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And you say this based on what? Not to mention that ICUs are not always "the sickest of the sick." New grads should not be hired into level 1, extremely high acuity ICUs the vast majority of the time, but the vast majority of ICUs are not that. Even still, my best friend started at a level 1 ICU as a new grad and did perfectly fine. My preceptor/charge nurse and our assistant manager both started on our unit. Titrating multiple vasoactive gtts, vent management, CRRT, deep understanding of pathologies, etc. are difficult concepts to grasp at first but with proper orientation are no more vexing than any other skill. Many ICUs won't get more than a few truly high acuity patients at a time. Most deathly ill patients are transferred to a level 1 trauma center, and those aren't the only ICU jobs OP can apply for. Our surgical stepdown unit is the same acuity as the surgical ICU at my old job. Sure, it was a big learning curve but me and my colleagues achieved a fairly comprehensive understanding of these skills within a few months. You either underestimate yourself and your peers, or overestimate how difficult critical care nursing is. Taking care of two ICU patients is not remotely the same as taking care of 7 floor patients. At most you can gain some skills like inserting NG tubes or starting IVs, but few of my colleagues are great with IVs and placing NG tubes is basically a reflex by, say, the third time. If you are willing to learn then you should be able to knock out tons of these by the time you're off orientation.

You apply. I don't understand these kind of threads I see sometimes. There is no magic formula or secret to it. Even getting your ACLS or any other certification besides BLS is not strictly necessary, might help a little bit but many people wait and let the hospital pay for it instead. I went from a year of level 3 ER experience to a level 1 inner-city trauma ICU---I applied and interviewed. Some of my coworkers have 4 months of med-surg experience. Several promising ones were hired as new grads. ICUs throughout the country hire new grads all the time, some even preferring them because they don't have to alter a med/surg or ER mentality to an ICU one. The myth that you need experience to get into the ICU is most likely propagated by med/surg nurses and the teachers in nursing schools (generally med/surg nurses as well) who say you need to get a "good med/surg foundation" before going into a specialty---more like their floor is understaffed with high turnover so they try to convince new grads to apply. It's nonsense. Apply, interview, get a job.

So now you are not allowed to be a nurse and "blatantly sexy"? Let's just go back to wearing white caps and dresses and stockings. Posting a revealing photo of yourself at a party is "hard to reconcile with a responsible nurse in scrubs"? There is literally no correlation between how virtuous you are and how good of a nurse you are. Half of the nurses on my unit are single 20-somethings that drink and party at least once a week, and when a fresh trauma with his legs amputated receiving massive transfusion rolls up there is absolutely no difference between them and those who don't. We are nurses, not politicians or nuns. We get judged on such a high pedestal but god forbid we are not completely tolerant and understanding of others like screaming, ridiculously entitled IV drug users, those who abuse the ER 365 days a year, violent criminals, the Muslim family patriarch who refuses to acknowledge a female nurse, or the dialysis patient that refuses to go to dialysis. In some areas nurses are little more than servants, unable to utter a word in their defense without management reprimanding them even though a family member screams at them because no one came to bring her mom ice while a patient down the hall is being coded. Nurses are people, if a girl wants to post a "side boobage" on facebook then who cares? Is this somehow worse than them posting a bikini photo? Am I not allowed to post a shirtless photo of me on the beach without repercussion because that's "blatantly sexy"? God forbid anyone sees that I have a large chest tattoo, that should be grounds for firing as well. How utterly ridiculous, this stupid standard we are expected to uphold in our personal lives in light of the poor staffing, ridiculous patient demands, and all the other problems of nursing. Good riddance to any employer who fires me because I curse on a facebook post---not a place I want to work and there are thousand hospitals in this country seeking experienced nurses. So many nurses are anxiety-ridden messes terrified of being fired, fearing their license will be taken away because they didn't scrub the hub for fifteen seconds. It's absurd. Posting HIPAA violations and things like that are understandable to punish, of course.

Are you sure she actually had asystole? I never trust any of those monitors, check for the pulse if you're going to call it asystole. Sounds like your patient was snowed for a bit by pain medication, it happens all the time. The only relevant vital sign here would be blood pressure if you're giving a drug w/ histamine release like morphine, and oxygen saturation. I assume you took vital signs during her episode? If both were fine, I highly doubt your relatively stable patient went into cardiac arrest just because you gave her some narcotics.

People are able to hate bedside nursing for whatever reason they want. Spare us your first year nursing student holier-than-thou attitude on the matter. People become nurses to take care of people, they hate being nurses because of unsafe ratios, ungrateful patients, ridiculous management initiatives, etc. For this we get paid the same or less than our friends who make Excel spreadsheets for finance companies. I see so many people on this forum that are extremely easily offended by some other people's attitudes in nursing. There is also a lot of complaining and dark humor especially in high acuity fields, and especially nursing students seem soooo offended by it, but when push comes to shove those nurses are still the first ones to hop on a code blue or advocate for their patient. Spare us the delicate sensibilities unless the nurse that has offended you is also just a bad nurse. Workloads being high and stressful is a 100% acceptable reason to complain.

Thank you about the inotrope comment, I wasn't completely aware of that and will look into it. I was moreso joking about the OR numbers thing to an extent. Our trauma residents have a constant battle with OR about this. While I can see the advantage of this, it's not like we have such a high PEEP for no reason, especially with ARDS/lung trauma patients. They come back from the OR after having their PEEP decreased and they've clearly derecruited and their ABG shows they're backsliding. You've mitigated one potential cause of morbidity but increased another, especially since we would have optimally fixed any volume depletion before the patient goes to the OR anyways. I suppose anesthesia's priority is to make sure the surgery goes well, doesn't mean they haven't potentially caused more harm in the long run. Still, I won't pretend to be an expert on vent management v. anesthesia when not even our own doctors see eye to eye on this. In the trauma ICU I naturally support my trauma doctors over anesthesia.

Not to be rude but did you just say 1:3 ratio is inadequate for telemetry patients? Even the California union-mandated ratios call for 1:4 or 1:5. No hospital can afford to literally double their nursing staff to give everyone that easy of an assignment. If orientees on my unit can safely take a CRRT patient on multiple pressors along with another vented patient on multiple pressors, insulin drips, etc. then you can handle more than 1:2 for telemetry patients. And I am completely in favor of eliminating nurses eating their young/inter-nurse fighting, promoting safe staffing ratios, etc. On the subject of Press Gainey and other surveys, I could care less. I provide good care to patients, am respectful to family, am always willing to explain things/provide education, so on. If a patient has unreasonable requests I will inform them how and why their request is unreasonable in a calm manner If they somehow still give me a bad survey I don't even give it a first thought, let alone a second. If management wants to slap me on the wrist I could care less. I've worked the floor, ED, trauma ICU, and have seen tons of hissy fits to me and my colleagues. Never have I seen an actual nurse punished for it. Management can worry about their Press Gainey scores, I don't care.

We utilize the Flotrac in my STICU as an easy method of determining hemodynamics just using an art line. For instance we can determine fluid deficits/response to fluid challenges using SVV or CVP (though I've been told recent studies show CVP is an unreliable indicator) to see if we have a preload problem, or SVRI as an indicator of an afterload problem requiring something like pressor support. To simplify, say my patient's hypotensive. I can look at the SVV/CVP, give some fluids, and if we see the numbers improve we know the patient will benefit from fluid resuscitation. If the SVRI is low, we know that the patient has an issue with vasodilation; if the fluid challenge doesn't help then a vasopressor will tighten them up and improve BP. No use throwing fluid into a patient in a vasodilated shock state, it'll just leak out into edema. In a cardiac patient we could see stroke volume/cardiac output and know we might want to correct a contractility issue with a positive inotrope like dopamine or dobutamine. Supposedly some common things can make the numbers off such as an elevated PEEP or APRV, both of which are common in the severe trauma population. Our OR switches patients to a lower PEEP or SIMV whenever they go down, I imagine because they hook patients up to the Flotrac while they're down there. Seems like a good practice to me especially in a vascular surgery (well, you know, my patient derecruits like mad but at least their OR numbers look good).