New grads in ICU

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Hey nurses - I work in a CT surgery ICU in a big teaching institution. Our surgeons do repairs for aquired heart disease and congenital heart disease, so our patients are both pediatric and adult, neonates to geriatrics, and the acuity is very high. The practice had always been to hire experienced ICU nurses only, but about 5 years ago we started to hire new grads. Our routine has been to orient new nurses to the adult population first, and to the pediatric population after proficiency in adult care has been demonstrated. For experienced nurses that could take a month, for new grads, it could take 2 years. The expectation is that eventually, any nurse will be able to provide care for any of our patients. We're running into problems. The 2 years it takes new grads to get to the peds orientation means less adult/peds nurses available to take care of the peds patients. One complication of this is that when we have new grads orienting, senior nurses are often not available to precept because they are needed to provide pediatric care. So, new people are precepting new people. Do any of you out there work in a mixed population unit? If so, how are you handling your orientation process?

Even in ICU's without mixed pops, are you hiring new grads and how is it working out? Grateful for any help- Denise

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Hey nurses - I work in a CT surgery ICU in a big teaching institution. Our surgeons do repairs for aquired heart disease and congenital heart disease, so our patients are both pediatric and adult, neonates to geriatrics, and the acuity is very high. The practice had always been to hire experienced ICU nurses only, but about 5 years ago we started to hire new grads. Our routine has been to orient new nurses to the adult population first, and to the pediatric population after proficiency in adult care has been demonstrated. For experienced nurses that could take a month, for new grads, it could take 2 years. The expectation is that eventually, any nurse will be able to provide care for any of our patients. We're running into problems. The 2 years it takes new grads to get to the peds orientation means less adult/peds nurses available to take care of the peds patients. One complication of this is that when we have new grads orienting, senior nurses are often not available to precept because they are needed to provide pediatric care. So, new people are precepting new people. Do any of you out there work in a mixed population unit? If so, how are you handling your orientation process?

Even in ICU's without mixed pops, are you hiring new grads and how is it working out? Grateful for any help- Denise

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Specializes in Critical Care, ER.

Well I'm a new grad about to start in a surgical ICU so I'm probably NOT who you want to hear from. But our hospital has specialized surgical ICUs (i.e. neuro, cardiovascular, burn, trauma, etc) and when I applied I made VERY SURE to confirm that the units viewed new grads positively (as the ER where I did my preceptorship did not). Well, the recruiter told me that they developed a system whereby the EDUCATION department, not the actual ICU was responsible for most of the education process and the new grads only spend part of their time with RNs on the floor and part of the time with the educators. Also, my hospital is a union shop which means that new grads are in the ICU because everyone wants us there, not just administration.

I have a hard time beleiving that you'd only need a month to train a MEDSURG RN who's never taken ACLS (which I did when I was in EMS) or experienced the critical care environment.

Don't get me wrong, I know I don't know anything and I may not make it. But why won't you people even give us a chance?

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Specializes in Critical Care, ER.

Well I'm a new grad about to start in a surgical ICU so I'm probably NOT who you want to hear from. But our hospital has specialized surgical ICUs (i.e. neuro, cardiovascular, burn, trauma, etc) and when I applied I made VERY SURE to confirm that the units viewed new grads positively (as the ER where I did my preceptorship did not). Well, the recruiter told me that they developed a system whereby the EDUCATION department, not the actual ICU was responsible for most of the education process and the new grads only spend part of their time with RNs on the floor and part of the time with the educators. Also, my hospital is a union shop which means that new grads are in the ICU because everyone wants us there, not just administration.

I have a hard time beleiving that you'd only need a month to train a MEDSURG RN who's never taken ACLS (which I did when I was in EMS) or experienced the critical care environment.

Don't get me wrong, I know I don't know anything and I may not make it. But why won't you people even give us a chance?

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I have a hard time beleiving that you'd only need a month to train a MEDSURG RN who's never taken ACLS (which I did when I was in EMS) or experienced the critical care environment.

The OP specified that hiring used to be of experienced ICU nurses only, before they began hiring new grads...I believe the one month transition period was referencing these persons - being new to that unit - being ready to take on the challenge of learning new patients after having a month to acclimate to the equipment and policies of that particular unit.
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I have a hard time beleiving that you'd only need a month to train a MEDSURG RN who's never taken ACLS (which I did when I was in EMS) or experienced the critical care environment.

The OP specified that hiring used to be of experienced ICU nurses only, before they began hiring new grads...I believe the one month transition period was referencing these persons - being new to that unit - being ready to take on the challenge of learning new patients after having a month to acclimate to the equipment and policies of that particular unit.
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Why not start half the new hires with the peds population and half of them with the adult population and then switch instead of making them ALL start with adults? New grads are starting in PICUs, so I don't see why they have to start with the adults and then move to the kiddies. I can't imagine any way of doing that without causing the problems you mentionned.

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Why not start half the new hires with the peds population and half of them with the adult population and then switch instead of making them ALL start with adults? New grads are starting in PICUs, so I don't see why they have to start with the adults and then move to the kiddies. I can't imagine any way of doing that without causing the problems you mentionned.

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Specializes in Critical Care, ER.
The OP specified that hiring used to be of experienced ICU nurses only, before they began hiring new grads...I believe the one month transition period was referencing these persons - being new to that unit - being ready to take on the challenge of learning new patients after having a month to acclimate to the equipment and policies of that particular unit.

OK. Does it really only take 1 month to orient a nurse who's being doing adult ICU for 10 yrs to PICU? Come on. If you're going to treat these different age groups homogeneously, then how could you train staff otherwise? What I mean is, someone chose to combine two critical care specialties that are traditionally separated. To formulate an education program that follows the traditional model of separating the two clearly won't work. You need to train people to work with your whole population all at once. While this may not be the greatest comparison, consider the ER. New grads in the ER are routinely trained to take care of all age populations concurrently (well, OK, except for the ER's that separate their adult and peds populations).

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Specializes in Critical Care, ER.
The OP specified that hiring used to be of experienced ICU nurses only, before they began hiring new grads...I believe the one month transition period was referencing these persons - being new to that unit - being ready to take on the challenge of learning new patients after having a month to acclimate to the equipment and policies of that particular unit.

OK. Does it really only take 1 month to orient a nurse who's being doing adult ICU for 10 yrs to PICU? Come on. If you're going to treat these different age groups homogeneously, then how could you train staff otherwise? What I mean is, someone chose to combine two critical care specialties that are traditionally separated. To formulate an education program that follows the traditional model of separating the two clearly won't work. You need to train people to work with your whole population all at once. While this may not be the greatest comparison, consider the ER. New grads in the ER are routinely trained to take care of all age populations concurrently (well, OK, except for the ER's that separate their adult and peds populations).

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When I received my RN I was a new grad in NICU. It was 12 weeks long with 2 days classroom and 3 days on the floor with a preceptor. I thought it was rather nice because our topics we covered in class you tried to get infants based on that. It appears to be a trend now with the nursing shortage many new grads are able to pick and choose their specialty than going to med surg area first. Some new grads can handle some can't. Now being in NICU for 5 years if I were to change my area like ICU I would definately have to take a refresher class I know I forgot a lot of stuff. :-)

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When I received my RN I was a new grad in NICU. It was 12 weeks long with 2 days classroom and 3 days on the floor with a preceptor. I thought it was rather nice because our topics we covered in class you tried to get infants based on that. It appears to be a trend now with the nursing shortage many new grads are able to pick and choose their specialty than going to med surg area first. Some new grads can handle some can't. Now being in NICU for 5 years if I were to change my area like ICU I would definately have to take a refresher class I know I forgot a lot of stuff. :-)

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