The same question everybody keeps asking...

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Specializes in SICU.

Is it better for a new graduate nurse to go right ahead and start out in the ICU or get a year or two of med/surg or telemetry experience first?

I am extremely confused. I think eventually I might want to be a CRNA, which would require 1-2 years experience in critical care. Even if I don't go the CRNA route, I think I would still want to end up in ICU or ER anyway, so wanting to be a CRNA is not the only reason I want to go into critical care. All of the major hospitals around here have 3-4 month critical care internships for new grads.

In my heart, I do think I would probably feel a lot more comfortable getting down the basics of nursing in med/surg before going into ICU. But people tell me that if I want to go the CRNA route, I should just go right into ICU, and to take advantage of these great critical care internships. I just don't know. At 27, I'm not terribly old, but this will be my second bachelor's degree, and if I do go to school again for the CRNA, I don't want to be that old, so I worry that I would be wasting some precious time by not starting out in the ICU right away.

I wish I could make a decision and know that it's the right one, but right now I feel like whatever I decide is going to be wrong.

Oh, and as a side note, my nursing school prides itself on the fact that a majority of its new grads go straight into working in specialty areas, rather than med/surg, so I feel this pressure of being seen as an underachiever if I don't go straight into the critical care internship.

Even though my question has been asked a million times before, I would greatly appreciate any advice or insight. Thank you!

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When I was about to graduate with my BSN, I felt exactly like you do (get some experience in tele/or med-surg, and then hopefully wind up in ICU or ER, with a very DISTANT goal being CRNA school). I wound up in SICU as a new grad (I was not expecting it, I just happened to be placed in ICU!! I was expecting step-down!!). I was scared. I was nervous. I was overwhelmed. But all these things worked to my advantage. I'm glad I went right into ICU b/c it's so different than med-surg or other areas--you learn the specialty right off the bat. It takes about a year to get semi-comfortable in ICU. The key is to always ask questions, NEVER assume you know it all!! Always seek the advice/opinions of your peers, and ALWAYS take every opportunity to learn, whether it be from MDs, RNs, RRTs, dieticians, etc. Anybody and everybody. After about 1 year in ICU I was set on becoming a CRNA...it's now been almost 3 years since graduation and I feel like I am a competitive applicant to CRNA programs this year (wish me luck!!). I applied last year and got interviews and then wait-listed. The key (at least for myself) has been to take everything as a learning experience. Soak up as much as you can no matter what you're doing. That will make you a competitive candidate for whatever it is that you end up pursuing. Good luck!!! Sorry to ramble, hope that helped some:mad:

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Specializes in SICU.
When I was about to graduate with my BSN, I felt exactly like you do (get some experience in tele/or med-surg, and then hopefully wind up in ICU or ER, with a very DISTANT goal being CRNA school). I wound up in SICU as a new grad (I was not expecting it, I just happened to be placed in ICU!! I was expecting step-down!!). I was scared. I was nervous. I was overwhelmed. But all these things worked to my advantage. I'm glad I went right into ICU b/c it's so different than med-surg or other areas--you learn the specialty right off the bat. It takes about a year to get semi-comfortable in ICU. The key is to always ask questions, NEVER assume you know it all!! Always seek the advice/opinions of your peers, and ALWAYS take every opportunity to learn, whether it be from MDs, RNs, RRTs, dieticians, etc. Anybody and everybody. After about 1 year in ICU I was set on becoming a CRNA...it's now been almost 3 years since graduation and I feel like I am a competitive applicant to CRNA programs this year (wish me luck!!). I applied last year and got interviews and then wait-listed. The key (at least for myself) has been to take everything as a learning experience. Soak up as much as you can no matter what you're doing. That will make you a competitive candidate for whatever it is that you end up pursuing. Good luck!!! Sorry to ramble, hope that helped some:mad:

I'm glad to hear a positive experience about going straight into ICU after graduation. I'm fully expecting it will be scary, but it sounds like you handled it well. Good luck with the CRNA application process!!

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I went directly into SICU from graduation. Its been about two years now, and I couldn't be happier that I made that decision.

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Poor med-surg. The specialty gets no respect sometimes-even from nurses. If you feel you would be better served in med-surg, a year or two there will give you skills and confidence. ICU will still be there if you want it.

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Specializes in Trauma acute surgery, surgical ICU, PACU.

The only way I would advocate a new grad going straight to ICU is if they have an *excellent* preceptorship program as well as actual classroom and clinical teaching.

Because otherwise you'd be kind of on your own to learn the critical thinking skills at the same time as managing the "tasks", and that can have very serious consequences - for you and the patient.

I really don't know why so many new grads on here are so insistent that the don't wanna do med-surg. It can be a great learning experience, and helps you grow in your practice as a NURSE before you become a Critical Care Nurse.

I can see some new grads being strong enough to do well in critical care right off the hop of they are good thinkers and ask questions as well as getting the right resources from their employer. Some won't do well as all, and it will shatter their confidence right out of school. So make the decision carefully, imo.

Good luck.

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Poor med-surg. The specialty gets no respect sometimes-even from nurses. QUOTE]

i second that, poor med surg. I don't know how it is in the US, but our medical/surgical wards are grouped by specialty (well, it is in all of the hospitals i have worked/visited). For example, my hospital has 6 medical wards (Neuro, Renal/Gastro/Endo/Pall care, Oncology/Haematology, Cardiac, Respiratory and Acute care of the Elderly) and 4 Surg wards (Ortho, Urology/Gynae/Breast, Vascular, Gen Surgery) they are VERY specialised areas

Anyhoo, back to the original question. Its personal choice, thats the bottom line, i dont think there is a right or wrong way to go about it.

if the program you wish to enter gives you good orientation, lots of education and support, supernumary time etc etc, then it would be worthwhile going for. However, if you just get tossed in the deep end (ie- "hi welcome to your first day in ICU, here, take this vent patient...") then i think having experience behind you is a good idea (of course, i spose you wont know how good the program is until you get there...)

bottom line- if you like ciritcal care, are interested in it, prepared to work hard, learn, ask lots of questions, then choosing to enter a critical care area stright up may work well for you.

personally speaking, I did a general new grad program (my area health service offers a general and critical care stream), I had 2 rotations (8wks ortho and 10wks rehab/transitional care) before a 10wk rotation in ICU (where i loved it and desperately wanted to get back, but also really wanted to finish my new grad). I then finished my final 2 rotations (10wks Oncology/haematology and 12wks Renal/Gastro/Endo/Pall Care), and 6months later have found myself back in ICU with a permenant full-time job and a years worth of experience behind me. Just last night I had a patient on CAPD, and cos i was a "renal nurse" (for a whole 12 weeks lol) i was the only one who knew how to do it (or more importantly, access the proper resources so that the unit as a whole could be educated on how to do it)

I apply the experience and knowledge I gained from my med/surg rotations to my practice every day in ICU, and am happy i completed the program instead of staying on in ICU. Having said that, you gain experience wherever you work. As i said before, if the ICU where you start is very supportive of "brand new" new grads (our crit. care stream won't put you near ICU or ED straight up, you have to work in either the cardiac, neuro or mental health wards, so you have at least 2 rotations before you get placed there) then go for it.

I was surprised to find out that the majority of nurses in my unit come from a previous medical/surgical specialty area (mostly renal or cardiac) and not a critical care one

good luck with whichever path you choose

parko

ps- my exclamation mark button isnt working and i can't add any to this post, i re-read it and it all sounds very serious without them lol

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Specializes in ICU.

You can start in ICU and if you feel like it is too much you can always step down. But, I would at least try it.

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Specializes in Cardiac.
The only way I would advocate a new grad going straight to ICU is if they have an *excellent* preceptorship program as well as actual classroom and clinical teaching.

Because otherwise you'd be kind of on your own to learn the critical thinking skills at the same time as managing the "tasks", and that can have very serious consequences - for you and the patient.

The same thing happens in medsurg. You get less orientation, more patients. The consequences are the same if you make a mistake and after the minimal orientation you are still 'on your own'.

I really don't know why so many new grads on here are so insistent that the don't wanna do med-surg. It can be a great learning experience, and helps you grow in your practice as a NURSE before you become a Critical Care Nurse.

.

I went straight into ICU, and still came out a NURSE. Med surg doesn't make you more of a nurse than ICU...

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Specializes in Trauma acute surgery, surgical ICU, PACU.

I went straight into ICU, and still came out a NURSE. Med surg doesn't make you more of a nurse than ICU...

No, you are very right there!

I'm just really sick of everybody slagging off "med-surg" like it's some kind of purgatory.

And maybe the old former med-surg nurse in me is still feeling the sting of some ICU nurses who forgot what it's like to work the "ward" and act like floor nurses are ignorant or lazy, etc. Or like there is something wrong with the "ward" - when there isn't, it's just different.

I think there is something to be said for both, imo.

Like I said, it depends where you go to work.

A hospital that has a great teaching program and preceptorship program in the ICU will allow new grads to excel. A hospital that doesn't can be very tough on a new grad who is just building his/her sense of the job. Where I work, you are required to have a bit of experience, and then an extensive teaching program to go to the ICU. It's very in-depth. And nurses still get overwhelmed at times. I can really see both sides.

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Specializes in Med-Surg Nursing.

I'm old school and feel that you should do a year of Med-Surg before going to ICU.

I had FIVE years of Med-Surg skills under my belt before I EVEN applied for an ICU position.

Why? Because you need to learn the basic assessment skills, time management, proper techniques for doing things like inserting NG tubes, IV's, etc. In a critical care environment, you have to be able to think on your feet and have really good critical thinking skills which most new grads don't have as of yet. In an ICU environment, teaching a new grad the basics is just usually too time consuming, cause from MY experience orienting a new grad in a VERY busy Level II Trauma ICU, things get pushed aside cause I am just TOO busy to teach the newbie the basics when I have two or Three VERY critical patients to take care of. There's NO such thing as 1:1 patient/nurse ratio in my unit.

I don't think you'll be sorry if you do a year in Med-Surg. Good luck with whatever you decide

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Specializes in Critical Care.

I'm going to come from a different angle on why you should do at least 6 months on a med surg floor. I did that, and am in the ICU right now, and Med Surg helped me trememdously. If you can handle 6-7 patients and their problems, ICU is a cake walk! I find ICU nurses complaining all the time how hard their job is, and I tell them to try Med Surg for awhile, and they will change their tune. But, I digress, I seriously think you should start in Med Surg to gain respect for that field of nursing, and the nurses in it. Mind you, I am now an ICU nurse, but some of my fellow ICU nurses wouldn't talk to their dogs the way they talk to floor nurses. I get very angry with that kind of disrespect. ICU always gets the reputation as "******." Most of the med surg nurses could run circles around an ICU nurse, but because we hang dangerous meds, or take care of vent paitents, we think we are superior and thats not the case. Don't get me wrong, I have 2-3 patients in the MSU-ICU, and I am beat at the end of the day, but I think what made me a good ICU nurse, was being a good Med Surg nurse first. Six months goes fast. My daughter just became a nurse and she listened to my advise about med surg, and she handles a load of paitents with ease. When she makes the step into critical care, she will hit the floor running and not be a scared newbie.

Doris

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