager know "let me think about it" and then I came up with an answer based on the information that was given to me, although I had already knew the answer. I didnt want to to seem like I "knew it all" and I wanted the manager to see that I have the ability to "think things through" before coming up with a solution.

The best thing I can advise you is to get a job as a Tech, or a Nurse Intern or Extern in an ICU, or some critical care area. You will learn so much. When it comes time to do your Capstone (Internship or whatever your school calls it), do it in the ICU. Make sure you show your williness to learn and that you are teachable. Ask alot of questions. Take the initiative. When you have down time, spend it looking things up that you have a question about. Also, offer to help as much as you can. This shows teamwork. When there is a code, offer to do compressions or the Ambu bag. These things will stand out.

Good luck and I wish you the best in your nursing journey!

[shoegalRN, RN]

anyone remember the "fired for no reason" thread? one of the reasons sal was fired was that she didn't study at home. ever. her days off were for fun; she didn't crack no stinkin' books.

i find it somewhat frightening that new grads who insist on starting in the icu don't think they need to study in their off time.

well, that's sure something you don't have to worry about with me! lol! i've got this great opportunity and i'm taking advantage of it. if that means i have to study from home, then that's what i'll be doing. i see no problem with it, i've been doing it for so long anyway. there's no way i'm letting this opportunity pass me by, especially all i've been through just trying to land a rn job.

thanks for that story. i remember reading that thread.

[viposse]

I too started straight out of nursing school in the IMC/ICU. I am now nine years a nurse and here is my advice: buy a good physiopathology book, an excellent critical care reference book, a pocket reference book to keep on your person; get a good preceptor and understanding supervisor; put night work (when you are stronger) in your rotation. In that way, you can learn to work more independently and with less resources. Study when you can, but don't overload or "overthink" everything. Expect to cry, expect to make mistakes, and demand to learn. Eventually, you will be a strong ICU nurse.

[studentinnursing]

Wow, loved reading your story. I have seen extern for tele jobs, so that is great info, thanks. I didn't realize you could even choose where to do clinicals or senior practicum, etc.

I've been thinking about CNA to get my foot in the door while doing prereq's (only 5 left!). I was going to do a CNA prep over these few weeks of break, but I didn't know if I could get anything in ICU as a CNA and/or get enough experience where it will make a difference.

I have two children, current career (work at home, very flexible hours), and full-time college; since I would be taking a large pay cut going to CNA, I really need to keep my current job as well to pay the bills and it is flexible for me to keep my grades up--then do CNA poole maybe for some kind of experience? Since I will only be able to do very minimal hours as a CNA, do you still think it will give me some valuable experience and/or help when trying to get into ICU? I have a year to get some experience before nursing starts--hopefully only a year :).

[studentinnursing]

Thanks for your responses. I have a sticky from another thread saved on my laptop to read whenever I have extra time at school, forget the name but very cool -- all about ICU "stuff"; it has info from lab values to just plain keeping everything neat, like IV lines not tangled up . . . I will study everything I have time for (and can understand at my level of education so far) on critical care.

[shoegalRN, RN]

Wow, loved reading your story. I have seen extern for tele jobs, so that is great info, thanks. I didn't realize you could even choose where to do clinicals or senior practicum, etc.

I've been thinking about CNA to get my foot in the door while doing prereq's (only 5 left!). I was going to do a CNA prep over these few weeks of break, but I didn't know if I could get anything in ICU as a CNA and/or get enough experience where it will make a difference.

I have two children, current career (work at home, very flexible hours), and full-time college; since I would be taking a large pay cut going to CNA, I really need to keep my current job as well to pay the bills and it is flexible for me to keep my grades up--then do CNA poole maybe for some kind of experience? Since I will only be able to do very minimal hours as a CNA, do you still think it will give me some valuable experience and/or help when trying to get into ICU? I have a year to get some experience before nursing starts--hopefully only a year :).

I don't know if they have CNA's for the ICU. I know they use Techs, or PCT's. Usually, after your first semester of nursing school, you can get a job as a tech or a PCT. I know someone I went to school with landed her ICU job as a tech during clinical rotations. She impressed a nurse and doctor so much that the nurse went straight to the ICU manager and said "hire her". She was hired the next day! She worked as a tech in the ICU during nursing school, did her Capstone in the ICU, and now she is a RN in the ICU. If I were you, I'd start applying for tech, PCT or Nurse Intern jobs after the first semester of nursing school. That way, you don't have to pay more money for a CNA course. Even if you get to be a tech on a Tele floor, that's good. When I worked as a Nurse Intern on a tele floor, I was floated to the ICU often. Mainly for 1:1's or just to help out doing tech duties, such as foley's baths, drains, blood sugars, things of that nature. This also helped when I went to interview for the ICU.

I would wait until you've learn the foundations of nursing to start applying for jobs and you will get that knowledge base in your first semester of nursing school.

As far as clinicals goes, your program should give you a critical care rotation. We had 3 weeks of ICU rotation during our Adult Health II clinicals. As far as your Capstone or Internship goes, this is where you (the student) will pick an area of nursing that is your interest and you will spend the last 7 weeks or so of your program working for free LOL! Our program asked for 3 areas, and they will try to place you with your first choice. There were so many folks wanting ICU/Tele. Labor and Delivery was another big one. I wanted the OR and only 3 people total wanted it, so we all got our first choice. I really regreted not doing my Capstone in the ICU, but I made up for lost time in the PACU.

You said you were getting your ADN, it's best to ask if they do a Capstone or Internship. The ADN's program in my area don't do Capstone or Internships. However, the ADN's programs in my area focus alot more on clinical time and taking full patient loads as part of their regular clinical rotations.

When are you starting nursing school?

[studentinnursing]

St. Petersburg College (way closer to home) and I might apply to USF's BSN; I'm doing BSN either school.

[Dreamer-RN]

nurse2be09,

I enjoyed reading how you landed in the ICU. I completed a summer externship in the Operating Room (tried for ICU but that is where I landed). I found the OR environment fascinating and enjoyed learning about the various surgeries (especially neurosurgery and cardiac). However, after this experience, ICU was still my first choice.

Some of your comments reminded me of some the responses I have received as a nursing student.

Also, my preceptor for the OR told me I would do good in the ICU because I pay close attention to detail and I ask alot of questions and have a desire to learn. I am also a structured person so that helps as well. I had a few nurses I used to work with on the Tele unit tell me the same thing because they would see me looking things up and asking them alot of questions. Not to mention, I like to "critically think" and find challenge in putting the pieces together.

I was chucking with the above. I received similar comments as well from one of my clinical instructors who spent majority of her career in the Operating Room and a couple of the OR folks I worked with during my externship (e.g., pay close attention to details and asking a lot of questions). The one that was ingrained into my mind was after asking one of my "why" questions with this one scrub tech, she responded saying I was too smart to work in the OR and to look into working in the critical care setting (repeated this numerous times while working alongside her, in front of the other nurses). I was little perplexed by her statement because I know intelligent men/women work in the OR too. Anyway, similar to you, I'm too curious and want to understand what is going on with the pathophysiology, pharm, etc., and the reasons behind certain procedures/actions.

[studentinnursing]

St. Petersburg College's ADN is where I'm applying for RN, sorry, don't know why I mentioned BSN.