Student seeking ICU advice

NurseLay · Sep 21, 2008

MegRN2B, I disagree with going to med surg for a year if what you want to do is ICU. Working in the unit has many differences ( as well as many similarities) from the med surg floor, and you will learn the skills you need as an ICU nurse in the unit. You will still learn and do the same skills you would do on the med surg floor in the icu. You will also learn many things that are specific to the ICU setting. If you feel you can handle it and they offer a good orientation program go for it!!!!! Good Luck!!!

Nursegreen did you take eyes off the end of your name?

nursegreen · Sep 21, 2008

No, it's just Nursegreen..:)

becembrie · Sep 21, 2008

Meg, if you really feel you want to work in ICU, then you should go to the open house and ask them if there is a possibility of starting out there when you graduate. They will be able to tell you what the requirements are and you can explain to them your desire to work on the unit. I think if you already know that is what you want to do, you should go for it. All they can do is tell you no. No matter where you end up, you will learn more in your first year of nursing than you ever thought imaginable.

Good luck.

RN1982 · Sep 21, 2008

If you don't end up in ICU, stepdown is a good stepping stone. I learned A LOT.

mpccrn, BSN, RN · Sep 21, 2008

the reason we usually like new grads to get some med-surg experience first is so they can get their organizaional skills together. trying to master those along with all the stuff you have to learn specific to critical care icu is daunting.....but can be done. i did it some 30 years ago. i help new grads do it now. it's definately do-able. it comes down to the person, how bad they want it and how much they are willing to do. i hope you have a preceptor that is willing to ensure your success. there is nothing more satisfying than to help a new grad develop into an icu nurse....we are the best in the hospital! :smokin:

imanedrn · Sep 22, 2008

...I was told by one of my preceptors that it makes no sense to do med-surg first because that is just task focused and they don't have strong assessment skills. I think people who start out in med-surg then transition to ICU will say start out in med-surg and those who start out in ICU as new grads will say forget the med-surg. You know what type of person you are and what you can and cannot handle...

Ok, bear with me... :spbox:

I agree partly that SOME of what we do is task-oriented in the sense that there are tasks that need to be completed. This is common sense. HOWEVER, if a nurse doesn't see the big picture (why was this new med ordered? why is Mr X going for Y procedure? what do X results mean? when do I need to call the doc and when can I manage this on my own?), then then she's not providing thorough, quality care to her patient. We do more than just pass meds!

The BIG problem I have, though, is your statement that we do NOT have strong assessment skills. $%(#$&%!!! EXCUSE ME? That's ALL we have to rely on in med/surg! Unlike the ICU, where the machines are telling you half of what you need to know, in med/surg, the only machine we have is for vitals and (sometimes) telemetry. Otherwise, we're doing EV-ER-Y-THING! And, withough my VERY STRONG assessment skills, I wouldn't pick up on little changes that tell me patient A is getting better or patient B is tanking and needs a higher level of care.

I don't want to make this personal, or a med/surg vs. ICU thing, but I would STRONGLY re-think the above statement.

P.S. I see this issue was already tackled, so please ignore it...!

FA to CRNA2b · Sep 22, 2008

If you really want to be an ICU nurse and can get into a fellowship with proper support, I say GO FOR IT! The learning curve will be very steep but the best place to learn how to be an ICU nurse is in the ICU. There is nothing wrong with starting in another type of unit either, and I wouldn't consider it a stepping-stone. They're all challenging in their own way and you will learn a lot. It's hard to get a position in ICU as a new grad so start job hunting early (like during springbreak) or get a tech position while in school. If your school offers a preceptorship in an ICU, that would be another option. Are you considering CRNA school by chance?

NurseLay · Sep 22, 2008

Ok, bear with me... :spbox:
I agree partly that SOME of what we do is task-oriented in the sense that there are tasks that need to be completed. This is common sense. HOWEVER, if a nurse doesn't see the big picture (why was this new med ordered? why is Mr X going for Y procedure? what do X results mean? when do I need to call the doc and when can I manage this on my own?), then then she's not providing thorough, quality care to her patient. We do more than just pass meds!
The BIG problem I have, though, is your statement that we do NOT have strong assessment skills. $%(#$&%!!! EXCUSE ME? That's ALL we have to rely on in med/surg! Unlike the ICU, where the machines are telling you half of what you need to know, in med/surg, the only machine we have is for vitals and (sometimes) telemetry. Otherwise, we're doing EV-ER-Y-THING! And, withough my VERY STRONG assessment skills, I wouldn't pick up on little changes that tell me patient A is getting better or patient B is tanking and needs a higher level of care.
I don't want to make this personal, or a med/surg vs. ICU thing, but I would STRONGLY re-think the above statement.
P.S. I see this issue was already tackled, so please ignore it...!

Not focusing, I just want to point out that you high lighted all that statement, but left out the fact that I said that is what I was told by my preceptor. I repeated an ignorant statement. I understand your PS, but I just wanted to point that out.

tri-rn · Sep 22, 2008

I graduated in May, and am about halfway through my ICU orientation. So far it's going VERY well, I couldn't be happier and I think I'm on track. I interned there for a year (10 weeks FT then 1 day/week during my senior year), which helped me to learn charting, assessments, and a lot of the equipment. As a student I wasn't permitted to take orders or pass meds though. Most of the nurses weren't comfortable letting me do much that was invasive (like pulling central lines, etc etc). So even with the orientation I have a lot to learn....

I would ABSOLUTELY ask if they hire new grads and more specifically about an internship. If you are obligated to the hospital anyway maybe they will be far-seeing enough to realize that if you and your new unit are a good fit you'll be more likely to stay beyond your obligation. (And maybe somehow working that into a conversation wouldn't be bad if you get an opening and can do it with a lot of tact )

geekgolightly, BSN, RN · Sep 22, 2008

I've had seven different preceptors in my four weeks of ICU orientation. In that time, each time someone new comes along and asks me how long I've been there, they are all surprised that I have had such little time in ICU. I don't think it's because I'm smart, I think it's because I have numerous years in med surg.

Today when my preceptor was slammed this morning with two critical patients while being saddled with an orientee, she kept saying how glad she was that I "knew what I was doing" (which I don't, but I know the basics and I can keep someone alive even if I din't know what the ScvO2 meant until today, I knew when my patient looked like crap and needed bipap!) so that she could focus on one while I focused on the other. She was so busy with 'tasky" stuff (yes ICU nurses do lots of tasky stuff), that I was left to sink or swim with a septic patient, with an INR of 8.8 who's a Jehova's witness (they did finally decide on FFP, which I didn't expect, but what thankful for) and I kept him afloat.

I am stressed learning all the stuff I have to learn, but SO THANKFUL for the years I spent in med surg. I think it's well worth it.

ilstu99 · Sep 22, 2008

I'm a BSN student in my third semester. I'm under contract with a local hospital to work for them for a period of time after I graduate. This week, they're holding an open house/recruitment get-together. I really want to work in the ICU as a new grad, but I'm not sure what to say or ask to be memorable to the ICU manager. I know all the usual things..dress professionally, firm handshake, speak clearly, smile..but is there anything else I should know? Is it difficult (or even advisable) for a new grad to get into ICU? This particular hospital hires a lot of new grads, so I would expect a good new grad training program. I appreciate any feedback you have (and also appreciate those of you who read this far!) :loveya:

I would ask a manger those exact questions....

"I'm very interested in the critical care environment. What's your opinion of hiring new grads directly to the ICU? Do you have a training program specifically for new grads? What's your orientation process? How long is the average orientation? What additional classes and certifications are needed?"

Don't assume anything about any programs they might have. I was hired as a new grad to the NICU of a wonderful teaching hospital. Sadly, they do not have any well-organized training program for new grads. Each unit does their own preferred training, and it's been very frustrating at times.

Just be honest, polite and direct. It's even okay to say, "I'm very efficient with dress professionally, firm handshake, speak clearly, and smile, but I'm not sure what to ask next!"

RNMeg · Sep 22, 2008

I think I would enjoy Med/Surg nursing..I certainly enjoyed my Med/Surg I clinical rotation. My concern, though, is that I'm under contract at this particular hospital (they're paying my tuition in full in exchange for work when I graduate) and there are terrible rumors about this particular hospital's med/surg unit. Every nurse I've told I'm working there after graduation has told me to avoid med/surg there. The nurses there are unhappy, unfulfilled, unsupported, and it's generally a toxic environment. If I were contracted with any other hospital, I would be happy to work Med/Surg first and then step into ICU. However, because of the Med/Surg situation there, I think it would be better for me to avoid that work environment altogether (it can't be a good learning environment if it's a bad working environment!) and just start where my ultimate goal is (that is, if the unit offers new grad jobs, of course :)). To answer the question above, no, I'm not looking at CRNA school, though I have the utmost respect for those that are/do. Someday I might go on to FNP, but for now, I just want to be a bedside RN :nurse: