Should new grads start in ICU?

[optimusRN]

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.

[CCL RN, RN]

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.

10 weeks is by FAR below the norm for new grad ICU preceptorship. I had 6 months.

If a new grad, in an ICU, with a GOOD preceptor, places a ventilated pt on NC, then she was let down! Big time.

Some people aren't meant to be ICU nurses, some people aren't meant to be any kind of nurses, and some aren't meant to be preceptors either. I've seen many people let down by their education department, educative, preceptors, and managers.

Btw, RE: deer in headlights look... Just wait. And pray. Pray that when you are overwhelmed, when you are scared, when you are nervous, that your preceptor isn't discussing your orientation with others, that your PCTs aren't discussion your fears with the Doctors, and that your culture, staff, team, and manager and willing to support you, instead of throwing you under the bus.

Have a good night.

[hiddencatRN, BSN, RN]

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.

Careful what you take offense to: your mom could be a great nurse and not the right preceptor for the new grad, or she could be the right preceptor but the other necessary elements of orientation are missing. A 10 week baseline orientation sounds horribly short for a new grad in ICU. It sounds like a sink or swim situation in your ICU if as a new grad she's expected to be ready for anything once orientation is over.

[Jenni811, RN]

That sounded terribly rude, i apologize. I didnt mean for it to sound like that.

it wasnt a 10 week orientation. it's 10 weeks then a re-evaluation to see what she needed. She was in orientation for like 4-5 months.

Its things she would be able to learn on a med/surg unit...like

-she was going to give insulin to a patient who was on an insulin drip and NPO. (just because they have orders, doesnt mean you have to give it)...all she had to do was titrate the drip.

-She couldnt figure out why the SCD's were not working. Try plugging it in!

-She was going to give Nitro a second time before checking a BP.

-Couldnt figure out why the automatic bp cuff wasnt reading the pulse, he was in A-Fib. I told her they don't read pulse if they are in A-Fib, we have to do manuals "Oh, really?"

...its things you can't be taught, and shouldnt have to be taught. It's this "critical thinking" we are always taught to do in nursing school.

[Jenni811, RN]

10 weeks is by FAR below the norm for new grad ICU preceptorship. I had 6 months.

If a new grad, in an ICU, with a GOOD preceptor, places a ventilated pt on NC, then she was let down! Big time.

Some people aren't meant to be ICU nurses, some people aren't meant to be any kind of nurses, and some aren't meant to be preceptors either. I've seen many people let down by their education department, educative, preceptors, and managers.

Btw, RE: deer in headlights look... Just wait. And pray. Pray that when you are overwhelmed, when you are scared, when you are nervous, that your preceptor isn't discussing your orientation with others, that your PCTs aren't discussion your fears with the Doctors, and that your culture, staff, team, and manager and willing to support you, instead of throwing you under the bus.

Have a good night.

Read the entire post--- its 10 weeks then a RE-EVALUATION! to see what you need, is your preceptor working out for you? What can make it better? etc.

She ended up close to 5 months.

[shoegalRN, RN]

That sounded terribly rude, i apologize. I didnt mean for it to sound like that.

it wasnt a 10 week orientation. it's 10 weeks then a re-evaluation to see what she needed. She was in orientation for like 4-5 months.

Its things she would be able to learn on a med/surg unit...like

-she was going to give insulin to a patient who was on an insulin drip and NPO. (just because they have orders, doesnt mean you have to give it)...all she had to do was titrate the drip.

-She couldnt figure out why the SCD's were not working. Try plugging it in!

-She was going to give Nitro a second time before checking a BP.

-Couldnt figure out why the automatic bp cuff wasnt reading the pulse, he was in A-Fib. I told her they don't read pulse if they are in A-Fib, we have to do manuals "Oh, really?"

...its things you can't be taught, and shouldnt have to be taught. It's this "critical thinking" we are always taught to do in nursing school.

I'm just wondering.....did YOU observe this new grad doing all these or was this second hand info that you HEARD about?

I'm not trying to be a smarty pants, but if this new grad made these types of errors, this should have not been discussed with any of her peers. This should have, however, been discussed with the new grad, the preceptor, and the educator. This shows the culture of this unit.

And I'm sorry, but 4-5 months is not enough time for a new grad in the ICU. Even after evaluation. Most hospitals I know offers 6 months minimum and then increase as needed. I surely hope the ICU in your hospital was not expecting a new grad to "get it" within a 10 week period. Talk about sink or swim. At my Level I trauma center, experienced nurses with 1-2 years experience gets minimum 3 months orientation in ICU.

[herowneulogy, BSN, RN]

Well everyone pretty much responded the same way I was going to for Ms Jenni:

-10 weeks is not enough

-You're biased because the preceptor is your mother, which I understand because she's numero uno in your book, but it doesn't mean she's giving the new grad what she needs to succeed or being supportive of her, either, etc.

-It's easy to judge, point fingers and laugh at what others are doing or mistakes they have made, but know this: You WILL be in that situation one day, as you've already mentioned that you're graduating soon. Pray that you get a job in the ICU with mommy so that she can spend extra time with you. If you end in Med/Surg or in any other specialty without her, you will also be that deer-in-headlights, too, sweetheart. Because as the saying goes "you don't know squat as a new grad RN straight from nursing school, but you know enough to kill someone". Nobody knows everything straight out of nursing school, and the ones that act like they do always get a reality check once they make a mistake. Start cultivating that humility now because there's nothing worse than a newbie walking around pretending to know everything, instead of asking questions.....according to my summer nurse preceptor. We're all human....making mistakes is just the part of the learning process.

Best of luck to you!

[NotReady4PrimeTime, RN]

And I'm sorry, but 4-5 months is not enough time for a new grad in the ICU. Even after evaluation. Most hospitals I know offers 6 months minimum and then increase as needed. I surely hope the ICU in your hospital was not expecting a new grad to "get it" within a 10 week period. Talk about sink or swim.

I agree with you on that. Our unit has a 16 week orientation for new grads. 1 week of classroom then 11 weeks with a preceptor followed by 4 weeks of "resource" shifts where the new grad is on his or her own with their preceptor providing a resource to them. This is often from the other end of the unit where the new nurse cannot be observed. For the most part though, this is on paper. If things go sideways, orientations are truncated. Sink or swim indeed.

[CCL RN, RN]

Well everyone pretty much responded the same way I was going to for Ms Jenni:

-10 weeks is not enough

-You're biased because the preceptor is your mother, which I understand because she's numero uno in your book, but it doesn't mean she's giving the new grad what she needs to succeed or being supportive of her, either, etc.

-It's easy to judge, point fingers and laugh at what others are doing or mistakes they have made, but know this: You WILL be in that situation one day, as you've already mentioned that you're graduating soon. Pray that you get a job in the ICU with mommy so that she can spend extra time with you. If you end in Med/Surg or in any other specialty without her, you will also be that deer-in-headlights, too, sweetheart. Because as the saying goes "you don't know squat as a new grad RN straight from nursing school, but you know enough to kill someone". Nobody knows everything straight out of nursing school, and the ones that act like they do always get a reality check once they make a mistake. Start cultivating that humility now because there's nothing worse than a newbie walking around pretending to know everything, instead of asking questions.....according to my summer nurse preceptor. We're all human....making mistakes is just the part of the learning process.

Best of luck to you!

Amen!

Oh yes, her time is a coming!

Like I said, just based on these few posts, I can tell you that this particular ICU is not a supportive culture at all! What a shame.

[eyeball]

That sounded terribly rude, i apologize. I didnt mean for it to sound like that.

it wasnt a 10 week orientation. it's 10 weeks then a re-evaluation to see what she needed. She was in orientation for like 4-5 months.

Its things she would be able to learn on a med/surg unit...like

-she was going to give insulin to a patient who was on an insulin drip and NPO. (just because they have orders, doesnt mean you have to give it)...all she had to do was titrate the drip.

-She couldnt figure out why the SCD's were not working. Try plugging it in!

-She was going to give Nitro a second time before checking a BP.

-Couldnt figure out why the automatic bp cuff wasnt reading the pulse, he was in A-Fib. I told her they don't read pulse if they are in A-Fib, we have to do manuals "Oh, really?"

...its things you can't be taught, and shouldnt have to be taught. It's this "critical thinking" we are always taught to do in nursing school.

My guess is that she is not stupid. She sounds overwhelmed and when any of us is overwhelmed our thinking capabilities suffer.

[Jenni811, RN]

Oh jeez people. Seriously, after this im done. So if you want me to read anything, private message me.

I'm not trying to be rude here, but you are not reading everything i am saying.

And i never called her "stupid" infact, if people actually READ my posts they would have saw that i called her a very smart girl. Don't put words in my mouth. i would never call someone stupid.

[Jenni811, RN]

ok sorry, all im saying, Bye

[NotReady4PrimeTime, RN]

I think this thread needs some down time before the snark level goes off the meter. I'll reopen it in 24 hours time. Please keep your posts respectful of others.