New Graduates In The Icu?

MarkHammerschmidt · Apr 10, 2008

I can't get past the feeling that a new grad has enough on their plate just learning the basics of practice, without the added stress of the ICU. There are lots of pros and cons to this, lots of opinions, and sure, some people do fine. But I think there's so much to learn to start with... people consistently underestimate the difficulty of the job, both technically and emotionally. I tell the new kids that it's "right up there with nuclear submarine", which is quite true - and they always laugh, as though it couldn't possibly be so. It is. Doesn't mean they can't do it - but I was never sorry I worked the floors first.

TX_ICU_RN · Apr 10, 2008

:balloons:
I am not sure I understand your post. Our nursing leadership team has decided to require one year of med/surg before any cross-training. I feel strongly about this in our facility because our ICU nurses are responsible for their own vents, we don't have Resp Therapy. Also, the care of med/surg patients really does build experience and confidence. I wish you the best though. Critical care nurse for 25 years. :rotfl:

I am usually all for new grads going to the ICU if they have a unit with a good internship program. However, in your hospital, I would not want anyone to go work in the ICU without at least one year of med-surg experience. I can't imagine not having RT to manage the vents!

neko11111 · Apr 16, 2008

I honestly think it depends on the individual. Some people have that certain drive, whereas others don't. Everyone is different. They say med/surg is more task oriented, whereas critical care requires more pathophysiology and critical thinking.

I don't believe it to be fair to judge someone on there amount of experience alone. I started straight out of school in a CCU unit - and thrive on it. I learn something new every night that I work and apply that knowledge. I also know enough to ask for help and keep my eyes open for every learning opportunity available. Also, some of the old school nurses ask questions about what they are teaching these days.... I've helped some with tricks of the trade when it comes to starting iv's...

If I had to start out in med/surg, I honestly would have shoved a pencil in my eyeball a long time ago and quit nursing all together. I knew that critical care/trauma was my calling,, the very first day I stepped foot on the ICU floors during school. It has been my drive, and I plan to advance my knowledge in this area for many years to come!

So- please, look at the individual before blowing them off just because they lack years of experience. And that's my :twocents:

sasparilla · Apr 16, 2008

I went from straight out of school to the MICU at our hospital, had a 12 week orientation plus a year of critical care class and have spent the last year working nights. I wouldn't have traded that experience for anything. It's what you make of it.

If you are fine with constructive criticism, know that it's a good thing to ask questions when your aren't 100% sure, get in on as many different experiences as possible and always do your best, the IMO you can make it in the ICU straight from school. I didn't have the greatest preceptor and have realized once I was on my own that in some ways I have been at a disadvantage so I took it upon my myself to learn what I didn't get taught. I found the nurses who I respect and ask them questions when I don't understand something. And they are ok with that, they know I am working on making myself a better nurse. I didn't have much experience, I've been a lab tech, worked as a unit secretary for a year before starting school and did a few months of NT before graduation.

But I am a person who thrives on activity and like to work my brain, I like excitement. Plus a group of 6 of us new grads all started around the same time and I can tell you, we are a team! Most of the nurses in our unit don't hesitate to help and on nights we are short (often enough), even the charge nurses will take patients. Has it been hard, yes. There are still days that I feel dumb as a stick. It just makes me work harder.

Like others have said, I think if I'd had to spend time in M/S I probably would end up hating nursing, it's just not for me and I know that. I have a lot of respect for the M/S nurses, their job is HARD with the nursing shortage in our hospital and sometimes having to take a large number of patients. I like knowing that I know my patients, their histories and their families. I'm right there watching over them. I think a lot of time in M/S, you don't have time to do that, you are too busy getting your 40+ meds each for your 6 (or more) patients, all in an hours time plus deal with all the patient and family requests for another blanket, a coke, free food for their family member, etc. Call me a bad nurse, but that would just frustrate me, THAT is what would burn me out.

So take a good look at your hospital and how well they support new grads, make sure you won't just be thrown to the wolves once your orientation is over. If you are satisfied that you will be in a good place, then go for it.

sarahrain · Apr 16, 2008

It has been 8 months I had been working in ICU with nil surgical and medical experience. I find that from ICU, I learnt how to detect subtle changes and be able to save the patient from deteriorating. And get a chance to practise ACLS. I am glad that I don't have to go thru med-surg ward.

I find with my experience in the ICU, I would be able to handle any emergency more effectively if I was scheduled to work in med or surg ward one day.

ddoosier · Apr 17, 2008

Precepting is a huge responsibility but does not require Xanax...(I am assuming that you were being humorus. ). Perhaps you may consider that your preceptee might be reacting to your negativity....Just a thought that has been invoked via experinece. 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.

ddoosier · Apr 17, 2008

Sorry..I'm new at posting I am replying to Lori. My initial response had ended with her preceptee reacting to her negativity. That being said, I did not have an overall good experience during my preceptorship. My preceptor is an excellent ICU RN. She was very irritated with my "redundant questions" and didn't make an effort to hide her frustration. As a result, I felt uncomfortable asking her questions and delegating to her. Because of her attitude and frustration, she in many aspects hindered my learning experience and my overall experience as a NG.

Precepting is a huge responsibility but does not require Xanax...(I am assuming that you were being humorus. ). Perhaps you may consider that your preceptee might be reacting to your negativity....Just a thought that has been invoked via experinece. 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.

APNgonnabe · Apr 17, 2008

I am a 24yo who went straight into ICU (after 3month on rotating MS which is part of or "residency"). While I do see the value of MS experience and for the most part agree with the points that people have made I do feel that the right individuals are able to be very good ICU nurses w/ the right orientation (which I believe I got). I thank everyone for their opinions, however, I do worry that a message may be being sent to our new grads that they are not good/experienced enough to be starting in the ICU and whether people like it or not they need the support and leadership of their fellow nurses new and experienced. It is because of every nurse no matter their background or experience level that other nurses improve. Quick side bar: to the postee w/ the newgrad who is clueless...Im sorry I know it's frustrating and can color your opinion for years to come.

NursKris82 · Apr 17, 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!

Of course you're a better nurse now- you've been a nurse for 11 or so years.

It is true that the shoratage is such that new grads are going to be in ICU.

I agree with some of the others that if the orientation is good and the person is right for the area and willing to do the work to learn they can do fine. I have a friend of mine who started in PICU as a new grad and she says it's the best way to go. She said ICU really teaches you how to think critically. She's been a PICU nurse for 10 years now and loves it. I think it just too hard to make generalizations. I see points on both sides, but people are different. Some new grads can shine in ICU and some more experiences Med- Surg nurses can flop and visa versa. Like I said, it's just too hard to make a broad generalization.

SpookyCat, BSN, RN · Apr 17, 2008

Hi all!

I am a junior nursing student at a private 4 year school. I was wondering if I am just being fed a load of bull in that b/c I am in my particular program I will be eligible to work in an ICU as a new grad? I have heard conflicting opinions in this.

I also was just hired at a large inner city teaching hospital in the SICU as an intern with a preceptor for 10 weeks this summer. Am I jumping into a frying pan? Will I learn enough to be eligible to work there post-grad? Is there anything in particular that I need to know/review before I start? I was thinking of buying any critical care books in advance b/c we will be having those classes next fall. Good idea or not? I understand that this will probably be tough but I would like to start there w/o making a complete fool of myself. What is the main difference between the average day of a med/surg nurse and one that is in a critical care or more specifically SICU? Any help/tips/advice in this matter is much appreciated.

Thank you!

Spooky Cat :uhoh3:

Pediatric Critical Care Columnist · Apr 17, 2008

The success of a new grad in an ICU setting depends on several factors. First and perhaps most important is the selection of the new grad for hire. Some people are just not cut out to work in an ICU, regardless of how many years they've been nursing and others seem to be born for it. Second is the design and implementation of the orientation process. Many units require new hires to attend a formal critical care course, which is an excellent place to start. Having said that though, it's easier to grasp the concepts taught in such a course if one already has some experience. If the didactic portion of the orientation is designed to provide the new ICU nurse with a strong foundation of the basics of critical care, and is broken up to allow the new nurse to apply the things s/he's learned before adding new and more complex information the nurse will have a better chance of succeeding. The clinical portion of the orientation must be geared to the learning needs of the new nurse and not to the needs of the unit or the boredom threshold of the preceptor.

If you can bring all those features together, the new grad will flourish. If even one element is missing, the odds of a good outcome drop significantly.

leosrain, BSN, RN · Apr 18, 2008

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?

Hey there! I'm just orienting to the ICU currently after about 2 years on med-surg. I just wanted to add to the comment above.

There is an UNBELIEVABLE amount of information thrown at new ICU employees. I'm noticing that there have been things I have had to ask a couple times before getting a full grasp.

There have been a couple times where I asked a question, received the answer, fully understood the answer....and then a couple days later needed to ask the same question again in order to reinforce my learning.

Hearing and understanding does not equal memorization.

Here's one anecdote: The other day I stood there staring at the monitor at the beginning of my shift. I started laughing out loud. My preceptor asked me what I was laughing at. I told him, "I've printed out an ECG strip at least 20 times...and now I'm sitting here drawing a blank...I can't remember how to do it!!"

We had a good laugh, and I felt silly when I was reminded that there's a giant "graph" button on the front of the machine.

Good nurses focuses learning resources for information...not on memorizing every last bit of detail. Better nurses than me still have to look up things that are fairly simple just to make sure...