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!
I started directly into the ICU right out of school, and I'm doing okay. BUT, if I had it to do all over again, I would have started in med-surg. I do not think that my hospital's ICU training program is adequate (barely 2 months, including 30 days of precepting), and the new grads get the exact same orientation as the nurses who had med-surg experience.
I watch the nurses who came to my unit with med-surg experience, and they just seem so much more composed and relaxed than the new grads. Most of my patients come from the ER or the floors where they have already had IV's started, Foley's inserted, etc... so even now (after 6 mos. on my own in ICU) I have less experience and comfort performing these skills than I would like.
I think that you should research the orientation training at the hospitals that you apply to before you make a decision on where you want to work. If the critical care orientation is not thorough and does not take into account your new grad status, then I would pass on critical care and take a position in med-surg. Six months or one year of your life is not very long (my last six months have flown by), and you could get the confidence and skills to carry you to success in critical care.
I don't want to discourage you from going right into critical care if that's what you really want. Some of the older teachers at my school tried to talk me out of it, and I didn't listen to them (I thought they were just being old-fashioned). Also, as you mentioned, there was a little bit of an attitude around my school that you could enter critical care if you were "smart enough," and I, as a high-achieving competetive student, felt that it would reflect poorly on me if I started in med-surg (all the other "A" students were headed for ICU, ED, etc...).
Live and learn!! Things are not so bad for me, and I guess I'm proof that it can be done even under less than ideal circumstances, BUT I hate the feeling of always having to play "catch-up."
I agree that med surg is a great starting point. I did 2 years of MS before going to the SICU and it totally helped me with time management. You can take care of 6-7 pts with no problem and when you get to the ICU just your two pts can overwhelm you but at least you know how to time manage and proritize. I think it also gives you that time to develop your very important sixth sense. Just knowing or having that feeling like something is about to go very wrong with your pt is invaluable in the ICU.
If you feel in your heart that you want to do the floors first, then do it. If you want to be a CRNA, you can get that year of ICU exp in a year or so.
On a side note, I think that it is horrible that your nursing school announces with pride that alot of grads go into specialty areas. That is great that they are doing what they want to do, but that doesn't mean that the nurses that end up in m/s have failed, and didn't get their first choice job or something.
After nursing school, I went straight to the ICU in the hospital my school is attached to and after just completing my first year I have given this question considerable thought. I think people keep asking this question because there are so many variables that can make or break the situation. I don't feel savvy enough to make broad generalizations about nursing, but I can share my experience.
Overall, I remain satisfied with my decision to go right to the ICU after graduation. Outwardly, there were many things that contributed to my feeling this way; my preceptor loves to teach, my ICU welcomes new grads, the larger organization my hospital is part of has a significant amount of courses available to nurses who want to take them (mandatory but with pay for new nurses) and while I was in school I had several opportunities to spend time in both the ICU and ER, including 180 hours with a preceptor in the ICU during my last semester of school. Without a doubt, I feel that an investment has been made in my development.
Inwardly and at the risk of sounding arrogant, I feel that I had some things going for me that were equally important. Nursing for me is a second career and prior to coming here, I spent many years working in an environment that demanded prioritization and communication skills. Additionally, having some career success before coming to nursing gave me a base level of confidence in myself to ask questions without worrying someone will think I'm stupid while also giving me a history of difficult times I survived to look back on and take stock in when I struggled as a new grad. Lastly, for better or worse (sometimes I feel both) I told myself, "Self, I want to be in the ICU period". From what I have seen on my unit of new grads who did not have a similar feeling or for whom ICU was a second choice, I think the flow of the unit wore them down until they left.
As a newbie with limited experience, I see choosing any one unit as a somewhat limiting decision. There are times I wish I had the basic skills efficiency of friends I graduated with who went to ER or Med Surg. By the same token though, they don't yet have some of the skills or confidence that I do with titrating drips or dealing with vents or dealing with unstable patients (and their families) in general. I respect the view of some seasoned nurses that everyone should do med surg first; I think I can see where that would be helpful. On the other hand though, my experience is that it worked out for me and quite a few people I know. The only recommendation I could make to someone, based on my experience, is that it seems almost impossible to survive in the ICU unless you really want to be there.
Good luck and I hope the long winded answer was useful to somebody.
I went straight into ICU after 16 months of nursing school. I had some previous college and so I only had to do 4 semesters to graduate. My school doesn't do summer break.
Anyway, our orientation was 1 week in the classroom and 12 weeks on the floor. 10 weeks on the floor was 7a-7p. The last 2 weeks are 7p-7a as the general rule is new grad nurses go to nights first. Nights are ALOT slower so you've got alot more time to digest things.
Anyhow, I finished orientation last week. I went to the hospital today find out my schedule and they asked me to stay and work for 4 hours which I did. I got a post op admission and it went fair since I had an LPN helping me. I was still 30mins late going hope.
Anyhow, I feel comfortable. I am the worst (THE ABSOLUTE WORST!!!) with managing tasks. That's why I picked ICU. Two to 2.5 patients vs. 6-7. God bless floor nurses.
I did my 135 hour internship in the ICU where I work so I was already pretty fairly familiar with how things went there. Then, I was a "nurse tech" for about 3 months on the floors. A "nurse tech" basically works as an LPN who can't pass meds so most of the time, if you don't mind, the floor nurses want you to work as an aide.
Anyway, doing my internship and working as an tech/aid at the same hospital at least got me familiar with the hospital, the computer system, the charting, etc.
The only drawback to my experience was that my preceptor was a Korean lady with 30 years PACU/ICU experience. Her english was such that she could answer my questions, but only in a basic way. Plus being an VERY experienced nurse, she did everything by feel instead of by protocol. Whenever I was helped by any of the newer, more American nurses, it reminded me how thick the communication barrier was between myself and my preceptor and how much more newer nurses respect hospital policies and procedures.
Anyhow, my preceptors (I had someone different for 2 weeks on nights) felt comfortable that I was ready to go out on my own. I'm sure I don't know what the hell I'm doing, but I know enough to know when, where, and from who to ask questions. I know my way around the unit and most everyone is really, really helpful. That's the key for me. It's a given that no one is gonna let you fall on your face where I work.
I say, if you want to, go ahead. In a lot of ways, floor nursing is harder that ICU nursing in my limited experience. As long as your hospital will give you an adequate orientation period, I say go for it.
. 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.
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.
Doris
I take offense with your remarks that med-surg nurses could run circles around an ICU nurse. I did FIVE yrs of Med-Surg before going into ICU. I don't think that I am superior BUT I DO think that because I take care of patients on the "brink of death" that it makes me higher caliber than a med surg nurse. Not every nurse wants to be an ICU nurse. I didn't want to go into ICU at first.....
ICU is certainly No cake walk.....when it's bad in ICU, it makes a bad day in med-surg look like a walk in the park.
Sorry Doris, but I completely DISAGREE with your post. I've seen a newbie graduate nurse darn near KILL a patient because they didn't know what they were doing and were too "haughty" to ask for help. There's a LOT to be said for humility in ICU. Know-it-all New Grads are the worst. Cause they don't ask questions till their patient is SERIOUSLY circling the drain.
I'm with Lou! I take offense to the idea that a med-surg nurse could run circles around me. Now a nurse who has worked in med-surg for 5+ years defiantly could on a med-surg floor, and i would be grateful for the advice i'd get from them. Stick that same nurse in my ICU, and i just might do the running. It that doesn't change the fact that ICU nurses deal with situations that would send most other nurses running for the hills.
I went from nsg school to the ICU, after 6 months of a hellish orientation (that i wouldn't trade for anything), i'm on my own and doing fine. yes, i still ask 5 million questions, and look up my meds, and research diseases i deal with. Recently I floated to telemetry (due to low census)-- had 3 days orientation; as opposed to the 3 months orientation for a tele nurse who wants to work in my ICU. Guess what? tele bores me stiff. ICU is a mental game, an emotional rollercoaster, a bunch of insolvable problems. Tele is a rat race, an organizational and juggling piece of art.
Yes, i have dealt with 6 pts and their problems, and it's not easy, but that doesn't make the ICU a cake walk. It's just a different set of problems. I've never talked down to a floor nurse, and I never will--that's just rude. But i don't insult my team either.
If I had to do it over again, I would still go straight to the ICU from nsg. school. If you find an ICU with a great orientation program, a good environment with loads of teamwork, and you don't mind coming home exhausted, or having your heart ripped out daily, i'd say go for it! It's not easy, but it's worth it (at least it is for me)
Thanks everyone for your responses! I really appreciate it. I certainly can see the value in working med/surg first before going into ICU. I think that I've decided, however, to go directly into ICU. The hospitals that I will be applying to are teaching hospitals with good internship programs, so I think I will have a decent support system in place. I know it will be a LOT of hard work, but I'm prepared to do it. I haven't graduated yet, but I have already taken an EKG interpretation course, and will also take an ACLS course, so I'm doing everything I can to prepare myself for this.
Furthermore, like I said before, I'm considering going to CRNA school, so I don't want to put another year delay on those plans, should I choose to do that. And if I choose to do that, I'd prefer to get a good 2 years of ICU experience in before starting a CRNA program, rather than 1.
Nevertheless, if I don't end up getting the ICU internship, I'll be happy working in med/surg as well. We will just see what happens. As much as of a typical control-freak future nurse that I am, I think that with a little luck and some hard work, things will end up working out like they are supposed to!
Congrats on making a decision! Considering you've put a fair amount of thought/planning into this, I'd say that whatever you decided would have been right for you. You will learn so much once you get there :-)
Entirely depends upon both the individual nurse, and the program they are considering. If you know you feel confident to try ICU, are a quick learner and feel comfortable learning a lot of new information, AND if your proposed position has a lot of support for newbies, go for it.
I know you have already made a decision, but here is just another vote for a year in med-surg:
Because you have a LOT more patients, you see a LOT more stuff. In the ICU you may see the same set of conditions (albeit very serious), whereas on med-surg you will see a real collectioni of stuff from serious to stupid. Having 5-7 patients a day gives you a wide variety of conditions, and therefore you can really improve your assessment skills. Let's face it, a lot of assessment has to do with whether you have seen something before.
It's not easy, but it's worth it (at least it is for me).thumb.gif.11fa0ddb3aacfb1b3953bc671abcfb7e.gif){kind=avatar}
msaaaz
16 Posts
for me i directly went to icu
but i think 3-6 month in m/s wards will be helpful to you