Should new grads start in ICU?

Nurses New Nurse

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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.

Specializes in NICU, PICU, PCVICU and peds oncology.

Let's try that again.

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Well I ended up getting a job on a med-surg step down unit. And luckily we have a sister ICU so I'm hoping to get to know the nurse manager there and transfer after a year. I was hoping to go straight into ICU but when a good opportunity came up I couldn't let it go!

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Specializes in Women's Health.

I went right into an ICU in NYC. My program was very heavy with clinical experience. I did just fine. :redbeathe

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Specializes in MSN, FNP-BC.

As other posters have said, it depends on you.

I really enjoy the ICU environment because of the challenges is presents. When you think about it, the ICU level is as high as it goes so if your patient goes bad, you're it. You have to deal with it and do your best because there isn't anywhere else for them to go unless it's heaven.:heartbeat

A good orientation, as others have said, is important. It will really help you develop your skills. We had 6 weeks of classroom lectures during our orientation plus working on the floor. It was quite intense!

What I think will really make or break you are the people you work with though. A good group of coworkers are worth more than their weight in gold! I can't count how many times I've asked everyone I work with questions that they have answered. If it weren't for them, this ship would have sailed moths ago.:nurse:

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
well i ended up getting a job on a med-surg step down unit. and luckily we have a sister icu so i'm hoping to get to know the nurse manager there and transfer after a year. i was hoping to go straight into icu but when a good opportunity came up i couldn't let it go!

do not worry... a year or two on a good step-down unit (one that actually has post cardiac cath and post open heart sxs) will help you to get into critical care unit later. you will be surprised how many of your patients will not be stable when you get them on your floor. thus, you will be exposed to patients that are really really sick!!! fortunately, you will learn a great deal while caring for them. to be honest, it will probably be the scariest and most rewarding experience you will have as a new nurse similar to working in an icu or an er. gl!

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Specializes in Pulmonary/MedicalICU.

OP:

It depends on the person. Everyone is different and, unfortunately, its really hard to tell if you will get it or you won't. Do you have any experience in an ICU, such as an externship? That would help you to know how well you will handle it. In an ICU there is alot to learn...you're learning all about how patho REALLY works (not just what the book says) and how to recognize things before they get bad, as well as figuring out how to chart, what to chart, when to chart, vital signs, procedures, titrating meds, lines, vents, suctioning, etc etc etc.

There is alot to learn about disease processes before you even get into the patient care and prioritization part. I worked on a stepdown before moving to the ICU and I found that time to be invaluable in becoming more capable at managing patients and prioritization of care.

But, like I said, some can handle it (some of my friends from school did great in ICU right out of school...some didn't), some can't.

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Specializes in Pulmonary/MedicalICU.
"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 did....been there, done that.

For you floor nurses (especially telemetry) that think that ICU isn't busy, get back to me when you have one patient getting intubated/extubated and/or lined out (TLC, a-line, sometimes shiley) on pressors with tons of meds and probably HIV/AIDS/HepC/TB/C.Diff (please select any combination of this list) while your other patient is on CVVH (aka CRRT, this is continuous dialysis for those unfamiliar) with 4 bags of fluids (that have to be stocked and changed) and an ultrafiltrate (urine) bag with some kind of intervention every 30 minutes (assuming there are no troubleshooting issues, which never happens...), charting, electrolyte replacement for CVVH, on a vent, charting, with 2-4 vasopressors that are being titrated, sedation titration, charting, IVFs, multiple antibiotics, PO meds, charting, arrhythmias, tube feeds, bowel movements, dressing changes, line changes...oh, and did I mention CHARTING.

I've worked both the floor (stepdown) and an ICU. Both can be busy at times. But I was never as busy with 5-6 patients as I can be in the ICU.

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I graduated in May 2009 and worked in 2 LTC facilities and a Rehab facility. I recently accepted a position on an advanced cardiac unit in a hospital and am in orientation. Today I spent a good deal of my shift feeling embarrassed and crying a bit. My preceptor humiliated me on the floor in front of my future co-workers and has been making me really stressed out. When I tell her that her constant hounding makes me too nervous to think on my feet, she tells me that I'll have to get used to it because this is a stressful unit. I absolutely hate it because of her and she even told me that I wouldn't cut it today if I couldn't handle it. I think that if your considering higher acuity out of college make sure that you'll get good trainers who have trained new hires before. This is gonna ruin my weekend :( Also just found out I'm PG with our first, so that might explain the crying episodes :)

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I graduated in May 2009 and worked in 2 LTC facilities and a Rehab facility. I recently accepted a position on an advanced cardiac unit in a hospital and am in orientation. Today I spent a good deal of my shift feeling embarrassed and crying a bit. My preceptor humiliated me on the floor in front of my future co-workers and has been making me really stressed out. When I tell her that her constant hounding makes me too nervous to think on my feet, she tells me that I'll have to get used to it because this is a stressful unit. I absolutely hate it because of her and she even told me that I wouldn't cut it today if I couldn't handle it. I think that if your considering higher acuity out of college make sure that you'll get good trainers who have trained new hires before. This is gonna ruin my weekend :( Also just found out I'm PG with our first, so that might explain the crying episodes :)

Congrats on the good news! Sorry you are having such a hard time with your preceptor. Do not let one person bring you down. Introduce yourself to others on the floor, especially the newer grads. You guys need to support each other. We all felt this way when we are new and your preceptor is only making it worse. She must not remember what it was like when she was new. Best advice I got on this board was to keep showing up. I lasted 6 months before quitting my first dreadful job, my second job is a much better fit. Hang in there and do your best, do not let one person make or break your future. Could you ask for another preceptor? It is normal to be nervous! You are new and not expected to know it all right when you get there. Trust me, your preceptor had to learn it all too.

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Specializes in Cath Lab/ ICU.
I did....been there, done that.

For you floor nurses (especially telemetry) that think that ICU isn't busy, get back to me when you have one patient getting intubated/extubated and/or lined out (TLC, a-line, sometimes shiley) on pressors with tons of meds and probably HIV/AIDS/HepC/TB/C.Diff (please select any combination of this list) while your other patient is on CVVH (aka CRRT, this is continuous dialysis for those unfamiliar) with 4 bags of fluids (that have to be stocked and changed) and an ultrafiltrate (urine) bag with some kind of intervention every 30 minutes (assuming there are no troubleshooting issues, which never happens...), charting, electrolyte replacement for CVVH, on a vent, charting, with 2-4 vasopressors that are being titrated, sedation titration, charting, IVFs, multiple antibiotics, PO meds, charting, arrhythmias, tube feeds, bowel movements, dressing changes, line changes...oh, and did I mention CHARTING.

I've worked both the floor (stepdown) and an ICU. Both can be busy at times. But I was never as busy with 5-6 patients as I can be in the ICU.

Don't forget, we can't restrain them anymore, so better be on the ball to prevent your pt on sedation vacation from self extubation, and please chart all the other interventions you have tried to prevent restraint use.

And when ICU nurses have to transfer pts to the floor urgently, we have to do it lightening quick, and then take the crashing pt in the same room. Or go upstairs to get the rapid response pt ourselves.

Seriously...

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