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new grads in icu

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by firehawkrn firehawkrn (New Member) New Member

firehawkrn has 12 years experience and specializes in CCU/ICU med-surg.

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You are reading page 2 of new grads in icu. If you want to start from the beginning Go to First Page.

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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.

I'm sorry, but this post shows a complete lack of understanding of the problem. Once you graduate, you'll understand how crucial it is to have enough senior nurses available to precept you and your fellow graduates, and how vital it is for pt. safety for a unit not to be staffed by new grads.

Not to mention the brain drain that continues by wearing down our experienced staff by burdening them with ever-increasing loads and telling them to just deal.

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267 Posts; 3,189 Profile Views

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.

Exactly. Why apply to critical care if you don't want to take "sick" patients? At some point you have to step up. It's not enough just to say you work in critical care; you have to actually "do" it.

Do they think it sounds more impressive to say they work in critical care?

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traumalover is a RN and specializes in ICU/ER.

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i DON'T FEEL NEW GRADS SHOULD COME OFF ORIENTATON TAKING THE SICKEST. WOULD YOU WANT THAT FOR YOUR FAMILY MEMBER? IN THE UNIT I TOOK LOTSA ODS/GI BLEEDS/LOW DOSE PRESSOR SEPTIC PTS AND MOVED UP THE CHAIN. I FEEL CONFIDENT NOW NOT THAT I KNOW EVERYTHING BUT I KNOW ENOUGH TO SPOT TROUBLE AND YELL FOR HELP WHEN I NEED IT. IT TAKES TIME....AND THE BURNOUT FOR EXPERIENCED NURSES TAKING RUN YOU TUSH OFF PTS IN OUR UNIT IS SEVERE.....

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nursenpnk is a RN and specializes in MSICU starting PICU.

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I spent my first year in an MSICU with 22 beds, I understand that new grads need to get the experience of taking care of the sickest of the sick, but we all have to start somewhere. I actually left this particular unit because I felt that new nurses were put into compromising situations when patients were crashing and the resource/charge nurse was not available to assist in pt care. I knew what I was getting into, I wanted to take the sickest of the sick, but at the same time patient safety is a HUGE concern. It is very appropriate to give new grads sick patients when there are resources to support them, I just think it's crazy for people to criticize newbies for not feeling completely comfortable with taking the sickest of the sick, if you learn to ride a bike you don't just jump on you do the training wheels then once you get things underway you remove them and spread your wings, that is how nursing needs to be for me. Being a new grad it is SO important to learn organization and fine tune your assessment skills so that when you do get your sick pts you can take the necessary actions. I also understand that the senior staff cant consistently take the sickest of the sick, however it is critical care and we all have to meet half way and realize that it is our duty to care for the sickest of the sick and somehow we need to balance this out among nursing staff. My new job has 9 new nurses ALL going to nites, so it will be interesting to see how we all function off orientation, some of them are new grads, where others have experience other than PICU, should be interesting to see how pt assignments are organized especially because we try to follow our patients with our own form of primary nursing care.

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firehawkrn has 12 years experience and specializes in CCU/ICU med-surg.

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WHOAAAA!!!!!!!! Let me clarify some of what I said. I've had both good AND bad experiences with newbies. And I don't believe for a minute that they should be "thrown to the wolves" to sink or swim. But a some point, EVERYONE has to take a "bad" patient. When a newbie wants to refuse a pt that is on a vent, no drips, unresponsive and DNR, when all the meds and cares are done.........that gets alittle frustrating. And in defense of our new grads, their orientation consists of 2, maybe 3 months (of shifts) and their off. I wish we could give them ECCO and classes, geez, I'd take 'em! If they are willing to learn, there isn't such a problem. But when I try, as charge nurse, to give them "heavier" pts on the days when census is low enough someone can "be right there", they still balk???? Sometimes I think it's some kind of prestige thing or something. A cushy job with only 2 or 3 pts...... Anyone who knows critical care knows thats fecal deposits. I'm not attacking the newbies, I just think they need to be a little more willing to let their gnoads drop and start to step up. And yes, it is a managment issue, no we have no union, and no, managements response is "you shouldn't have given them that pt." What happens when "that patient" is all there is to give????

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suanna has 30 years experience and specializes in Post Anesthesia.

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I couldn't agree more- you are being dumped on. My hospital was forbidden to hire new grads by union contract for many years but as the shortage of RNs became more critical we negotiated a compromise. New grads with an ICU preceptorship and recomendation from thier instructor can be hired. The ratio is no more that 25%of any shift with less that 1 year experience. The hospital has to use overtime or agency if more help is needed. Not the best solution but it beats 3-4 crital patients for each nures. The staff that are hired are the best of the lot and can usually hold thier own after a few weeks. I'm afraid without our union we would be in the same boat as you. Thank goodness for a collective voice.

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fronkey bean has 13 years experience and specializes in Cardiac Care, ICU.

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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.

But if they weren't comfortable taking care of patients, why did they let them off of orientation? Of course the seasoned nurses need to let the newbies know they will be there as a resource but tthe newbies need to take the patients in order to learn how to take care of them.

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fronkey bean has 13 years experience and specializes in Cardiac Care, ICU.

491 Posts; 6,585 Profile Views

I couldn't agree more- you are being dumped on. My hospital was forbidden to hire new grads by union contract for many years but as the shortage of RNs became more critical we negotiated a compromise. New grads with an ICU preceptorship and recomendation from thier instructor can be hired. The ratio is no more that 25%of any shift with less that 1 year experience. The hospital has to use overtime or agncy if more help is needed. Not the best solution but it beats 3-4 crital patients for each nures. The staff that are hired are the best of the lot and can usually hold thier own after a few weeks. I'm afraid without our union we would be in the same boat as you. Thank goodness for a collective voice.

3 or 4 critical patients?:eek: OMG how do you keep any nurses if thet will let them take 4 ICU patients?

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hlfpnt is a BSN, RN and specializes in LTAC, Homehealth, Hospice Case Manager.

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I don't work ICU yet, but eventually this is where I want to be. For myself, I didn't feel like school alone prepared me for the acuity of an ICU pt...because of my lack of knowledge & experience I didn't feel safe going right into it. So I chose to go the long way around...I've spent the last year in LTAC & am very comfortable working with vents & multiple lines/tubes/drains. Most of our pts have a fairly high acuity & are multisystem failure. Our pts are usually chronic, but can go from stable to rock bottom in a heartbeat. Nope, our supervisors don't assign by acuity, you get what you get & you deal with it. You have to be on your toes at all times. My next stepping stone is a tele med/surg unit. Speaking only for myself, I felt like I needed some general nursing experience behind me first. I think being more comfortable with my skills & role as a nurse first is the best choice for me.

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clee1 has 9 years experience and specializes in Hospice, Med/Surg, ICU, ER.

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I am a recent grad: Dec 2006, and am an LPN.

I have been floated to the ICU on several occasions from my normal med/surg unit. Lemme tell you that I love the ICU, and plan to work in one as soon as I can after I bridge.

Sure, as an LPN, I can't do any vents or cardiac drips, but the opportunity to care for two "really sick" folks as opposed to my normal seven pt mix of total cares and IV Abx recipients is awesome to me.

The ICU I float to is chock-full of experienced RN's, and every one is a helpful coworker and gracious preceptor. I have always felt completely comfortable caring for the pts they assign me, because of the atmosphere of that unit.

I agree with the OP - If you can't take the heat, get the heck out of the kitchen. Ask all the questions you need to, get all the help you think you need; but the ICU is no place for the timid.:uhoh21:

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NoviceToExpert has 2 years experience and specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.

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I just joined this site and I'll throw in my hat and post for the first time. First I'll say that when I say "you" in my post I am not directing this to any member that has posted in particular, but to "you" as in nurses plural, in general, or any one nurse my comments might apply to.

I am a new RN, BSN, and I have taken a position as full-time day staff in critical care.

From my small bit of experience I have seen enough to have an opinion on this, however humble.

I don't think there can be a fair generalization of safety or competence from unit to unit. Each unit has its own culture. Each nurse, new or experienced, has his/her own skill set, his/her own potential and also his/her own limits. Everybody knows something and nobody knows everything is how I see it.

My unit is severe. Nurses bully rather than nurture. As said in another reponse, new grads are left to flounder until they make a mistake and then they are figuratively lynched for it. One may miss a standing order set dose for a prn med that is on a 6 page OH order set and the entire unit knows in minutes (even though the preceptor never discussed the order set with the new nurse, or even noticed the most recent labs pointed out by the grad), whereas an experienced nurse can miss putting the microfilter on an autotranfusion set, running CT blood directly into circulation and if the new RN notices and clamps and stops the tranfusion she is therefore spending all her time "looking for other nurses mistakes and not doing her own work!" True story...Can you imagine?!

One new grad holds back somewhat and asks questions often, to her credit. She is thus deemed "stupid." Another takes the initiative, does her homework, graduated at the top of her class, asks when she is really unsure, but otherwise is a self-starter and jumps into any assignment given wholeheartedly. She is thus deemed the "know-it-all." As you can see, a new grad just cannot win. I know this because although I am one of the newbies, the senior nurses freely gossip in front of me. I have heard their opinions of everyone else on the unit who isn't there... God knows what they say about me, I can only imagine.

Here's the catch 22... experienced nurses complain they are overworked and understaffed... duh, there's a nursing shortage that is only going to get worse. That's why new grads ARE needed in the ICUs across the country. But then when they have the help with enthusiastic young nurses who are so very eager to learn and obviously the cream-of-the-crop since they have exhibited the chops to get a slot on an ICU and are deemed the best applicants (or wouldn't have been hired), they bully them, instead of mentoring them and elevating them by making themselves available to TEACH. If there are new grads on any unit it is absolutely incumbent upon every staff nurse to facilitate their education not only for reasons of patient safety but out of simple professional respect. Every clinician has learned every skill they have from someone more expert. How soon they forget. They behave as if they leapt out of the womb a CCRN. Respect and lack thereof is the number one retention issue according to the last poll I saw. Any nurse that isn't part of the solution is unequivocally part of the problem. Set yourself apart and make a difference for these new grads.

I believe the best nurses do the most with the least. Think field trauma creativity and apply it to the highest tech units at the richest hospitals... This is what you have to work with... a staff of various skill levels... You can work with what you have and take a new nurse under your wing, whether you are assigned to precept them or not, and elevate the staff and culture of your unit... or you can leave it as is and maintain something to complain about by perpetuating an archaic eat-your-young culture. This culture is embarrassing to be part of, in my opinion. I'll never understand it.

For the amount of work that needs to be done to provide safe patient care, the number one priority, it flummoxes me to see nurses participate in a culture that drives young enthusiastic competent new nurses off the floors. Check the ICU retention figures for new grads...they are miserable. Senior nurses complain they are overworked and understaffed, and then workable solutions arrive on the doorstep dressed in scrubs with new licensure, and they are driven out. I think some people just like to stay miserable and have something to bark about. Ultimately if the culture of any floor just cannot be overcome, do the grads a huge favor and have the management not take new RNs on the unit and find another solution to the problem. Don't make an RNs first year experience hideous. In my opinion, new RNs on ICUs with appropriate mentoring can be your greatest asset. But new RNs on any unit take their reponsibility very seriously. They are terrified to make an error. Magnify that by the acuity in ICU. Then exponentiate it with bullying. That's a recipe for disaster. Embrace the new RNs. TEACH them. It won't take long to feel bolstered by them. Encourage us, don't discourage us. Before long you may have a unit everyone wants to be part of with no staffing issues whatsoever rather than a unit to which you can't convince nurses, experienced or not, to apply.

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48 Posts; 2,250 Profile Views

I just joined this site and I'll throw in my hat and post for the first time. First I'll say that when I say "you" in my post I am not directing this to any member that has posted in particular, but to "you" as in nurses plural, in general, or any one nurse my comments might apply to.

I am a new RN, BSN, and I have taken a position as full-time day staff in critical care.

From my small bit of experience I have seen enough to have an opinion on this, however humble.

I don't think there can be a fair generalization of safety or competence from unit to unit. Each unit has its own culture. Each nurse, new or experienced, has his/her own skill set, his/her own potential and also his/her own limits. Everybody knows something and nobody knows everything is how I see it.

My unit is severe. Nurses bully rather than nurture. As said in another reponse, new grads are left to flounder until they make a mistake and then they are figuratively lynched for it. One may miss a standing order set dose for a prn med that is on a 6 page OH order set and the entire unit knows in minutes (even though the preceptor never discussed the order set with the new nurse, or even noticed the most recent labs pointed out by the grad), whereas an experienced nurse can miss putting the microfilter on an autotranfusion set, running CT blood directly into circulation and if the new RN notices and clamps and stops the tranfusion she is therefore spending all her time "looking for other nurses mistakes and not doing her own work!" True story...Can you imagine?!

One new grad holds back somewhat and asks questions often, to her credit. She is thus deemed "stupid." Another takes the initiative, does her homework, graduated at the top of her class, asks when she is really unsure, but otherwise is a self-starter and jumps into any assignment given wholeheartedly. She is thus deemed the "know-it-all." As you can see, a new grad just cannot win. I know this because although I am one of the newbies, the senior nurses freely gossip in front of me. I have heard their opinions of everyone else on the unit who isn't there... God knows what they say about me, I can only imagine.

Here's the catch 22... experienced nurses complain they are overworked and understaffed... duh, there's a nursing shortage that is only going to get worse. That's why new grads ARE needed in the ICUs across the country. But then when they have the help with enthusiastic young nurses who are so very eager to learn and obviously the cream-of-the-crop since they have exhibited the chops to get a slot on an ICU and are deemed the best applicants (or wouldn't have been hired), they bully them, instead of mentoring them and elevating them by making themselves available to TEACH. If there are new grads on any unit it is absolutely incumbent upon every staff nurse to facilitate their education not only for reasons of patient safety but out of simple professional respect. Every clinician has learned every skill they have from someone more expert. How soon they forget. They behave as if they leapt out of the womb a CCRN. Respect and lack thereof is the number one retention issue according to the last poll I saw. Any nurse that isn't part of the solution is unequivocally part of the problem. Set yourself apart and make a difference for these new grads.

I believe the best nurses do the most with the least. Think field trauma creativity and apply it to the highest tech units at the richest hospitals... This is what you have to work with... a staff of various skill levels... You can work with what you have and take a new nurse under your wing, whether you are assigned to precept them or not, and elevate the staff and culture of your unit... or you can leave it as is and maintain something to complain about by perpetuating an archaic eat-your-young culture. This culture is embarrassing to be part of, in my opinion. I'll never understand it.

For the amount of work that needs to be done to provide safe patient care, the number one priority, it flummoxes me to see nurses participate in a culture that drives young enthusiastic competent new nurses off the floors. Check the ICU retention figures for new grads...they are miserable. Senior nurses complain they are overworked and understaffed, and then workable solutions arrive on the doorstep dressed in scrubs with new licensure, and they are driven out. I think some people just like to stay miserable and have something to bark about. Ultimately if the culture of any floor just cannot be overcome, do the grads a huge favor and have the management not take new RNs on the unit and find another solution to the problem. Don't make an RNs first year experience hideous. In my opinion, new RNs on ICUs with appropriate mentoring can be your greatest asset. But new RNs on any unit take their reponsibility very seriously. They are terrified to make an error. Magnify that by the acuity in ICU. Then exponentiate it with bullying. That's a recipe for disaster. Embrace the new RNs. TEACH them. It won't take long to feel bolstered by them. Encourage us, don't discourage us. Before long you may have a unit everyone wants to be part of with no staffing issues whatsoever rather than a unit to which you can't convince nurses, experienced or not, to apply.

Wow, you sure have a lot to say. I am a new grad RN as well. I would never attempt ICU. It is just not safe, and many new nurses who apply to the icu later realize this. That is why the retention rate is low. As far as the icu only taking the cream of the crop graduates, that is bs. They will take any new grad who applies, the 2 new grads from my class in the icu were the poorest students in our graduating class. How does a potential employeer know if you are the best of the best as a new grad anyway? There is nothing to base it on, you have no nursing practice history, and they could care less if you made A's or C's!!

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