I'm just curious about the general thoughts on new grads in the ICU.
The units I work in have been seeing a huge influx over the last 2-3 years, mostly out of necessity. For the most part, they have been doing well, and we all know there are nurses of 30 years out there who can be more scary than a new grad. We are a medium acuity ICU and it's probably a good place for new grads interested in critical care to get into.
On the downside, there has definitely seemed to be an increase in rookie mistakes, some of which have been potentially deadly to patients (pneumos from badly dropped dobhoffs, extubation without turning off sedation, missing critical changes in condition, etc).
Part of me feels like we've dumbed down the nursing process to the point that even in critical care any average nurse can do it. ICU used to be a respected nursing position and they were considered the "best of the best" (I've even heard patients say that a time or two). We were called on to start IVs and answer tough questions and handle difficult situations, but now we have a bunch of one year old nurses who have barely put in a foley running around the units.
Again, most are doing well, and I don't intend this to be a condescending post, but I find myself skeptical of the decision I've seen in at least 2 or 3 hospitals to allow a lot of new grads into staffing.
We need the staffing, yes, but when a rookie mistake is putting patient's lives at risk, is it worth it?
I got hired as a new grad in the ICU, but I wish I hadn’t accepted it. Here’s why:
1. I wanted to learn so much so fast! I asked questions non stop. And the older experienced nurses, including my preceptor but to a lesser extent than others, got sick of it quick.
2. (I truly believe this has a lot to do with why they were all so cranky) My orientation was a joke. I spent two weeks in hospital orientation/online training for policies and such. Then 3 weeks on telemetry where they put little to no effort in actually training me (I was basically a glorified aide who could pass meds) because I wasn’t staying on the unit. No solo patient care but a mish mash of passing meds, winging assessments that I never got feedback on, and some patient care. So down to ICU I went where the first two days were with two nurses who weren’t my designated preceptor, one of them completely threw me to the wolves and said “I’m sitting at this desk if you need me” in a very “this is a test to see if you’ll need me” way. The second did similar but was a little more hands on. Third day I get a hold of my designated preceptor and we’re good to go. Fast forward 4 weeks and I’ve yet to totally handle patient care alone on an actual critical patient. My preceptor was very hands on and while she let me do most things alone she couldn’t help but literally hover at all times and help out on little things even if I didn’t ask her to. So week 5 my director says cut her loose completely and just support. Then week 6 we’ll triple her up so she gets the feel of that and week 7 she’s on her own. I asked to quit week 5, she said stick it out longer you’re doing great, and I officially quit in week 6.
So I’m fresh out of nursing school and they have to somehow make me competent in 6-7 weeks. Plus keep an eye on me (because we all know they would) after that WITH their own patients because come on who really trusts a new grad with three months experience tops with an ICU patient. I don’t blame them for the burn out. And I don’t blame them especially since I get the feeling I’m not the first new grad (or new hire) to quit before orientation was over.
3. Now I have a cloud over my career and my psyche of bailing on a new job before finishing orientation and a sinking pit in my stomach about ever going back to a critical care setting. I may never be able to, and honestly I feel like I’m missing out because I think I could be great at it.
— so the great takeaway of my drawn out story is that I don’t think ICU’s should hire new grads unless they have an extensive orientation process and experienced nurses who are compensated enough and happy enough in their position to support that process. And I know those aren’t reasonable expectations for many hospitals. So it’s a tough situation to be sure
Specializes in ICU, ER, Home Health, Corrections, School Nurse.
On 12/6/2018 at 5:11 AM, Mr. Murse said:
Part of me feels like we've dumbed down the nursing process to the point that even in critical care any average nurse can do it.
I've been a nurse for 40 years, and started in ICU. Yes we felt we were the best of the best. But truth be told, many times I felt that after setting up enough art lines, assisting at enough Swan insertions (they were big back then), titrating enough meds, and mastering all the intricacies of all the procedures, it kind of became routine. Most of it didn't take any great intellect, it was just learning the protocols.
I started as a new grad. The same controversy existed back then as it does now. I totally felt the displeasure of the more experienced nurses, at having to deal with me as a new grad. Having observed nursing now for a long time, I really think it's about the character and the personality of the individual. Many new grads did way better than some of the floor transfers.
You here now about how nursing has changed, that newer nurses don't have the same work ethics, etc etc, But if I look back critically at some of the nurses I worked with back then, there were some doozies. Drug addicted, coming to work intoxicated, pulling pranks on each other and generally behaving in less than a professional manner. They were some crazy times.
Nursing is so much harder now than it used to be, so I think nurses respond to it differently than before.
My ICU doesn't hire new grads straight out of school. Whether they have med surg experience or telemetry experience, as little as 1-2 experience, they need to have something. We just recently hired 1 new grad fresh from school - and at first was very weary, but she is very bright and very energetic to learn more. They also gave her to a very experienced preceptor, so my ideals have changed. With the right amount of guidance, they can do well. I can see she is trying very hard - harder than most nurses with 40 year experience on our floor.
I was hired into an ICU and I start in a little less than a month. I passed Nclex first try, but def not in 75 questions, which to some is an indicator that I may be wanting. What I am worried about is that I have 0 healthcare background. Im 33 and am currently in management in a manufacturing plant. When I voiced my concerns about my eligibility to work in a critical setting to the units Clinical Practice Leader, he assured me that I will learn everything I need to learn on the unit and not to worry about it.
I ordered the ICU Book to study and an EKG interpretation book so that I can at least have SOME exposure to ICU specific care. As experienced nurses that have witnessed the influx of new grads, what would make me an ideal new grad nurse on the ICU? I have started a list of skills that I intend to check off as I gain proficiency in them and I have started a list of questions as well. I am eager to learn and to be a competent nurse.
Specializes in Critical Care, Emergency, Education, Informatics.
When there is a problem, it generally isnt’t He new grad that is the problem. It’s the lack of solid education based orientation/residency program for them to grow into critical care nurses.
I've personally noticed backlash from older and more experienced nurses with the new grads who enter into critical care units. Times have changed so be it. There's nothing wrong with new grads in speciality areas. I've been told by hiring managers that they like to hire new grads because we are fresh, excited, willing to pour our all into it and not burned out or stuck in our ways. I had a pretty terrible preceptor on a critical care unit who basically wanted to put me in her old shoes and do med surg first. Sorry chick, I was hired in this position.Take it up with mgt! I was treated like absolute crap by her. Oh well! New grads can learn with the best of em! Get used to it!
When there is a problem, it generally isnt’t He new grad that is the problem. It’s the lack of solid education based orientation/residency program for them to grow into critical care nurses.
Just for a little devil's advocate, I'll ask: Who pays for this residency program? What resources do you devote to training new grads to walk and run at the same time without cutting into some other integral part of the overall mission? Critical care is already hideously expensive, and not an especially big profit-generator for most hospitals. Meanwhile, healthcare expense is the leader driver of bankruptcy in the US, absurdly inefficient compared even to other first-world healthcare models, and leaves thousands of uninsured and under-insured Americans with inadequate access to healthcare.
So who pays? Do hospitals hire more administrative staff and simply bill more so that the orientation process can be easier for people without experience? Or lengthen orientation and do the same? Do nursing schools offer more intensive critical care training, raising their prices and ultimately billing students via their loans? Do hospitals get serious about hiring the best possible critical care nurses to the bedside so that they can more effectively pull double duty and train new grads while taking care of the critically ill? Doesn't that undermine the hiring of new grads anyway? Might part of the problem be that nurses with a year and a half of experience are training new grads with no experience in a field that is fairly demanding and complicated?
I have nothing against new grads and have seen some do remarkably well in an ICU environment and become absolutely great nurses. But if the problem with new grads in an ICU is that they're not getting adequate training, then consider that one explanation for that might be that they're being trained by under-experienced nurses... because that hospital hires too many new grads to their ICU.
Specializes in Cardio-thoracic Surgery Recovery and Resuscitation.
I wholeheartedly support new grads in the ICU. This being said, facilities need to take advantage of the probationary period when someone is clearly not making it in that environment. Our ICU is relativity high acuity in a level one trauma center and primarily hire new grads. We feel that they are very plastic out of nursing school and have the drive necessary to put their nose to the grind and learn the ropes. I have found this to be a huge factor in creating great nurses on our unit and new grads tend to have more of this drive. We have had to find a home for some of the nurses in a med-surg unit if they haven't made it on our unit after an extensive, prolonged orientation.
I will say it is more of a gamble though. A students academic success does not have any clear correlation to professional success at the bedside. A nurse with prior experience is more established in their practice which is great for providing an outside perspective and a grounded practice.
All in all, an idealized unit would have a mix between new blood and the old guard but as stated in other posts, the necessity of a nursing shortage leads many units to take whatever thy can get.
New grad CVICU nurse here. I'll speak on my own behalf and my own perspective with no particular bias. The hospital I joined had an 8 week long internship that was filled with didactic training that ranged from ACLS training to foley insertion/art line use. After we were done with that, we spent the next 8 weeks training on the floor with a preceptor. The preceptor would take patient loads all the way from ECMO patients that are singled, to fresh hearts, MAZE procedures, VAD patients, step down patients, etc. They have us go into weekly classes and in-services that help us understand hemodynamic stabilizing and reading wave forms on PA caths.
I've been off orientation for 3 weeks and I've taken and managed patients that are on multiple drips like dobut, levo, neo, milrinone, etc. I've sat and spoke to the intensivists and cardiologists to learn what they want and how they want it.
I feel as though if a new grad has the tenacity to enter into a critical care floor, they're already a cut above the rest. They're willing to expand their knowledge immediately after nursing school and place themselves into an uncomfortable position. The best thing for a seasoned nurse to do isn't to sit there with the attitude of "back in my day" and rather be nurturing. Average nurses can't function in an ICU situation, I know that because I've seen float pool nurses take stepdown patients and drown. The nursing process hasn't been dumbed down, the focus of care has simply changed and the nurses are evolving into what's expected today.
This is interesting to me as a new grad in an ICU. I haven't made any mistakes like this. How does your floor and management handle these mistakes? Do you guys have a decent ratio of senior to new nurses? Mine does not, we are mostly new and the most senior nurse on shift is generally a 3 or 5-year RN. Recently I've been penalized for accusations like sending a contaminated urinalysis, asking for "too much help," and hooking up an NG wrong to suction, without being notified or educated on these instances until I'm sat down by my manager. No patient harm was caused. My manager is also known to bully, pick favorites, and scare nurses out of the ICU. That's another story, though. However, I think we can be here if there is sufficient support/resources for us. I don't believe my floor has this. We are also a mid range acuity, by the way. I haven't had a vented patient in weeks, no pressors for a whiiiiiiiile, either.
woosinatress, BSN, RN
3 Posts
I got hired as a new grad in the ICU, but I wish I hadn’t accepted it. Here’s why:
1. I wanted to learn so much so fast! I asked questions non stop. And the older experienced nurses, including my preceptor but to a lesser extent than others, got sick of it quick.
2. (I truly believe this has a lot to do with why they were all so cranky) My orientation was a joke. I spent two weeks in hospital orientation/online training for policies and such. Then 3 weeks on telemetry where they put little to no effort in actually training me (I was basically a glorified aide who could pass meds) because I wasn’t staying on the unit. No solo patient care but a mish mash of passing meds, winging assessments that I never got feedback on, and some patient care. So down to ICU I went where the first two days were with two nurses who weren’t my designated preceptor, one of them completely threw me to the wolves and said “I’m sitting at this desk if you need me” in a very “this is a test to see if you’ll need me” way. The second did similar but was a little more hands on. Third day I get a hold of my designated preceptor and we’re good to go. Fast forward 4 weeks and I’ve yet to totally handle patient care alone on an actual critical patient. My preceptor was very hands on and while she let me do most things alone she couldn’t help but literally hover at all times and help out on little things even if I didn’t ask her to. So week 5 my director says cut her loose completely and just support. Then week 6 we’ll triple her up so she gets the feel of that and week 7 she’s on her own. I asked to quit week 5, she said stick it out longer you’re doing great, and I officially quit in week 6.
So I’m fresh out of nursing school and they have to somehow make me competent in 6-7 weeks. Plus keep an eye on me (because we all know they would) after that WITH their own patients because come on who really trusts a new grad with three months experience tops with an ICU patient. I don’t blame them for the burn out. And I don’t blame them especially since I get the feeling I’m not the first new grad (or new hire) to quit before orientation was over.
3. Now I have a cloud over my career and my psyche of bailing on a new job before finishing orientation and a sinking pit in my stomach about ever going back to a critical care setting. I may never be able to, and honestly I feel like I’m missing out because I think I could be great at it.
— so the great takeaway of my drawn out story is that I don’t think ICU’s should hire new grads unless they have an extensive orientation process and experienced nurses who are compensated enough and happy enough in their position to support that process. And I know those aren’t reasonable expectations for many hospitals. So it’s a tough situation to be sure