new grads in icu

[firehawkrn]

I need some advice, or maybe just to vent. Everybody has a different opinion of new grads in the icu. I've had good experience and I've had not so good. The issue now, is that on our dayshift, ALL the new nurses are new grads. There are maybe 2-3 seasoned nurses. Our icu gets everything from fresh open hearts to medical to psych. If a "really sick patient" gets admitted, we have to completely change patient assignments, because the newbies say "That patient is too sick, or really sick, I can't handle that." What the h### did they apply to the icu for??????? I agree, we shouldn't eat our young, but we shouldn't load down the old pack mules til they can't take anymore either!!! I'm truly concerned for patient safety and managment could care less. HElp!!!! Comments?? suggestions????

[GregRN]

I'm hearing two things: "Why did they even apply to the ICU then" and "this is a patient safety issue." Pick a side.

You have brand new grads working in the ICU, ones who are concerned for patient safety and demonstrate it by saying, "This is above my level of care that I can safely provide this patient. Someone more senior should take this..." That said, this is NOT a new grad or seasoned nurse issue. This is PURELY a management issue. Why the eff would management put so many new RN's together on one shift? This strains everyone and sets up everyone to fail, both new and senior nurses. Your best bet is to JOIN with the new grads (don't eat them, don't chastise them for being new or being in the ICU as new grads) and go to management as a GROUP to inform them of the dangers of having so many new RN's on one shift. You'll strengthen your relationship with the new RN's, will look like leaders and will strengthen your voice with management.

Do you have a union? Get the union involved as well. This can be a serious patient safety issue, as already demonstrated.

[cardiacRN2006, ADN, RN]

That's weird! I wanted to always have the sickest patients-still do!

[firstyearstudent]

I'm hearing two things: "Why did they even apply to the ICU then" and "this is a patient safety issue." Pick a side.

You have brand new grads working in the ICU, ones who are concerned for patient safety and demonstrate it by saying, "This is above my level of care that I can safely provide this patient. Someone more senior should take this..." That said, this is NOT a new grad or seasoned nurse issue. This is PURELY a management issue. Why the eff would management put so many new RN's together on one shift? This strains everyone and sets up everyone to fail, both new and senior nurses. Your best bet is to JOIN with the new grads (don't eat them, don't chastise them for being new or being in the ICU as new grads) and go to management as a GROUP to inform them of the dangers of having so many new RN's on one shift. You'll strengthen your relationship with the new RN's, will look like leaders and will strengthen your voice with management.

Do you have a union? Get the union involved as well. This can be a serious patient safety issue, as already demonstrated.

I agree completely. Why are you blaming coworkers? Management hired them, probably because they couldn't find or didn't want to pay for more seasoned nurses.

[firstyearstudent]

ooops/

[ukstudent]

I can see where the OP is going. If the new grads never take on the sickest then they will never learn how to do it, even when seasoned. Maybe when one comes to the unit a new grad could take the patient with a seasoned nurse close by for guidance. Are your new grads having classes and being tested in compentcy on equipement that they might not see every day such as ballon pump's, LVAD's etc? Do you have a clinical specialist that could help them while taking on the sickest.

Management does need to even out the new grad to seasoned nurse ratio both day and night.

[oldiebutgoodie, RN]

I can see where the OP is going. If the new grads never take on the sickest then they will never learn how to do it, even when seasoned. Maybe when one comes to the unit a new grad could take the patient with a seasoned nurse close by for guidance. Are your new grads having classes and being tested in compentcy on equipement that they might not see every day such as ballon pump's, LVAD's etc? Do you have a clinical specialist that could help them while taking on the sickest.

Management does need to even out the new grad to seasoned nurse ratio both day and night.

Well, sure, you can just throw a new grad into a serious situation, watch them flounder, and compromise patient safety. I don't agree with this thinking, however. The grads are obviously smart enough to want more time under their belt before taking a fresh heart or other serious patient.

If it's like my old unit, they would throw in the new grad, and when they had problems, would "counsel" them with remarks like "Well, maybe you're just not ready for critical care" and write them up. (And not offer any help).

Every ICU I know is understaffed and overworked, with lots of new grads and lots of turnover. Maybe there has to be a better way.

Oldiebutgoodie

[ALEXIS VALIENTE]

i understand the the new grads coz even i become nervouz when im handling a cva pt. i alwats feel like im not yet experienced enough to handle them. by the way, im just a student.

[pinksugar]

I can see where the OP is going. If the new grads never take on the sickest then they will never learn how to do it, even when seasoned.

I agree with this. I am a new grad in ICU/CCU and I WANT the sickest patients. I want to be able to take care of these very ill people, and the only way to learn how to do it is by jumping in, asking questions, and taking on opportunities to care for very sick pts.

I had my first CRRT pt (with my preceptor) the other day and it was awesome. I learned so much just from one day of caring for this one pt.

As a side note, we get lots of extra classes for CRRT, IABP, Swans, etc. There are many experienced nurses on our unit - I think that is why I feel more comfortable taking the sickest pts. There is always someone to ask, even if my preceptor is not around. All of the nurses on my unit seem to love teaching and are very cool, so I think I got lucky.

[Ivanna_Nurse, BSN, RN]

Im a new grad in ICU as well. It is part of my orientation protocol that I take the sickest/most critical patients. In fact, I did a schedule swap this week to be available to take a cardioversion thats coming in monday. At times I feel uncertain, but I have experienced nurses available every shift that I work. I work in an 8 bed unit, which also has alot of vasculars, but also psych and medical issues. We are balanced pretty well, with one seasoned nurse per new grad for at least the first year, which means the other new grad that has started is on an opposite schedule. I would consider talking to management as someone else suggested, see if you can spread em out between days and nights, opposite weekends or just plain different shifts. ~Ivanna

[traumalover, RN]

I'm an ICU nurse x 3 years. We just hired 13 new grads....in a twenty bed ICU. I am considered experienced which to me is ridiculous. I consistently take the worst pts and it is backbreaking and hard and I am burnt......but it is safer for the patients. New grads need to become confident in their assessment skills. And time management. Our charge nurses are excellent at identifying pts who need nurses who are fast efficient and knowledgeable-in my first year I would never have been the best nurse for some of the patients I take now.

[CaLLaCoDe, BSN, RN]

I do not work ICU, possibly never..it's just not me. I worked ICU as a nurse assistant and was dumbfounded when all the "experienced" nurses were on days and all the newbies were on nights with a sporifice 2 or three experienced nurses to help out. I think the experienced nurses should be required to work both days and nights. And a ratio of experienced to inexperienced nurses be established. It's just not fair to the newby nurses to be slammed with too much scary stuff and no one to get an understanding from as to how to handle the critical situation.