Should new grads start in ICU?

hiddencatRN, BSN, RN · Feb 12, 2011

I have heard many nurses say "new grads should get at least 1 year med-surg experience". On the other hand, I have had some say that if a new grad has a good orientation and education they can succeed on an ICU.
I've always been interested in working on an ICU. I feel it's a bigger challenge and would push me more.
Did any of you start in the ICU as a new grad and wish you didn't? Any good stories from being a new grad in the ICU?
I'm starting to feel discouraged from achieving my goals. I would like to go to CRNA school one day and it seems like it's going to be difficult to get the experience I need.

I think you should really think about how you handle stressful situations and your learning style. Starting in a specialty like ICU will be very challenging, but if you're someone who gets motivated by challenges, that might be a great thing for you.

I have a few friends who are starting in ICUs and a few of my classmates are starting in emergency departments. I think the key is finding a place that will really invest in you and train you well.

diprifan · Feb 12, 2011

"I feel it's a bigger challenge and would push me more." - Please work on a telemetry floor when you have 3 discharges and 2 admissions in an 8hr shift, and tell me if that wouldn't "push" you.

I wish I did ICU out of school... correction, I thought I should have done critical care right out of school... I had good grades and did well in clinical... But I've come to the conclusion that I'm really glad I didn't. I've learned quite a bit, and I am no where near the level of self autonomy to do ICU. I need to build some skills before I move on.

But hey, if the opportunity arises, take it.

herowneulogy, BSN, RN · Feb 12, 2011

I feel the same way as the OP. Desperately want to start in ER/ICU, but nobody is willing to give a new grad a chance. It's depressing really...

This one hospital in the area that hires new grads into the OR as scrub nurses, but even with the economy being the way it is, I'd never take that job starting out.

shoegalRN, RN · Feb 12, 2011

I started off in an ICU in a level one trauma center and I wish I didnt.

In fact, I had one week left on my orientation and I switched to the ER and been there ever since. I also work Stepdown from time to time.

I would have been successful in the ICU had I had a better orientation. I had no less than 8 preceptors. It was horrible!

Then I came to the conclusion I didnt really like vents, suctioning, sputum, or trachs. I, however, like titrating drips, art lines, central lines, doing IV's, inserting foleys, NG and OG tubes. I love the hussle and bussle of the ER, never knowing what's gonna come through the doors, and I love trauma! I love fixing the patients and getting ready to ship them out. I love the fast pace and ICU really didnt provide that for me.

If I were you, I would start off on a Stepdown unit. Those pts go down hill FAST! It's a good place to start off to get your basic skills down, then after a year or so, switch to ICU or ER. That way, the only thing you are focusing on is learning how to be an ICU or ER nurse because you would have had your basic nursing skills down.

Good luck!

Catch22Personified · Feb 13, 2011

In this job situation these days, I'd take anything. I'd even work in Mother/Baby and I'm a male that was horrified there for clinicals.

Ambitiouz · Feb 19, 2011

I guess I'm an odd ball as I didnt want ICU. I'm about 6 months into my first RN job in the ICU and desperately want out. I only accepted it because of the economy and how hard it was for new grads to get jobs. But my gut told me before starting that I wasnt ready for the ICU environment. Drips, vents, trachs, having to be assigned to codes as well as your own patients, total pt care, etc. Being on night shift, I dont feel I have the resources available to me like day shift new grads to really learn because I never see the docs. Also with ICU I get no delegation experience, no techs for help. Although u can work up to to be charge. As of now I'm trying to stick with this job for a year and transfer out. However, there are so many new grads in my ICU and a lot of them do exceptionally well. So it's doable if you have that desire and motivation. For me I just dont like this area, but who knows I may revisit it down the road.

chuckz, BSN, RN · Feb 23, 2011

I started out as a new grad in an MICU of a trauma 1 hospital. I thought I was going to not be able to make it. I had a 4 month preception and I needed every second of it. I want to go to CRNA school myself. I came from working as a nurse extern in the ER and loved it. Just by luck, I got hired in at the MICU. It took everything I had to get the flow, the protocols, the way things are done, the charting....that's not even counting patient care. The vents, drips, deaths, it was very hard at first. My boss kept telling me, "you'll get it, it will click."

Well I am hear to tell you that it clicked. It just takes time and spending the effort to learn. It is nerve racking at times and stressful, but doable. My boss said at one time he was against hiring new grads, but he likes it now if he picks the right people. He told me he can train new grads to be the nurse that they want instead of dealing with older nurses who have biases and are against learning new things. I think if you want to succeed and have the right preception, that you will.

Good luck to you. I just want to let you know it can be done.

Jenni811, RN · Feb 23, 2011

Probably not a good idea!! I'm a senior in nursing school (Graduate in May) and i work as a PCT in the ICU.

we have a new grad- bless her heart! she gets SO frustrated, and overwhelemed. Today her patient was crumping, nothing they were giving would work with this patient. He was 98 years old, and family REFUSED to let him go. She was so overwhelmed with everything, she eventually called another nurse for help...the doctors were getting upset with her because she didnt know what she was doing, she couldnt answer their questions much less multi-task.

Its good to get the basic experience of being on the floor. learn prioritizations, learn to deal with stable patients, learn the computer charting, PRIORITIZATION!, etc.

Who am i to say though?? im still a student myself- but just what i see in the new grads that come into our ICU. We no longer hire new grads, or 2 year RN's! (yes they cut out 2 yr RN's)

herowneulogy, BSN, RN · Feb 26, 2011

Probably not a good idea!! I'm a senior in nursing school (Graduate in May) and i work as a PCT in the ICU.
we have a new grad- bless her heart! she gets SO frustrated, and overwhelemed. Today her patient was crumping, nothing they were giving would work with this patient. He was 98 years old, and family REFUSED to let him go. She was so overwhelmed with everything, she eventually called another nurse for help...the doctors were getting upset with her because she didnt know what she was doing, she couldnt answer their questions much less multi-task.
Its good to get the basic experience of being on the floor. learn prioritizations, learn to deal with stable patients, learn the computer charting, PRIORITIZATION!, etc.
Who am i to say though?? im still a student myself- but just what i see in the new grads that come into our ICU. We no longer hire new grads, or 2 year RN's! (yes they cut out 2 yr RN's)

Sorry to say, but this might not have happened if she was given a proper orientation. By the way, do you know how many months were provided towards her training? I still believe that new grads can start off in the ICU as long as they are adequately trained (4-6 months at the minimum, I know some places that offer up to 12). Having said that, I have to confess that I am a new grad RN, looking to start off in the ICU/ER, so my experience on this topic is limited. A new grad ANYWHERE will be frustrated and overwhelmed until, as a previous poster stated, "it clicks" and becomes a close to second nature as possible. People forget that Med/Surg is a specialty also, and yes, new grads there are just as frightened and can be viewed a slightly useless starting out, especially if they received a poor orientation/training. Just my :twocents:

Jenni811, RN · Feb 26, 2011

Careful what you say--- my mother was her preceptor, and she is an amazing nurse!!

I know for a fact, she had plenty of orientation time. She was even a PCT in ICU before then. Orientation time at this hospital is really good, about 10 weeks then they do "re-evaluation" after 10 weeks are up to see if you need longer, or what can be done to facilitate learning. Orientation is very individualized, they gave her MORE than enough time to learn as a new grad. she just is not cut out for an ICU nurse.

Let me put it this way....she had a patient sedated and on a ventilator, he was crumping!!! Sats goin. There are orders for Oxygen but its just a "set of orders" post-operativley...what does she do??? She puts on Nasal Cannula Oxygen......On a guy sedated on a ventilator.

She can handle the basic CABG, post-operative. But when she gets something thats "a little different" she is a deer in freaking headlights.

i'm just saying as an ICU nurse, especially in this hospital, you have to be prepared whatever comes your way. I've never seen an ICU in another hospital so i shouldnt be saying too much.

CCL RN, RN · Feb 26, 2011

Probably not a good idea!! I'm a senior in nursing school (Graduate in May) and i work as a PCT in the ICU.
we have a new grad- bless her heart! she gets SO frustrated, and overwhelemed. Today her patient was crumping, nothing they were giving would work with this patient. He was 98 years old, and family REFUSED to let him go. She was so overwhelmed with everything, she eventually called another nurse for help...the doctors were getting upset with her because she didnt know what she was doing, she couldnt answer their questions much less multi-task.
Its good to get the basic experience of being on the floor. learn prioritizations, learn to deal with stable patients, learn the computer charting, PRIORITIZATION!, etc.
Who am i to say though?? im still a student myself- but just what i see in the new grads that come into our ICU. We no longer hire new grads, or 2 year RN's! (yes they cut out 2 yr RN's)

Sounds to be like she did the right thing. She got concerned and asked for help. KUDOS to her.

Sometimes, even today, I get overwhelmed. I do my best to keep it inside, but we are human. And people dying is hard to handle sometimes. Especially a good, young, septic shock pt. (for me anyway...)

I agree with the PP, the poor new grad sound like she was let down by her orientation.

Also, might I make a comment about the culture of your unit?

I was a PCT once too. If a Dr came to me then, or now, and complained about a nurse, it would be a dead end conversation.

Sounds like this poor new grad is being let down in many ways.

To the OP: I started off in the ICU as a new grad. I did fine. Find a place with a good orientation, and pray for a place with a safe culture.

Good luck.