Staying in critical care after new grad

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Would you recommend it to other new grads if they really enjoyed PICU? Or would you advise them to go back to a normal ward and consolidate their learning etc?

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Specializes in Pediatrics, Emergency, Trauma.

Could you please clarify your question??? Maybe it's early for me, but honestly if I knew what you were asking, I could help. :)

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I'm currently doing my last rotation of my new grad year in PICU, and am really enjoying it and look forward to work everyday. I was pretty set on staying in PICU, however I've been advised by a senior nurse on the unit that I shouldn't... And she was quite adamant and harsh on some of the things she said about not staying on the unit after I finish my year.

I know a few people have the same view on this as her - that you should go back to a normal ward and develop your time management skills, consolidate your learning etc.

Just wondering what the PICU nurses on this forum did? Did you start working in ICU soon after you became an RN or did you develop your skills in another area and then come to ICU after a few years?

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Specializes in PICU, CTICU.

I personally started in the PICU as a new grad out of school. Our hospital hired a good number of new grads into our PICU and had a great orientation program for both step-down and ICU. It is by no means an easy place to start, but I wouldn't have changed it for the world. The support of your team and co-workers is very important, so don't let one nurse decide your career path for you. If you're eager to learn and passionate about the unit, I would say go for it!

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I am a former new grad nurse who started a year and a half ago straight into the picu. I absolutely love it and had no trouble learning time management of my patients. Of note, time management of 6 floor patients is very different than time management of 2 critically ill patients. You'll run into those who hate new grads and those who love them. Don't let what the people who dislike it get you down- do what you love and strive to be excellent at it. Good luck!

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I would stay in ICU, hands down. Especially if the acuity and/or census if often low and there is competition to actually get a sick patient. 6 months is nowhere near enough to have have ICU down to a tee. If you like it, then stay!

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She may be speaking about the PICU that she works on. Perhaps there isn't a great training program there or the staff/other aren't supportive of new grads however that doesn't mean you shouldn't start in the PICU if you want to. BUT you SHOULD find a supportive environment, as those who surround you make or break your day. You need a LOT of support and a non-judgemental environment to survive.

I started here as a new grad and my unit hires about 5 new grads every 3 months. I've only been here 9 months and I still feel like I'm incompetent some days. It's a VERY steep learning curve and I think I need to start studying outside of my job because there is just so much to learn. Here's the most difficult part (for me): learning new technical skills (learning to use the equipment, what it does, where it is, who to call for what etc.) AND putting it together with critical thinking- I pretty often get caught up in how to do something rather than why I'm doing it because the skill has to be done at THAT moment- no time to think why, you have to innately know it... and thats where time and practice come in to play. I also struggled with organization and remembering everything in the beginning but as time has passed I've improved a little. Anyway, I'm happy I chose to start at the top (meaning difficulty wise) because anywhere I go from here will be a breeze, right?! :)

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I think it really depends on each person, but overall NO a new grad should not be hired into PICU. Step-down yes, with good training. With potential to go to PICU later. I speak with experience as a new grad who was hired into PICU along with several others. Only a couple made it, and in the meantime there were unsafe things being done. The new nurses were mostly good nurses but overwhelmed and inexperienced and felt rushed. Heck, I did not know what a normal-looking patient was like as far as VS without consulting my little badge card to double check. And here I was expected to catch early signs of decline and also to manage drips, vent, etc. I was so scared I would practically vomit on the way to/from work. I went to step-down and LOVED it! Now I'm 2 years in and my manager asked me to train back to PICU when they need extra nurses. But I made it clear I will only take patients I feel safe with even if that means refusing them at shift report time. I am no longer new and feel intimidated about taking patients I did not feel safe with, and I also know more how to listen to my gut.

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Specializes in Pediatrics, Emergency, Trauma.
I think it really depends on each person but overall NO a new grad should not be hired into PICU. Step-down yes, with good training. With potential to go to PICU later. I speak with experience as a new grad who was hired into PICU along with several others. Only a couple made it, and in the meantime there were unsafe things being done. The new nurses were mostly good nurses but overwhelmed and inexperienced and felt rushed. Heck, I did not know what a normal-looking patient was like as far as VS without consulting my little badge card to double check. And here I was expected to catch early signs of decline and also to manage drips, vent, etc. I was so scared I would practically vomit on the way to/from work. I went to step-down and LOVED it! Now I'm 2 years in and my manager asked me to train back to PICU when they need extra nurses. But I made it clear I will only take patients I feel safe with even if that means refusing them at shift report time. I am no longer new and feel intimidated about taking patients I did not feel safe with, and I also know more how to listen to my gut.[/quote']

Well said. :yes:

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I started as a new RN in the PICU. If it is what you want to do then just start off in the PICU. I've trained many new nurses and nurses transferring to the PICU. I've had the most difficulty from nurses who came from a general peds floor or med/surg. They may have time management skills, but they have a skewed sense of urgency and don't prioritize things well. I'm not saying all of them are like this. I've worked with some amazing nurses that came from very low acuity units.

I personally don't believe that gen peds/med surg is a stepping stone to ICU. I think the units are very different. I sometimes had difficulty when I floated to gen peds. Priorities are very different for those patients and you can be just as busy and often times more busy.

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I would agree with LadyFree 99%. I was a relatively new nurse, 10 months part time, before I started in critical care. My facility does a FANTASTIC job with it's orientation. I have felt very well supported. However, I do think it's depends on each person and the environment that you'd be going into. It will need to be a place that likes new grads, is willing to invest in the initial training and the ongoing support. You'll also need to be willing to put in outside time to get in early and look things up on your patients, and to get in studying outside of work.

However, if PICU is what you want, go for it. I'd apply to general Peds too, but go for it! There are some of us who are just meant for critical care. I had an incredibly hard time managing 6 patients. I always felt like I didn't get things done and didn't know everything about my patients. In the ICU, that's your job and you've got to be on top of it. Hands down, I love ICU and I know it's where I was supposed to be.

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Specializes in kiddies.

Stay in ICU all the way! PICU NICU or adult ICU.

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