new grad vs 1 yr exp. orientation to ICU

Sunshine0425 · Sep 8, 2008

Well, I worked on a Med Surg floor for eight months before starting in ICU...I am sooo glad I did. I was so stressed as a new grad on the floor, but quickly got my assessment skills down, time management, etc. I really feel like it helped my transition into ICU so much easier. Especially seeing the tough time the new grads we have right now are having. It is just SO much info to learn. To answer your question, it is true...I didn't get a super long orientation, eight weeks, but did fine. Good Luck!!!

may2kd · Sep 16, 2008

I don't agree at all. Med/Surg nursing is 100% different than being in the ICU. I have oriented both sets and the new grads are much easier to train. They haven't already learned bad habits, and 9 times out of 10 they're still in the school zone of asking a million questions and looking everything up. It's a different way of thinking, it's different time-management wise, it's just plain different. And if ICU is your end-game, or going onto NP school or anesthesia, why waste a year of your life on having 5-8 patients that you barely have time to assess properly and just give meds to all night?

With that said, most hospitals will give you the full 3 months orientation since you won't have any ICU experience. And believe me, if you've never worked acute care or step down you'll want every week of that 3 months!

NurseNature · Sep 16, 2008

I think I made the right decision starting on a med-surg floor b/c I still feel pretty overwhelmed just trying to learn about the hospital's P and P's, let alone all the other obvious stuff a new grad has to become familiar with. As you can see, I am already trying to stress out, or maybe just thinking ahead, a little bit about a transfer to the ICU that I am not planning on even making for at least one year from now. :specs: I will forever be asking questions. I have always been a very inquisitive one. I want to know a reason for eveything, so I don't think that will be an issue for me. I suppose I just want to make sure I get a proper orientation.

ddoosier · Sep 21, 2008

I started out as a new grad in the SICU. Listen to yourself and what you want to do. There are many RN's that feel that Med surg is the first place to go to earn your wings and pay your dues. I disagree completley. Although my first year was painful, as mentioned, critical care is a complete different approach. It really depends on the orientation. There is a different approach to time management and everything else such as hemodynamics and learning how to critical think and being able to see around the corner and having a plan of action. We have RN's that have come to our unit from the Med surg who have commented that they have felt like waitresses on the floor and it was nice to get back to pathophys and critical thinking. I'm sure not all floor nurses feel this way and it was not made out to be a negative comment. They all transitioned well, and felt the uncertainty in orientation that I felt as a new grad.

The one advantage that you have, is that you are fresh and that was a huge advantage for me. I knew from the beginning that I wanted to be an ICU trauma nurse. So why start somewhere else if I had the opportunity to begin my career in the ICU? :nurse: Another thing, ask what the success rate for new grads are in the unit that you are considering. I believe that the success of new grads is a direct reflection of the unit itself. We have strong and very knowlegible preceptors. Our new grads are respected and protected. We don't expect from you to know everything, but it is expected that you know when something is wrong. Hope this gives you some insight.:)

geekgolightly, BSN, RN · Sep 22, 2008

You do what's right for you. All of my preceptors have been thrilled that I have experience and relieved that they don't have to teach a new grad the most basic of basics.

poppy07 · Sep 22, 2008

If you have been in the unit, and feel comfortable in the environment and competent with the skills you have learned so far through clinicals-- GO FOR ICU!

If you, on the other hand, still are unsure of your basic assessment, fear critical situations where you need to act fast and know your ABCs, go to med-surg and get your comfort level adjusted. Then, go to ICU.

Here's a perfect example: Nurse with maybe half year or more experience in our ICU almost killed her patient the other day letting Amiodarone run in at too high of a rate and couldn't figure out what she was doing and why pt's B/P was low. This same nurse was checking pulses with a doppler a few weeks ago, unable to find even the dorsalis pedis- I helped her find them. She was checking for posterior tibialis on the lateral side of the ankle, and then didn't even bother to get them right with the doppler. THIS NURSE SHOULD BE ON A MED-SURGE FLOOR learning the basics.

Think about it; these are very critical patients and you need to know your stuff and have a drive to learn a lot on your own!

claugh · Sep 25, 2008

All the posts are good, but can lead you to more insecurity on making a decision. As has been noted, you know yourself, and you know your level of skills/confidence.

This is what I assessed when stating out. I knew M/S was not where I wanted to go, but I also knew that was the best place for me to start out and solidify my skills, resulting in confidence. I set a goal of 1 yr and have been into it for 1 ½ yr. I just got a call yesterday with an offer to go to SICU, and jumped at the opportunity. The orientation is 8 wks and should be no transitional problem, at all; given my readily available bag of readily available facts. This was acquired over time, and not having ANY previous experience in the health care industry, the transition from text to real life over the first year was tough.

There is always a challenge going to a new department, but you were up to the challenge with your nursing program, and achieved your goal. Be honest with yourself and decide which path will provide you with the best foundation as you advance in your career.

For some people it works to jump right in and are not as affected by the chaotic environment presented. For others, like me, it is better to get established, then move to a higher anxiety position. You know how you are, go with it...

Good luck

mrod, LPN, LVN · Sep 30, 2008

"Here's a perfect example: Nurse with maybe half year or more experience in our ICU almost killed her patient the other day letting Amiodarone run in at too high of a rate and couldn't figure out what she was doing and why pt's B/P was low. This same nurse was checking pulses with a doppler a few weeks ago, unable to find even the dorsalis pedis- I helped her find them. She was checking for posterior tibialis on the lateral side of the ankle, and then didn't even bother to get them right with the doppler. THIS NURSE SHOULD BE ON A MED-SURGE FLOOR learning the basics."

Not sure if this really matters if she was in the critical care unit or MedSurg...she still did not know how to do it, either way she would of needed to be taught or maybe she just does not know what she doesn't know. Also, basic skills or not.....if you do not use them, you lose them. Now yes, knowing where pulses are and knowing how to check with a doppler if essential in the units but, how about if it is possible she never encountered this??? (Devil's advocate here)

You can learn the basics in the critical care units and a good preceptor with teach that but a good nurse will be able to learn from their preceptor as well.

I think it depends on the individual. Most critical care nurses are leaders, type A personalities but some are opposite. Some need that 6 month to 1 yr experience while others fly right into the critical care units.

I say, go with what you feel and know what you know and know what you do not know...isn't that we we nurses do anyway??

poppy07 · Oct 1, 2008

Once you are done with orientation, "you are on your own" as they say... This means, you are an independent nurse with those around you as resources. At this point in the ICU, there is no excuse to not know where dorsalis pedis pulses are and where posterior tibialis pulses are- we check these in EVERY assessment. Being able to run vasoactive drugs and critical drips should be a familiar item. If you don't know- you have sources to look to. It annoys me that people fail to recognize this fact.

Besides, this person was off orientation now for months and months. It's knowing when to ask for help, and not just others realizing you are about to kill your patient and not have any clue about any of it.

ICU nurses need to be among the best! These are the sickest patients in the hospital, and they're in the ICU for a reason.