New Grad TMICU position

MYSTICOOKIEBEAR · Jan 20, 2016

Congratulations!They will most likely train you on days as most hospital systems do this. The great things about days is that you get to experience a lot of things, you have a lot of support, and you get to see a lot of the procedures that are only feasible during the day time. So if at all possible go to days for training.

Nights however is where you will learn your clinical judgment, where yo have much more autonomy, and where you truly grow as a Critical Care nurse. Since there are far less staff on at nights, sometimes you have to make decisions and calls that can end up saving someone or potentially killing them. I work in a top 10 hospital and usually only have a CT surgery fellow and a Critical Care resident on the Cardiac surgery side and have a Surgical resident on the Transplant side.

On the whole the nurses on nights have a higher propensity to make tough calls and make difficult decisions than our day time counter parts, because we have more autonomy and it is sometimes left to us to do so. I feel that we do much more critical thinking because of this. Days is much more task oriented and looking to the MDs, NPs, PAs, for guidance where as for nights it is more critical thinking, making a decision, and acting.

I would say get your feet wet on days and once you start to feel comfortable or feel that you have experienced a lot, taken a lot of admissions, know the standard algorithms and pathways of care for your patient populations, THEN take a walk on the wild and unknown and join the Dark Side! :zombie:

Da1uLuv_RN · Jan 21, 2016

Thank you Mystic for your response. It was very insightful. I did not take into account that resources will not be as readily available on nights as it would be on days. I assumed that working nights would be a slower pace (as slow as critical care can realistically be)where I would learn without being in the way, however, that does not seem like the case. When I say, learn with out being in the way, I mean not having too much of the hustle and bustle that the daytime brings allowing myself and my preceptor time to really hone in on some training. Is that an odd way of thinking in critical care?

From what I gather, it is safer to train on days because of the fact I'm new and all that needs to be learned will be learned there. Once I get comfortable than switch to nights. How long did it take before you felt comfortable enough to join the dark side? lol

MYSTICOOKIEBEAR · Jan 21, 2016

It is slower in the sense that you really ONLY have to worry about your patient so you are allowed more time to focus on them and their care. You're not working with PT/OT, dietary, dealing with a lot of teams or the teams consulted for your patient, not having to worry about too many procedures TEE, Ultrasounds, PA/Lat XR, Nuclear Med, or any other procedures, just you and your patient. That's not to say that you may not have to emergently prep your patient and go to the OR, go to CT, MRI, Cath lab, or IR.

That is not at all an odd way to think about critical care, it absolutely makes sense. It is important to be able to handle the hustle and speed of day shift and once you have that down, you can move to the calmer yet sometimes much more intense night shift. The thing about nights is that you have to be able to hold your own and help others in really bad situations, not that you don't get that during days, but it is especially important on nights due to the scarcity of house staff and mid level providers.

As for me, I was switching back and forth on days for about 5 weeks , and realized that nights is where I wanted to be. I took the plunge at 3 months time. Days and nights is a very different kind of stress, it is similar in many ways but also very different.

Like I alluded to before, days is more of a I have a lot of things to do in not a lot of time and there are too many cooks (services) in the kitchen but if SHTF there are a lot people who can call the shots and help out. Nights on the other hand is a there is signicantly less to do but if SHTF I better know what to do and better make the right call until the cavalry arrives. This is very important especially if your resident is newer and not used to the intensity and pressure that the ICU is notorious for delivering.

Da1uLuv_RN · Jan 21, 2016

That makes a lot of sense. I believe I know what to do now. I truly appreciate your input. I'm excited and nervous to be starting this new journey in my new nursing career. This site is awesome! Thank you so much.

Da1uLuv_RN · Feb 19, 2016

I went with the day shift Mystic. Thank you again for your thoughtful response.