New Graduates In The Icu?

ThumbzRN · Apr 12, 2005

I went straight from bartending into a busy 43 bed ICU out of an ADN program. The unit includes CCU, SICU(trauma level II), and MICU. It has been two years now and and I have learned alot. I would not trade the experience for anything. I continue to find ways to learn and improve my practice. Not to scare you, but I was like a deer in headlights for the first year and there were days I felt like I did not know enough to care for people with such a low reserve. I was lucky to have great mentors and other staff willing to answer all of my questions giving me guidance. Without there support I would not have felt safe. Now I have much more confidence. Starting in the ICU was very hard, but in retrospect very rewarding. I have seen many do well through our intern program. Many who did well were externs before the intern program. Just make sure if you go into a specialty area that that the training program is adequate and that the staff will support you in your development as a nurse. I think if your dedicated enough and ask plenty of questions you can survive in the ICU. Remember to take criticism constructivley, learn from your mistakes, and realize nobody is perfect. With every patient there is something to learn no matter what area you choose. The hospital should progress you as you become more efficiant and knowledgable in your practice. I feel at home in the ICU. I hope you feel the same way no matter what area you choose. Good Luck.

Morguein · Jun 17, 2005

What kind of orientation do your ICU's provide to new grads? Do you have classes for them? And if so, do all of the new grads have classes or only when there is enough orientees or money? How long is the orientation for your new grads? Is there a consistent system that you all follow for each orientee? I am very curious about how other ICU's train new nurses (new grads and experienced nurses coming from other departments). Oh, and one other question; how much experience must your nurses have before they can be preceptors? Thanks for any responses. :)

bellehill, RN · Jun 17, 2005

I wouldn't trade my 3 years of med-surg for anything. When I did transfer to the neuro ICU all I needed to learn was the critical care part of the unit, I already had a handle on the basic nursing care. I too have seen new grads in the ICU that are great and some that are scary, but we also have seasoned ICU nurses that I consider scary. It depends on the person, personally I would want med-surg first.

KimberRN1 · Jun 19, 2005

My hospital has several specialized ICUs.....MICU, SICU, OHRU, PACU, CCU, MSICU, NSICU, NICU, and PICU.....They take new grads probably because of the large number of units and the nursing shortage.....New grads are precepted for 3 mos on days (more if you need it) then go to work on nights usually 7a-7p...nights is a good shift for new grads in the ICU because it's not as hectic as days, and you always have help from other nurses......Our hospital is a teaching hospitals and residents are constantly in the unit on days writing pages of orders, sometimes useless...alot of times stupid.....You know those just for the heck of it orders .....I think day shift for a new grad would be like throwing them to the wolves.....Nights are busy because of the acuity of pts but they usually don't have residents making rounds writing tons of orders.....On nights you can usually figure out what's best for you in charting and managing critical pts....

New grads or any new ICU nurse at my facility takes a 40hr EKG class....skills class (swans, a-lines, etc)...CRRT class (continous renal replacement therapy)....ACLS.....Spend one day with IV therapy.....Intra Aortic Balloon Pump class....Computer classes....and many many other classes...Plus everything the hospital requires for any new nurse..... Example: You can't take a CRRT pt if you haven't had the class...

I went into the MICU right after graduation...yea it was deer in the headlights for the 1st year but it's like that for experienced floor nurses who come to the units as well....And if you work in a unit you know that if your pt goes bad everyone in the unit is in the room in an instant....Sometimes you can't even get to your own pt ....lol...the way it kind of works out is when someone goes bad it's not your pt it's everyone pt.....the teamwork really comes into play....In our units we don't usually have pt care so the RNs have to help each other give baths...clean pts who mess etc...Or if you do have pt care you help them because the pts usually have so many lines and are on the vent..

Personally I feel that if you want to do ICU then go into it right after you graduate....I mean it's not going to hurt you if you work med/surg before ICU, but in our hospital the nurses notes aren't the same...we don't have anyone passing PO meds....you get your own labs..draw blood from lines...get your own ABGs.....you run critical drips....etc etc....You're still going to go to the unit and learn everything ICU so why not learn it from the start....

Gigglesforall, BSN, RN · Jun 23, 2005

Hi everyone~ I just found out today that I passed the boards and will be starting my job in an ICU in Chicago on July 5th. It's always been my dream/goal to work in the ER, but I didn't want to be thrown right in there at first and decided that starting in ICU would be much better for me. I have never had much desire to work on a regular med-surg floor. I am very excited to start in ICU and understand people's concerns when it comes to having a brand new RN being in control of such delicate patients. I agree with those that say it's up to the extensiveness of the orientation program. In my mind if I started in med-surg sure I would gain a good background in med-surg nursing, but I don't think I would benefit from how to make the critical and fast paced decisions that I will have to make in ICU and eventually, ER. I believe that right now I am still in "student" mode and am dedicated to focusing on my new career without all the other distractions of being a student and I can just focus on learning nursing.

ladybug5982RN · Jul 13, 2005

i am an icu nurse and i started out as a new grad in the icu,but i had worked in the hospital setting for 13 years doing various other jobs before getting my rn. i think it depends on the person. another girl from my class came to work in the icu the same time i did and she had never worked in a hospital but rather had a previous business degree. she has had a difficult time.i was also recommended to go to icu by two of my professors from nursing school. i was nervous but i have done very well.i was told by my mentor that she prefers nurses right out of school because they have not picked up alot of bad habits yet and she can teach them the right way to do things. i love icu and would not work anywhere else. i work about 5 days a week,12-13 hr shifts because we are so short staffed and i love it!!:nurse:good luck on what ever you decide.

Ruby Vee, BSN · Jul 14, 2005

hi everyone~ i am very excited to start in icu and understand people's concerns when it comes to having a brand new rn being in control of such delicate patients. i agree with those that say it's up to the extensiveness of the orientation program. in my mind if i started in med-surg sure i would gain a good background in med-surg nursing, but i don't think i would benefit from how to make the critical and fast paced decisions that i will have to make in icu and eventually, er.

by spending a year or so in med-surg, you would learn basic nursing skills -- the building blocks for your eventual career in icu or er. you'd learn how to organize, prioritize, compartmentalize. you'd learn how to talk to patients and families, how to summarize for report and what you need to tell the physician and what can wait until morning rounds. and you'd do it in a more forgiving patient population. you might also learn to anticipate so that some decisions don't become "critical and fast paced" and some problems are nipped in the bud before they become major problems.

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[color=#4b0082]i've been in the icu since 1982, after five years of hemotology, oncology, bone marrow transplant and step-down experience. i've seen new grads become great icu nurses, and i've seen experienced nurses become scary icu nurses. the worst new grad i've ever seen darken the icu transferred to the stepdown unit for three years, learned, grew, and as now a superb icu nurse. but the nurses who last in the icu are the ones who had some basic nursing experience before starting in icu. the nurses who start in the icu just seem to burn out faster.

Maggie in NC · Jul 14, 2005

Some new nurses want to go into ICU/ER because it is a requirement for application into some C.R.N.A. and P.A. programs. (Don't flame me!!)

I certainly wouldn't want to spend a year or even six months in med-surg if my ultimate goal was to get into a C.R.N.A. program. (times awastin for us "nontraditional" students!). I wonder if some hospitals take long term goals of the nurse into consideration when placing them.

Just a thought....

coffee_anyone · Jul 21, 2005

I graduated last August and started in ICU in October. When interviewing I mentioned that I wanted to go to a med-surg floor and they wanted to place me on a med-surg/hospice floor due to some hospice work I've done. As soon as I mentioned that it may be difficult for me to transfer and adjust from that to ICU - which was my ultimate goal - they suggested that I just go directly to ICU and I did.

It's been a challange. I've had some major life changes during this transition too - not making this any easier. I do look things up when I get home when I don't fully understand something or I've made room in my brain for other information... now and then I have weeks of feeling confident... this last week... a tough week... has me wondering again if this is for me. Ultimately, I do think so, I just need to get through this stupid phase which brings on my low self-esteem issues.

I'll continue to take it one day at a time... it's all one can do. Tonight I'm back in after one day off - I hope it's a good night, I could use one.

sarah_bellum · Feb 19, 2008

I graduated in December and passed board two weeks ago! I have worked in critical care for years as a UAP, US, cardiac monitor technician and PCT. As a UAP, I always received compliments on how happy they were to see me, how I did a good job.

When I interviewed for my new role, my manager asked me if I wanted to orient in the stepdown unit at first, to get my time management and organizational skills together.

I was hesitant to do this at first but, stepdown has been a gift. I am so much more comfortable now. I can independently take care of 4 surgical stepdown pts, usually at least one on a vent.

Here is the thing that keeps eating me. I was a little insulted to find out that they had hired a new grad in October (before me) with no hospital experience. She is orienting directly in the ICU. She took boards on Friday.

The manager is new to an ICU. The SICU never hired new grads before this year. Do you think she is experimenting with new training because the unit was struggling to keep up with all the newbies? There are four new grads with less than one year, including myself. I am the newest hire.

Or do you think this stepdown orientation is a reflection on me? Since I don't remember ever receiving negative feedback as a UAP at this job, I'm really confused.

love-d-OR · Feb 19, 2008

Sarah_bellum, I though you said she asked you if you wanted to orient into the step-down unit first? Did she say you HAD to? From your discription of events it sounded as if she suggested it and asked if you will feel more comfortable. You were allowed to say no, right? If you feel comfortable with your decision, then don't sweat it. Good luck

lorilou22RN · Feb 19, 2008

Thanx to all that have posted that MS should come before ICU, boy I have been reamed on other posts when I say that ie: you are too "old school", one person told me that with "the nsg shortage like it or not NG's WILL be in the units." I personally think that experience should come before going to the critical care depts. I started MS for 5 years, tele for 3 and ICU the past 3 years. The nurse I am now, vs the nurse I was then is HUGE. Way more able to perceive potentials, and intervene BEFORE emergencies. I am a firm believer that to be a good nurse anywhere you must be proactive not reactive!

On another note I am orientating a new grad (green as grass, not even a tech on the floor). This is her 2nd career so she is around my age late 30's-early 40's. This change seems to be huge for her. Extremely overwhelming, and I do feel for her, yet I am having some issues, and need advice. She has been in orientation 7weeks (total 16), all her classes are completed. She has a good handle on her book knowledge, yet practical application, and putting the pieces together are a struggle. She feels like an idiot, and to be honest I have been frustrated at times with her incessant questions, questions I know that I have covered in the past. Simple things like why do ABG's get deferred to resp, or sent to them if A-line available, why does lab get venous draws. Yest we had a 20 min explanation re: blood cultures x2, her question: why 2 sets (1 from line, 1 peripheral), and why redraw, they were done on Sunday? One day we were tubing this lady, and you know it gets very crowded, noisy etc. I was getting the drugs drawn up, getting ready to push them and she is at my elbow, asking so why are we doing this? I did not have time to answer her questions then, so I didn't, next time I look she is not anywhere, found her eating in the breakroom! Asked why she left, and she stated "it was too crowded, and I didn't understand what was going on." I was furious, what a good learning experience and she leaves.

Anyway (sorry so long), what should I do, do I take a xanax (LOL) before work so I don't get aggravated at her, or is there some other way to help facilitate her understanding? Also, has anyone experience difficulty with orientating older first time nurses vs: young fresh grads. I'm beginning to think that you can't teach old dogs new tricks. Thanks

PS I feel really bad, cause she has cried twice.