RNs who are/were ICU new grads - what was your orientation like?

[Unesdala]

Hi all! I'm a new grad who started in the SICU last fall. Basically, during my six month orientation, I'm working with my preceptor and learning on the fly with no formal educational situations. I've suggested doing the AACN Essentials of Critical Care Nursing course, but have been told they don't have the budget to cover the costs of the course.

All in all, I feel like I'm being set up for dangerous pratice. I'm learning tasks but I'm not getting a full understanding of critical care, so I'm nervous about being on my own in the future.

I love critical care and I absolutely think that new grads can succeed in ICUs.

I'm just wondering how we can best facilitate that success. How have all of you been trained? What did you like or dislike about your critical care orientations? What would your suggestions be for an ideal training program?

[JulesCCRN]

Our new grads and new hires to our ICU have to take the AACN course and it has been very helpful. I was on orientation for about 3 months and had to know my rhythms and drips before that time was up. But, I had several years of nursing experience. But, hands on experience was the greatest tool. I worked with experienced co-workers too and they helped and taught me a lot. I never felt alone. Good luck. You will do well because you want to be successful!

[mcco5665]

I am a new grad and am currently orienting in the NICU. Our orientation is 12 weeks. When I first started it appeared that my orientation was going to be very organized. Now that I am almost done I can honestly say it was anything but. I am supposed to be going off on my own next week and I haven't even met again with my educator. I had several different preceptors and some of them didn't even want to precept. I feel that my orientation was not good and that there is still so much for me to learn. I started on my unit while we were very busy and I am not sure if this is why no one has really paid attention to me or closely followed my training. I am very nervous to go out on my own.

[babyNP., APRN]

I work at a large level IIIC NICU that does surgery and ECMO. We got 20 weeks of orientation and usually had a 4 hour class once a week with three exams. Since our NICU keeps its own step-down within it, Phase 1 was 5 weeks doing stable infants on things like nasal cannula, Phase 2 was 5 weeks doing stable ventilators, etc, and Phase 3 was 10 weeks with critical infants on ECMO, oscillators, nitric, vasopressors, bedside surgery, etc.

Our lecturers were doctors, NNPs, experienced bedside nurses, dietitians, physical/occupational therapy, social work, etc etc. Additionally we received our NRP and STABLE certifications during the orientation.

If we needed more time, we got a couple more weeks.

[limaRN, BSN, RN]

I had a 6 month orientation in the ICU/CVICU that I work in now as a new grad several years ago. I did not have any classroom training but did take the ECCO course and I thought it was ok. Some modules were better than others. I did a lot of self studying- the AACN procedure manual, the essentials of critical care book, bojar's cardiac surgery book, and the AACN website has excellent articles and free CEUs for members. Studying for the CCRN helped review a lot of info for me too.

[missnurse01, MSN, RN]

I, and many nurses older than I am, never had a real orientation. You shadowed and did on the job training basically. There were no classes or formalized instruction. You learned as you go.

even if you end up in this situation, and they won't give you more orientation, and you decide to stay at this facility, then you will forever anyways be learning things on your own. I would read the aacn procedure manual during down time, read journal articles, and be a fly on the wall in any room where that pt was sicker than mine or something I hadn't seen was going on. I also paid out of pocked for a ccrn review class which was great and wish I had done it a long time ago. Read a ccrn review book, tons of info, got mine at the library.

good luck in trying to get more orientation so you can feel comfortable!

[Dpeterson777]

I am working as a new grad in a busy ER with many ICU pts that have to be held while waiting for transger to the unit. I remember feeling SO overwhelmed during my first 4 months. I remember crying some days, laughing some, and feeling completely like an idiot some days. TODAY, I am 6 months in, and I will say, IT IS SO MUCH BETTER. You will be amazed at how much more you will feel "in your skin" after 6 months. Something happens to where you are now anticipating orders, understanding labs, v/s, and pt symptoms. I cant really explain how this transition happens, BUT, it does. I felt like quitting some days because I felt so under-prepared. Once you get the "groove" of your unit and get the basics down, you will feel so much better! Once you don't have to think about what to do next and start to feel more natural, you will feel better. I've heard from most in my unit that it takes ATLEAST a year to feel just comfortable and not dangerous!! Just remember to ask for help when needed and you will be fine!

[Unesdala]

Thank you for your comments and advice, everyone! It helps to hear of others' experiences... helps to put things in perspective. I really appreciate you all taking the time to share your thoughts!

[ICURN19]

If you do not feel that you are comfortable, talk to your supervisor. If you do not get adequate training then you may have to consider working med-surg first. I'm not saying that you won't be able to do the work but if you are not receiving the training you feel like you need then you need to speak with someone. It's your license that is on the line, not anyone else's. Sometimes preceptors forget that they already know the information when they are training.