Question for the CCRNs

aCRNAhopeful · Apr 2, 2010

Anyone that I've ever talked to that has gone into ICU (or their specialty of choice) as a new grad does not regret it one bit and fully recommends others to do the same if they can. If critical care is what you want, go for it!

WindwardOahuRN, RN · Apr 3, 2010

So, here's the background info. I'm a tech at a large teaching facility and I am one of the few that work with the STAT team. As in, I get called for particularly tricky IVs, help transport ICU patients to CT/MRI and such and follow our stat RNs (who are all CCRNs) to codes and rapid responses. Basically I am there as a go getter and to help them with whatever they need. I am in a unique position as a tech in that I am able to get involved in situations that typically do not involve techs, vents and art lines and swans and balloon pumps are all very familiar to me. I've learned so much working with the RNs. After working with the CCRNs for so long, the idea of working on a Med-Surg floor makes me sigh. I just don't want to do that kind of nursing. I am also a senior nursing student who is made aware daily that being a nurse in ICU involves years of experience. As much as I want to go into ICU I am fully aware that as a new grad, going into an ICU situation would be dangerous. So what I'm wondering is this; how long did you all work on the floors before going into ICU? Any advice? Thanks so much!

I had massive experience before entering ICU.

It is so refreshing to read that a new grad would consider him/her self "dangerous" when entering an ICU situation. So many feel that they are uniquely equipped for such a venture. Pardon my French but---b*******.

Get your initial experience as a floor nurse. Dealing with patients, families, docs----so many important lessons to learn.

BTW---the CCRN designation is basically b******* now, IMHO. Years ago, it meant something. Now? No. I know nurses with the CCRN designation that I would not trust to take care of my dog. And I love my dog.

NeuroNP · Apr 3, 2010

I went straight into the ICU after graduation and I know several nurses who did the same. I do not regret it in the least. I work with several nurses who had the "few years of med-surg experience" and they struggle in the unit. Med-surg and ICU are totally different mindsets. A good ICU will not let you be dangerous. You'll get orientation and there will be other ICU nurses around you to ask questions of.

aCRNAhopeful · Apr 3, 2010

Exactly! I'm a new grad in ICU but I'm still safe. In fact, I ask for the sickest patients if possible. But I have a few conditions to me accepting the really sick ones. Most importantly is that I have a resource person like a supervisor available to me. I ask my supervisor to come in when things are getting unstable to make sure I'm doing everything they would do and am not missing anything. I even ask them to come in when things are stable just to make sure they know what I have going on and could offer advice if needed. I would be completely unhappy in medsurg and in fact I would just plain hate my job. Some new grads are cut out for ICU I don't know why some people can't accept that. It takes someone who has I love of physiology, critical thinking, the occasional adrenaline rush, and most importantly: knows their limitations. (this list is not all inclusive). Before anyone starts slinging "You are dangerous because you are confident" or "You don't know what you don't know" etc. etc., Im not saying I have it mastered and I probably never will, but I do now how to be safe and utilize my resources.

NeuroNP · Apr 3, 2010

I would be completely unhappy in medsurg and in fact I would just plain hate my job. Some new grads are cut out for ICU I don't know why some people can't accept that. It takes someone who has I love of physiology, critical thinking, the occasional adrenaline rush, and most importantly: knows their limitations. (this list is not all inclusive).know" etc. etc., Im not saying I have it mastered and I probably never will, but I do now how to be safe and utilize my resources.

I've said several times, if it was required for me to work med-surg fist, I wouldn't have gone to nursing school. Nothing against med-surg and med-surg nurses. I've floated to med-surg before and actually learned a lot from med-surg nurses with years of experience, but it's not my cup-o-tea. And it is totally different.

You're right, not EVERY new grad is cut out to go straight into the unit. I worked as a tech in a BUSY Level I ED for two years before school. I've got time management DOWN! :-) Many nights I find myself totally caught up way before my fellow new grads (and even some experienced nurses) with similar loads. Initially, I worried that I was missing something so I asked another nurse with years of experience and she told me that I was just very well organized. I've had several nurses work with me a while and find out later how much experience I've got tell me they assumed I'd been doing this for years (I'm not sure if that means I look old...:-)

Also, you're right about the physiology and critical thinking. I'm precepting a senior nursing student right now and he keeps saying, "why don't they teach that in nursing school?" whenever I go over some advanced physiology. I say, "because they have a ton of stuff to cover and this level of depth isn't necessary for most nurses." But, some people really love that (I do and he does too) and go over and above to learn it and understand it. When I worked in the ED, I took every opportunity to get residents, fellows and attendings to teach me stuff LIKE THEY WERE TEACHING MED STUDENTS. Yes, I had to go look a bunch of stuff up and read a lot on my own, but I understand that stuff better than most nurses with my experience.

akj777 · Apr 3, 2010

LOL, it's funny you say that. One of my CCRN has been one for about 30 years and she said the same thing the other day. "It used to mean something...sigh."

up-n-atom · Apr 4, 2010

I am new nurse with just under a year in ICU, I had similar experience or maybe even less than akj777 when I started, its been tough, but I'm so glad I started in ICU, I love it. What helped me the most was a great preceptor and a great orientation, I still ask lots and lots of questions, I have spent plenty of time on my days off looking up what I don't understand. Also, the ICU is hard work, I always come to work ready to work...this seems obvious but sometimes I think some nurses transferred from the med-surg floors thinking 1-2 patients is better than 6-8 patients. Good luck akj77 you can do it!

allnurses Guide · Apr 6, 2010

4 months med/surg/orthopedics.. then I did an ICU rotation in my grad year and never left!

Tsiasn · Apr 6, 2010

Yeah, I really don't understand why you think it'd be dangerous.

I'm a new grad just off orientation and although I'm not getting the most critical pt.s on the floor, I am being built up to that point with one or two gtts, and the occasional CABx1 or mini valve (:)). Yes, they're babying me but I am new, what should I expect? What WOULD be dangerous is if they gave you a post-op bleeding pt. whose going down your first day off orientation, but that would say more about your unit than you....

I felt like you but opposite. I worked in Med-Surg as a tech for 2 years prior to getting this nursing job and couldn't really see myself entering that specialty.. you can do it if you really want it!!!! I think the hardest part would be actually *getting* a job in the ICU, but you sound like a fantastic candidate.

Dinith88 · Apr 6, 2010

New grads can be ok going into ICU (or any other department). There's just a bigger (much bigger) learning curve than with experienced nurses who migrate to ICU.

And regardless...even when a new -grad becomes a 1 year, 2 year, or even a 3 year nurse....the experienced ICU nurses can pick them out fairly quickly (not saying they suck...just that their relative inexperience can be obvious). There is NOTHING more valuable than experience. ICU 'culture' is only a fraction of what nursing is...and this core nursing-knowledge developes wherever you work....not just in critical-care...(the ICU stuff is the same as any other specialty)

Throw good grades, test-scores, ambition, and everything else out. EXperience trumps them all. (well...as long as you're not a complete moron)... This is why any ICU that is run well (i repeat 'that is run well') will ALWAYS prefer experience over ambition...but...obviously, circumstances can and do dictate otherwise.

NeuroNP · Apr 6, 2010

And regardless...even when a new -grad becomes a 1 year, 2 year, or even a 3 year nurse....the experienced ICU nurses can pick them out fairly quickly (not saying they suck...just that their relative inexperience can be obvious). There is NOTHING more valuable than experience. ICU 'culture' is only a fraction of what nursing is...and this core nursing-knowledge developes wherever you work....not just in critical-care...(the ICU stuff is the same as any other specialty)
Throw good grades, test-scores, ambition, and everything else out. EXperience trumps them all. (well...as long as you're not a complete moron)... This is why any ICU that is run well (i repeat 'that is run well') will ALWAYS prefer experience over ambition...but...obviously, circumstances can and do dictate otherwise.

I've been a nurse about a year, all of it in the ICU. Experienced nurses who meet me and work with me tell me all the time that they assumed I had years of experience. One night, I was floating to a different unit and worked with two experienced nurses. This very subject came up and for several hours, they went on and on about how new grads don't know anything and they shouldn't come straight into the ICU. All the while I kept smiling inside. Later, another nurse came over to visit on a break. These two that I'd been working with introduced me and went on and on about how good I was and how they wanted to talk me into coming on full time. They said it was obvious I'd "been around." I really wanted one of them to ask me, "so how long HAVE you been a nurse? " :-)

I've never had anyone peg me for a recent grad. Experience is certainly important, but in my opinion, nursing places far too much importance on it. Experience is not created equal. I've worked with nurses who have "years of ICU experience" but it is all from a smaller ICU in a community setting. Compare that to someone who worked for a year or two in a busy, high acuity academic setting. The "less experienced nurse" will often be able to run circles around the other one.

Also, I think education certainly plays a big role. I graduated from a 2 year program and I work with several people who graduated from a particular 4 year program. Those 4 year new grads know WAY more than most of the people I graduated with. Am I saying 4 year programs are better than 2? No, just that THIS 4 year program is better than THIS 2 year one.

There are so many variables that go into this. You can't just boil it down to how many years it's been since you graduated.

I disagree about the steeper learning curve. I touched on this earlier, but I've seen many nurses come to the unit from years of experience on the floor or telly and flounder. Almost without exception, the nurses in the ICUs I work in that are the best are the ones who started there. I work with several nurses who have YEARS of floor experience, who came to the ICU before I did and so have more ICU experience than I do, who still seek me out to ask questions.

I'm not at all trying to toot my own horn or say "I'm so great." In fact, I work with several new grads with less than a year experience who I could say the exact same thing about. (and others who have no business VISTING the ICU, much less working there...what I'm saying is, it's a very individual thing.) Orientation matters as well. In the CTICU where I work part time, new grads get 6 months of orientation before they're on their own, combine that with classes to go over all the stuff they may have barely touched on in nursing school (after all, we've got to work Jean Watson in, so sometimes advanced hemodynamics have to go :-). And experienced preceptors have told me that in those 6 months, they only have to teach the right way, they don't have to "unlearn" the things that experienced nurses spent years learning.

Of course, this is only my "experience"...I've been around nursing for years before going to nursing school and I've heard this same debate over and over again. No amount of arguing on a Internet forum is going to change people's mind. We can agree to disagree. But, to the OP, if you want to work in the ICU, work in the ICU. Don't let anyone tell you you can't go straight in or that any good unit wouldn't take you as a new grad. My "experience" says otherwise.