New Grads in Critical Care area's

[kindz22]

Do you think that new graduate nurses should be allowed to work in critical care area's like ER and ICU?

[EllaBella1, BSN]

I support them, mainly because I was one. Now I'm a couple years in with a CCRN to my name, and feel that going right to critical care was the absolute best choice for me. We hire a few new grads every year, and I find that the new grads (again, the ones who are really motivated), move right up the ranks in the unit. They tend to have to work a little harder up front, but struggle a lot less than some of the nurses who worked med-surg prior to moving up.

In terms of the comment that most ICU new grads state they couldn't handle a med-surg assignment, I actually agree, at least initially. The reason I say that is because as an ICU nurse I micromanage every aspect of my patient's day. Want to get up to the chair? Pee/Poop? Eat? Drink? You better believe I will be right there next to you while you're doing any/all of that and measuring your I+Os, ambulating you, etc. It absolutely freaks me out when I walk through the med-surg floors to see patients out of their rooms and walking around independently. lol. I know that my time management would be impacted because I would be managing my patients like I manage my ICU patients, and I know there isn't time for that with a 7 patient assignment. But in time I would adapt to the flow of the unit. That said, I have floated to PCU, and have dealt with a 4 patient assignment without too much trouble.

[bgxyrnf, MSN, RN]

Yes, new grads can and should be hired into specialty areas. However, they need to be supported by the unit, the educator, the manager, and the rank-and-file nurses, techs, and clerks.

If they are not supported, they will fail... but despite the fact that the system will blame them, the fault lies not with the newbie but with the system and its people.

[lcgivz12]

I worked as a new grad in an ICU and did great. A surgeon recommended i buy "The ICU Book" which is basically the bible for residents in internal medicine. I read it whenever I encountered a new disease process and would know ahead of time what doctors needed to know about their patients and what they would order. I recommend that book to every new ICU nurse. If the new grad is humble and just learns from everyone without an ego, they'll do fine. Don't assume you know anything.

[PeakRN]

I worked as a new grad in an ICU and did great. A surgeon recommended i buy "The ICU Book" which is basically the bible for residents in internal medicine. I read it whenever I encountered a new disease process and would know ahead of time what doctors needed to know about their patients and what they would order. I recommend that book to every new ICU nurse. If the new grad is humble and just learns from everyone without an ego, they'll do fine. Don't assume you know anything.

I second this. The ICU book is a great reference that is neither dumbed down nor written pretentiously.

[Orion81RN]

No. I believe that new grads need to gain experience with nursing assessment in a less acute area first. I think assessment is key for acute care, right next to prioritization, and those are skills that require practice.

The only exception would be if a hospital has a very strong new grad preceptorship program for at least 6 months.

Just my opinion.

[Orion81RN]

I worked as a new grad in an ICU and did great. A surgeon recommended i buy "The ICU Book" which is basically the bible for residents in internal medicine. I read it whenever I encountered a new disease process and would know ahead of time what doctors needed to know about their patients and what they would order. I recommend that book to every new ICU nurse. If the new grad is humble and just learns from everyone without an ego, they'll do fine. Don't assume you know anything.

That was pretty cool of the doctor to take an intetest in your learning and offer that advice.

[PeakRN]

That was pretty cool of the doctor to take an intetest in your learning and offer that advice.

That's one or the benefits of areas like the ED and ICUs, medicine and nursing generally have a more team oriented approach to care.

I have responded to adult codes and RRTs in the PICU and the pediatric intesivists genuinely want the input and advice of the ED nurses. The PEMs actually appreciate when we run a case by them and start meds when they are busy. The adult ED docs actually value our nurses opinion on what pressors or sedation meds we think will work best (for example I greatly prefer neo for sedation related hypotension).

[Kareegasee]

I work in a Level 1 Trauma and Surgical ICU that frequently hires new grads. I think there is something to be said about the importance of the interview process... I can say honestly that our manager has done a fantastic job selecting "the good ones" with her keen eye. When I started, I was part of a group of 20+ new grads beginning on our floor and I was one of 3 who had previous experience. (The volume of new hires was due to an odd mass exodus related to many becoming NP's and CRNA's all in the same year). We are a learning hospital with a very rigorous orientation program (new grad or not) with over 30 required classes scheduled into our first 12 weeks for ICU RNs and mandatory one-on-one time between the manager, educator, and orientee discussing progress, goals, and ways to improve.

To sum up my point, I agree with several others who believe that with the right training/orientation, new grads can succeed in the ICU. I have seen it, and I am very proud to say that I work with these young nurses. I would trust my life in their "shiny and new" little hands. They know how to monitor, they know how to assess (like either are hard, honestly). They know when to ask for help and they know how to access their resources. That's all it really takes.