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????

[oldiebutgoodie, RN]

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.

...

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.

I agree totally with you! I started in critical care and was treated like dirt. This being a second career, I didn't feel like putting up with a lot of C*** to prove myself to a bunch of mean-spirited people, so I moved on. I spent a year on the unit, and at the end, there were people who still never spoke to me.

The best was how this nasty bunch really dug in during the time that my father was dying and I was very stressed out. They reported me to the manager that I seemed stressed out (well, duh) and implied that I wasn't making the grade.

Yes, I'm still bitter. ICUs with staffing problems probably have it coming.

Oldiebutgoodie

[oldiebutgoodie, RN]

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!!

This poster has a right to post her opinion, whether she is a new grad or not.

Oldiebutgoodie

[NoviceToExpert]

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!!

I respect your opinion based on the fact that staffing criteria may be different in your neck of the woods. My hospital probably hired about 50 new grads since June. Many applied to the ICU. The new grads that got the slots were all Sigma Theta Tau with dual health care licensure in other collaborative areas with track records in those careers spanning a decade each. I should have mentioned this to substantiate my claim, so I can understand how someone reading this from afar without knowing the unit can jump to conclusions. So to clarify, in my hospital the slots for ICU were/are quite competitive, with slots actually still open with new grads turned down for the remaining positions.

[cardiacRN2006, ADN, RN]

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!!

I was the ONLY new grad accepted into my unit, and yes, they did ask for transcripts. And they very much cared that I received A's and not C's.

Many new grads are more than capable of entering the ICU.

[NoviceToExpert]

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!!

Oh, one other thing... I did want to mention that the responsibility of nursing is immense on any unit for any nurse whether ICU, med/surg, telemetry, OB, behavioral health or otherwise. A new nurse on any floor can have a death on their hands at any moment, a code, an aspiration, a PE, a preeclampsia, etc. Each unit has its own specific skill set and therefore a new nurse is a potential danger in ANY unit while ramping up to its learning curve. On med/surg handling 6 or 7 patients without knowing all the meds being given and familiarity with dosages, while still learning time management skills, can be just as serious as a new nurse having one patient in the ICU. In the ICU with advanced monitoring, Swans, A-lines, etc. if something is going bad the rest of the staff knows it and jumps in where needed. Other floors don't have the edge of some of this technology and can walk in on a dead patient. It happens. This is why when nurses are floated from other units their skill set is considered. Even with 20 years experience a nurse with one specialty is a danger on an unfamiliar unit... different skill set. Charge's responsibility is to take this into account. I think to suggest any unit is "safer" for a new nurse dumbs down nursing and its demands across the board. No unit is easy and each has its own dangers. Every floor needs the same support I speak of in my blog. And any unit can have a culture that is just as lethal. Step down units, telemetry and med/surg floors are lower acuity but not less dangerous given the other variables thrown in for nurses on those floors with steep learning curves of their own.

[clee1]

Oh, one other thing... I did want to mention that the responsibility of nursing is immense on any unit for any nurse whether ICU, med/surg, telemetry, OB, behavioral health or otherwise. A new nurse on any floor can have a death on their hands at any moment, a code, an aspiration, a PE, a preeclampsia, etc. Each unit has its own specific skill set and therefore a new nurse is a potential danger in ANY unit while ramping up to its learning curve. On med/surg handling 6 or 7 patients without knowing all the meds being given and familiarity with dosages, while still learning time management skills, can be just as serious as a new nurse having one patient in the ICU. In the ICU with advanced monitoring, Swans, A-lines, etc. if something is going bad the rest of the staff knows it and jumps in where needed. Other floors don't have the edge of some of this technology and can walk in on a dead patient. It happens. This is why when nurses are floated from other units their skill set is considered. Even with 20 years experience a nurse with one specialty is a danger on an unfamiliar unit... different skill set. Charge's responsibility is to take this into account. I think to suggest any unit is "safer" for a new nurse dumbs down nursing and its demands across the board. No unit is easy and each has its own dangers. Every floor needs the same support I speak of in my blog. And any unit can have a culture that is just as lethal. Step down units, telemetry and med/surg floors are lower acuity but not less dangerous given the other variables thrown in for nurses on those floors with steep learning curves of their own.

For a "new grad" you have a remarkable grasp of the "profession of Nursing" as a whole.

You will obviously be a credit to any unit/facility that you wind up in.

My compliments to you.

[CaLLaCoDe, BSN, RN]

I just have dedicated to myself forever more to never be mean, petty, or frankly idiotic to a newby nurse. It isn't right and besides when you call yourself a professional is highly hypocritical LOL...;-) IMHO...OK all right already...!

PS. Ahem, NoviceToExpert, could you be my preceptor in ICU in what let's say ten years, I know you'll be a good one, ah pleeeeeeaaaaaaasssseeee!

[nursursie]

I started out as a new grad in micu with a great preceptor and this was 6 yrs ago. The experience was great and even though I have just reentered icu after an absence of almost 4 yrs of working psych, I haven't forgotten a thing. New grads have to take the responsibility of wanting to learn twice as much as others and jumping in. Icu is not for every new grad.

[fronkey bean]

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.

Congratulations for hanging tough in a bad situation. It is unfortunate when experienced nurses do not nurture the next generation, it inhibits the speed at which new nurses aquire skills, and prevents a new nurse from developing a sense of confidence and a sense of belonging, all of which can prevent a new nurse from becoming a competent long term employee. This is just self-defeating behavior considering how short staffed most units are.

The fact that you overcame their behavior tells me you will be a good ICU nurse (tough skin is a must). I hope you will precept often and start a new trend (be aware though that they may try to undermine you as a preceptor because you "don't know enough to precept").

[nurse1970]

Why work in the CCU if you don't want to take care of "sick" patients. The patients in the CCU are sick, thats why they are there. I think new grads should be able to work in CCU, but with a preceptor that is willing to take on the job and until they are ready to be on their own. But no one should be able to say they don't want a patient because they are too sick. Critical care is just that, critical care. These patient's have a lot going on with them and they need skilled nurses caring for them. New nurses have to start somewhere and if that somewhere is CCU, they need to be willing to jump in there, be hands-on and learn. Thats the only way to do it.

[VegRNmom]

I can understand your frustration. I started my nursing profession in the NICU. At my particular hospital, new grads received 13 weeks of orientation and then some if the new grad wanted/needed it. On nights there were quite a few new grads, but the management stratigically placed us so that we would be near a seasoned nurse should a problem arise in which the new grad would need assistance. For example, they wouldn't allow a room to be all new grads. I think that all of the new grads had enough orientation/practice that we were very comforatable on our own. Also, when we first stated taking patients, they had a seasoned nurse follow us for three days just to monitor our competancy. I remember on my second and third nights of this, they were understaffed and I ended up taking the patients (both vented) independently. It was scary, but exhilarating, I finally felt like a 'real' nurse!