Published Oct 12, 2017
Do you think that new graduate nurses should be allowed to work in critical care area's like ER and ICU?
What do you think?
Been there,done that, ASN, RN
No. Basic skills must be learned first, before than can be applied in critical care areas. I have worked with several nurses that started out in ICU, and even though they were eventually successful, they are sorry they did it. Also, there is NO way they could handle a med-surg assignment, and they know it.
sallyrnrrt, ADN, RN
From a crusty ole bat,
"Back in the day" before nursing education changed
We had the clinical skills, & critical thinking ....to safely work critical care,
But today is nnot yestterday
My unit takes maybe 2 new grads a year. The other new hires are experienced ICU, or new to ICU but experienced nurses. With enough support it can be done. The new hires have been great to work with. My manager has a strong ability to pick out and hire quality nurses, and she hires new grads she feels will succeed.
Just to get it out of the way, there can be a lot of variety in the acuity level of one ICU's patients compared to another ICU. Same deal with staffing levels, autonomy, etc.
Anyway, I'd say that an a motivated new graduate in an ICU environment well-staffed with veteran nurses and well-prepared for rigorously orienting and supervising the occasional new grad will often be successful.
Hiring a whole bunch of new grads at a time and keeping the overall experience level low in an ICU is a recipe for terrible care, on the other hand. In some cases, a hiring strategy focusing on new grads is like throwing pasta at the wall and seeing what sticks - the hospital expects a lot of the new hires not to make it. In other cases, the hospital simply doesn't set expectations for new hires very high in the first place and just accepts an inferior level of nursing care.
In any case, if one of my loved ones were critically ill, I wouldn't want the nurse taking care of them to be 3 months out of school and asking their 'senior' nurse who's 14 months out of school for advice when they run into a problem. That's no good.
My facility only hires new grads into the ICUs under a 2 step program. They work on a step down or tele unit for a year or so, then transition to the ICU when they are deemed ready.
llg, PhD, RN
Yes ... but only if the conditions are right. The new grad needs to be well-prepared (student externship, capstone, work in same/similar unit is another role, etc.) ... and the particular unit has to be well-prepared to receive them (experienced in hiring new grads, having realist expectations, having strong orientation program designed for new grads, existing staff prepared to give the needed support, etc.)
But if you are talking about the average new grad being thrown into the average ICU with the average orientation ... no.
A skill likely not given enough credit - I'm not sure that can be taught! That's wonderful to hear. Honestly. It is just good for everyone.
I can't speak to adult ICU but I believe new grad programs in NICU work quite well in the NICUs who can support them with a solid orientation. This has to do a lot with the fact that not every NICU patient is on drips and ventilated. So I guess NICU is a whole other beast.
However my philosophy has always been if there are less critical adults on the floor wouldn't it make sense for a new grad to learn how to care for these patients before moving to ICU. You don't really have the same option in NICU, there are level 2 units but these are often difficult to get into for new grads (don't have a long orientation and are usually quite well staffed with senior nurses). Whereas level 3 NICUs will still have stable patients for new grads to start with. I've heard some people say, new grads should work with well babies ( ie. Mother baby) before NICU. 1. Again these jobs don't tend to have a lot of new grad positions 2. Sure you'll learn about newborn assessment, feeds ect. But it's still so different than NICU, you are not going to be learning IV meds, NG feeds in mother baby.
I think it depends on the person and the unit. Obviously, unqualified people should be weeded out in the interview process, if not, they definitely will be weeded out if the unit has a proper orientation set in place.
It all depends on the individual's motivation and how well they will be supported. Our ED hires new grads and we have had amazing success, that being said we also have a great training program. New grads are given a 5 month residency in which they have both class room education and preceptorship in the ED. We have had a few nurses who decide that the ED is not for them during this time and we work with them to find a different area that will be a better fit (they also have the option to leave the training program completely without contract obligations but no one has chosen that yet).
Hiring motivated new grads means that we get to train them, not try to fix the bad habits someone else taught them. I personally do not believe that everyone needs to work in med/surg for 2 years before going into a specialized area, the experience in critical care and med/surg is just so different. That being said there are many who believe that all nurses should start in med/surg, especially those who are teaching in nursing schools. Do not fight with them, it does not win you anything or benefit you in any way.
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