New RN Grads in the ICU

HealingHands327 · Nov 3, 2007

All my instructors say that at least 1 yr in med surg would help a lot in your experience in ICU. Not to say it's impossible to start at ICU (hospitals generally will train), but i would say it is at least safer for your license. heh. Since you are interested in ICU is it b/c you are interested in CRNA school?

good luck.

Should new RN Grads be alowed to enter the ICU right after passing the NCLEX, or is more nursing experience needed.

deeDawntee, RN · Nov 3, 2007

This is a tough question. There is no reason that a bright new grad can't succeed in the ICU with a good orientation, preceptorship etc.

I want to warn you about something that not a lot of people think about before they start in ICU.

About 3 months after I started in the ICU, 2 new grads started, (after about 18 months, one is doing very well and the other one is still struggling). I have spoken to both of them and by far the hardest part for them both was the attitude of some of the regular staff who felt they had NO business being a new grad in the ICU. And, I want to tell you, we were set-up quite well to accept new grads, they had willing preceptors and extended orientations.

I can really see both sides of this issue. I feel for the new grads, they have had it tough. But, I also know that the more experienced nurses want to know that they have coworkers who can watch their backs when a patient is going bad. They want to know they have coworkers who they can count on.

So, if you are really wanting to start in the ICU. I would say, go for it, but be prepared for the attitude of some of the nurses. Also, as soon as you start feeling on top of your workload, be the one who helps your coworkers with the occasional turn, etc. It will help ease fears that you are a part of the team; that you are an asset and not a liability. Also, be fast to forgive, you will need to, because you will need to prove yourself, I hate to say. Good luck, you can do it with the right attitude.

llg, PhD, RN · Nov 3, 2007

It depends on the new grad ... and on the specific ICU.

Some new grads are ready for an ICU environment. Some have had health care experience prior to entering nursing school and some take preceptorships, electives, etc. that help them prepare to enter an ICU right after graduation. Other new grads are not as well prepared and struggle with the high level demands of the ICU.

Some ICU's regularly hire new grads and have special orientation and mentoring programs that can meet the special needs of the new grad. The staff is used to working with new grads and everyone has reasonable expectations for the performance level of the new grads. Other ICU's rarely hire new grads and may have unrealistic expectations and may not have the ability to meet the special needs of the new grads.

So ... the correct answer to the original question really is, "It depends." If you are considering a job in an ICU as a new grad, you need to do a very thorough assessment of both yourself and the unit. Most important, that assessment has to be brutally honest. You can't allow your hopes and dreams to distort your assessment of the specific situation.

Good luck to you all!

WTTsMom · Nov 3, 2007

Hi, my name is Cynthia and I'm graduating from school as a RN in December I just finished my ICU clinical and I also love ICU!!! I think I could handle the high stress of the unit but I'm worried because I lack A LOT of skills that I'm sure you need in the ICU. For example, I've only started a few IV's, only suctioned once, ect, ect... I've talked to a couple of nurses and they informed me that I would get quite a bit experience in orientation but I'm wondering if I'll get enough. I''m considering med-surg nursing for a year just to get myself prepared but my heart is in the ICU.

Please reply if you started ICU right out of school and let me know you handled developing skills. Would you recommend it? Or would you recommend going to med-surg first?

Thanks,

Cynthia

SICU Queen · Nov 3, 2007

We take new grads into our ICU and they do just fine... but we have a dedicated educator and an in-depth orientation program, as well as some excellent preceptors. None of our nurses give attitude to the newbies - in fact, we all keep a "motherly" eye on them when they're fresh out of orientation and are taking patients on their own. We want them to learn and be successful.

If you want to work ICU, go for it. Be sure, however, to find one with an extensive orientation program, and if possible, talk to some of the nurses that went there as new grads and find out how their experience was.

And BTW, new grads DO NOT, DO NOT, DO NOT need to go to Med-Surg for a year first!!!! That is a DIFFERENT SPECIALTY!!!! :nono:

medchick · Nov 3, 2007

I started in a NICU right out of school and have been doing very well. I have been there almost a year now and love it. I had a great orientation and the unit is giving residency classes to the new NICU nurses (there are 5 of us). It has been a great experience for me. I don't think I could ever do adult nursing now that i have done this. Good luck to you.

RNperdiem, RN · Nov 3, 2007

I once had a manager tell me that she places new grads in units/shifts where they will find the most support to succeed. She said the night shift in a particular unit had a more welcoming environment that could support new grads. The day nurses were more agressive, so the manager avoided hiring new grads for that shift.

A new grad will do well in a unit staffed by a stable core of experienced nurses who work well together. Stay away from and ICU staffed by a patchwork of new grads, floaters, per diems, agency nurses, and a few overburdened senior nurses.

GregRN · Nov 4, 2007

there is no reason to think a person can't be successful going straight from school to the icu. i did it in a high-acuity micu, then transferred to a high-acuity sicu 9 months later. med/surg nursing if far, far different than icu nursing: the focus is different, the goal is different, the skills are different...everything is different. for someone who wants to do icu nursing i really don't think med/surg prepares you all that well for the icu. in fact, i have seen more people struggle moving from floor nursing to the icu than i have seen new grads transition to the icu.

i've posted this a few times before but these are my thoughts on going to the icu as a new grad, some of the things i observed and experienced. just a few things to think about:

there are many variables that need to come together in order to go straight into the icu out of school and be successful. some of them have to do with the person, some have to do with the hospital and/or unit you will work. first, is the icu where you really want to be? are you aggressive/assertive enough to move at that pace and not get pushed aside when things turn south? do you work better getting to know 1-2 patients very well and at a deep level, vs. 5-8 patients on the surface? do you like the detail involved in putting together the puzzle of an icu patient? when the fit hits the shan and your patient crashes, do you want to be at the forefront in getting them stable again or would you rather let someone take care of the crisis and then you take the patient from there? can you navigate the delicate waters of family members' anger and anxiety when their loved one becomes acutely ill and they have nowhere else to place that energy except on the nurse? are you prepared to handle/learn end of life issues, both from the patient's perspective and their family's? those are just a few things to think about. if you answered "yes" to those, then the second part becomes the most important.

secondly, does the hospital where you are considering going into the icu have a track record for successfully placing new grads in the icu? what is their training program like? how long? are you 1:1 with a preceptor? does that person have a successful track record as well? what resources are available to you as a new grad icu nurse, i.e., education and training departments in the hospital, cns's, access to doc's, resource books and material, computer applications and training, hand's on education, etc? how acute is the facility in which you will be working? how long is training before you will be expected to work independently? what is the culture like on the unit in which you will be working? are they receptive to new grads or would they rather beat them up for a bit to see if they can "make it"? when working independently, is the unit very helpful to new grads just off orientation or do they give the attitude of "sorry, you're on your own now"?

i've seen very smart, driven and capable people fail miserably going straight to the icu because the facility in which they were working was not adequately set up to take on new grads. the system failed them and no matter who was placed there, it's likely they would have failed as well. likewise, i've seen people who were not quite ready for the icu get through a very good training program, only to decide later that the icu wasn't quite right for them. where you fall in the middle of all this, and the facility in which you work, will likely predict your success in going directly to the icu from school.

sunspotmia · Dec 3, 2010

No I wasn't interested in CRNA school I just wanted the ICU at the time and wondered if I could handle it right out of nursing school as some of the other new grads at the time had, but it looks like things have changed a lot in the last few years LOL.

sunnycalifRN · Dec 3, 2010

As several posters have said, it depends on the ICU and it depends on the new grad. We only will hire new grads that have done their nursing school preceptorship in our unit because we have seen them "in action", so to speak.

We have a 3 month-long orientation that can be extended, if necessary. In the 5 years that I've been in ICU, there have only been 2 new grads who resigned/transferred (out of 14 total). In both cases, they did not like the stress level. The one med-surg transfer into ICU did fine but required a 6 month orientation (problems with prioritization).