Thinking of starting in the ICU

I am graduating from an RN program in December, so it's time to start getting those interviews arranged. Up to a few weeks ago, I was sure I wanted to go straight into the ER on graduation, but then I started falling in love with critical care nursing, and I am thinking hard about it. I have a pretty good grasp of Patho, still a lot to learn, my skills are pretty good, I've been able to manage 4 patients on a renal floor during clinicals, and my instructor, who had been in critical care for many years, seems to think that I'm a good fit for the critical care environment. I eventually want to go into Trauma, and would love to become an NP down the line. I have read a lot of the posts here, and I am still weighing things out in my mind. But I do have some questions:

1. Does having critical care experience open or close doors to future opportunities on other floors? My hospital has a bid system where you can pick up shifts on other floors, and I don't want to be locked out from doing this. Especially I would love to be able to work in the ER.

2. What are the things I need to polish up on and have a good grasp of if I am to start in the critical care unit? I am a self-motivated learner and do a lot of extra reading on stuff coz I find it interesting.

3. What kind of tasks do critical care RNs do the most?

4. What's the general environment like?

Any more tips and ideas?

thanks all![/quo

Critical Care will open doors for you. So much teaching and learning goes on in ICU's. I congradulate you on your graduation and ur obvious excitement in starting ur career. That said, IMO only, you need to have some experience in med/surg prior to working in a critical area. "tasks" are not what is important,it is the ability to assess,critical thinking ,"gut feeling",priority skills, time management,and so much more. In my experience,(not always,but many) new grads coming into a icu become task oriented. Machines,monitors,pumps,etc,,, all valuable tools but will not give you the info u need the most,and that u get from the pt. Treating the pt,not the numbers,comes with experience. Sorry, just what have seen throughout the years. Good Luck!

Critical Care will open doors for you. So much teaching and learning goes on in ICU's. I congradulate you on your graduation and ur obvious excitement in starting ur career. That said, IMO only, you need to have some experience in med/surg prior to working in a critical area. "tasks" are not what is important,it is the ability to assess,critical thinking ,"gut feeling",priority skills, time management,and so much more. In my experience,(not always,but many) new grads coming into a icu become task oriented. Machines,monitors,pumps,etc,,, all valuable tools but will not give you the info u need the most,and that u get from the pt. Treating the pt,not the numbers,comes with experience. Sorry, just what have seen throughout the years. Good Luck!

Thanks for your feedback. I have already received this response many times when I have mentioned wanting to start in the ER, and I am familiar with the fact that in these intense units (CCU, ER, and indeed the entire hospital), you really do need "the ability to assess,critical thinking ,"gut feeling",priority skills, time management,and so much more". I understand all that and I thank you for reiterating it.

The reason I ask about "tasks" is because I want to know what skills and procedures I need to read up on and go to the lab to practice while I am still in school before graduation.

I appreciate your opinion, and I am sure there are many who echo it. So any information on the Critical care environment re the questions I asked will be greatly appreciated.

thanks again!

It sounds like you are the perfect new grad to start right out in the ICU. Personally, my belief is that there is no reason why a new grad can't be successful starting right out in ICU. I have been an ICU nurse for about 18 months now and a few months after I started two new grads were hired. They both were given extended orientations and after they were on their own they were given the more stable patients. One of them is doing really well and the other is still struggling. I have spoken to both of them and by far the hardest part was the attitude of some of the nurses who felt they had no business starting in the ICU as a new grad. I know it was brutal for the new grads, but I can also see the other side. The nurses want to have coworkers who can cover their backs and be there when a patient is going bad. They want coworkers who are assets and not liabilities. It takes a while for a new grad in whatever area they start to have a global awareness of what is happening around them. And I want you to know that my unit was set-up for it and had preceptors who really were and are committed to having the new grads succeed. So I would just warn you to be ready for at best skepticism that you should be there and downright resentment that you are there as a new grad from the occasional nurse.

If you are going to succeed, you are going to have to let that attitude roll of your back, to stay positive and forgive quickly. Also, when you have your feet wet and one of those nurses asks for help with a turn, be ready and willing to help. That will ease their fears that you are looking at the welfare of the whole unit....

Thanks for your feedback. I have already received this response many times when I have mentioned wanting to start in the ER, and I am familiar with the fact that in these intense units (CCU, ER, and indeed the entire hospital), you really do need "the ability to assess,critical thinking ,"gut feeling",priority skills, time management,and so much more". I understand all that and I thank you for reiterating it.

The reason I ask about "tasks" is because I want to know what skills and procedures I need to read up on and go to the lab to practice while I am still in school before graduation.

I appreciate your opinion, and I am sure there are many who echo it. So any information on the Critical care environment re the questions I asked will be greatly appreciated.

thanks again!

I am sure that your instructor can inform you whats available in your lab that pertains to icu nursing. Tasks such as aline dsd,swan dsd are not unlike a routine cvp dsd's,very sterile. Swan line numbers and interpretation,use and diag.relations can be read in most critical care books.ACLS is a requirement usually within 6mths of hire into ICU and in order to travel with critical pt. So much, you will learn it in time.

Most critical care nurses are very strong willed and can be a bit controlling,somewhat ADD about pt appearance and care. Just a few of our many personality traits. We work hard, and are hard on ourselves and sometimes others. Very tense unpridictable enviorment requiring readiness at all times for whatever comes your way.

Review critical care drugs commonly used in the facility u will work. Pressers,sedatives,pain meds,ACLS drugs.Common replacements,(k,ca,ca glu.) Blood glucose protocol,strictly adhired to in ICU pt's due to healing and wide use of steroid treatment.

I could go on and on. It will come. I can tell by ur responce that u can stand on ur own. Have fun with what u choose and choose well . Lots of great things ahead for u I am sure.

1. does having critical care experience open or close doors to future opportunities on other floors? working in the icu opens many doors for both educational and career advancement. most ers want nurses to have a few years of icu experience before working the er. being an icu trained nurse looks great for becoming a np too! by the way, the ed is considered a critical care area too.

2. what are the things i need to polish up on and have a good grasp of if i am to start in the critical care unit? i am a self-motivated learner and do a lot of extra reading on stuff coz i find it interesting. that is great that you like to learn, the icu is a good place for people that like to learn. polish up on your assessment skills... if you have good assessment skills to start with, it will make things a lot easier. you can also brush up on procedures such as iv insertion, ng insertion, etc because you will be doing that often. also brush up on procedures such as intubation, central line insertion, etc that you will be assisting doctors with. start reviewing medications that you will see such as vasopressors (neosynephrine, dopamine, levophed, etc), sedation drugs (ativan, diprivan, etc), and any other medication that is common in the icu (cardene, heparin, nexium, etc) make sure your cpr skills are up to date and get into an acls class as soon as you can after you start your job. you can start reviewing acls protocols and medications now because those will help you understand why we do certain things during a code because i guarantee that you will participate in many codes as a critical care nurse.

3. what kind of tasks do critical care rns do the most? asking what specific tasks is basically asking a question with an answer that goes on forever. critical care nurses do many many things. we provide basic patient care such as bathing, assessing, medication administration, etc. critical care nurses also provide advanced care to our patients... critical care nurses are able to do things that nurses on a general floor are not able to do such as give certain medications. most icus have a lot of standing orders which means that we are allowed to do certain things and give certain medications without calling the doctor. for example, we are allowed to order an x-ray after certain line insertions (corpak, central line, etc) many critical care nurses go on for extra training for things such as picc line insertion, etc.

4. what's the general environment like? the icu is usually a fast paced environment where things can change in a heartbeat (or lack or one...ok bad joke) some days it is quiet in the icu, but that is usually the calm before the storm. some days it is so busy that you never get a break and you end up working overtime (yep, you can go 17 hours without eating only going to the bathroom once)

any more tips and ideas? if you like the critical care environment, then go for it, i did!! my advice that i give to all new grads is, learn all you can, listen to what your preceptor says, take every opportunity you can, and never give a medication you don't know or say you know something when you don't. never be afraid to look something up! good luck!!!

it sounds like you are the perfect new grad to start right out in the icu. personally, my belief is that there is no reason why a new grad can't be successful starting right out in icu. i have been an icu nurse for about 18 months now and a few months after i started two new grads were hired. they both were given extended orientations and after they were on their own they were given the more stable patients. one of them is doing really well and the other is still struggling. i have spoken to both of them and by far the hardest part was the attitude of some of the nurses who felt they had no business starting in the icu as a new grad. i know it was brutal for the new grads, but i can also see the other side. the nurses want to have coworkers who can cover their backs and be there when a patient is going bad. they want coworkers who are assets and not liabilities. it takes a while for a new grad in whatever area they start to have a global awareness of what is happening around them. and i want you to know that my unit was set-up for it and had preceptors who really were and are committed to having the new grads succeed. so i would just warn you to be ready for at best skepticism that you should be there and downright resentment that you are there as a new grad from the occasional nurse.

if you are going to succeed, you are going to have to let that attitude roll of your back, to stay positive and forgive quickly. also, when you have your feet wet and one of those nurses asks for help with a turn, be ready and willing to help. that will ease their fears that you are looking at the welfare of the whole unit....

thanks for the advice, i will definitely keep this in mind. letting a lot of things roll off my back is something i have become accustomed to since starting nursing school. i used to be very sensitive to people's attitudes and words to me, but i have found that i am able to actually deal with it much better on the floor by remembering that it's all about the education and me becoming the best i can be and learning all i can even if it's being yelled at me!

i am sure that your instructor can inform you whats available in your lab that pertains to icu nursing. tasks such as aline dsd,swan dsd are not unlike a routine cvp dsd's,very sterile. swan line numbers and interpretation,use and diag.relations can be read in most critical care books.acls is a requirement usually within 6mths of hire into icu and in order to travel with critical pt. so much, you will learn it in time.

most critical care nurses are very strong willed and can be a bit controlling,somewhat add about pt appearance and care. just a few of our many personality traits. we work hard, and are hard on ourselves and sometimes others. very tense unpridictable enviorment requiring readiness at all times for whatever comes your way.

review critical care drugs commonly used in the facility u will work. pressers,sedatives,pain meds,acls drugs.common replacements,(k,ca,ca glu.) blood glucose protocol,strictly adhired to in icu pt's due to healing and wide use of steroid treatment.

i could go on and on. it will come. i can tell by ur responce that u can stand on ur own. have fun with what u choose and choose well . lots of great things ahead for u i am sure.

thank you very much. definitely a good list for me to start working with! i appreciate your detailed reply. thank you for the wishes. i am looking forward to being an rn, and to bringing the best i can to my patients and to the profession.

1. does having critical care experience open or close doors to future opportunities on other floors? working in the icu opens many doors for both educational and career advancement. most ers want nurses to have a few years of icu experience before working the er. being an icu trained nurse looks great for becoming a np too! by the way, the ed is considered a critical care area too.

2. what are the things i need to polish up on and have a good grasp of if i am to start in the critical care unit? i am a self-motivated learner and do a lot of extra reading on stuff coz i find it interesting. that is great that you like to learn, the icu is a good place for people that like to learn. polish up on your assessment skills... if you have good assessment skills to start with, it will make things a lot easier. you can also brush up on procedures such as iv insertion, ng insertion, etc because you will be doing that often. also brush up on procedures such as intubation, central line insertion, etc that you will be assisting doctors with. start reviewing medications that you will see such as vasopressors (neosynephrine, dopamine, levophed, etc), sedation drugs (ativan, diprivan, etc), and any other medication that is common in the icu (cardene, heparin, nexium, etc) make sure your cpr skills are up to date and get into an acls class as soon as you can after you start your job. you can start reviewing acls protocols and medications now because those will help you understand why we do certain things during a code because i guarantee that you will participate in many codes as a critical care nurse.

3. what kind of tasks do critical care rns do the most? asking what specific tasks is basically asking a question with an answer that goes on forever. critical care nurses do many many things. we provide basic patient care such as bathing, assessing, medication administration, etc. critical care nurses also provide advanced care to our patients... critical care nurses are able to do things that nurses on a general floor are not able to do such as give certain medications. most icus have a lot of standing orders which means that we are allowed to do certain things and give certain medications without calling the doctor. for example, we are allowed to order an x-ray after certain line insertions (corpak, central line, etc) many critical care nurses go on for extra training for things such as picc line insertion, etc.

4. what's the general environment like? the icu is usually a fast paced environment where things can change in a heartbeat (or lack or one...ok bad joke) some days it is quiet in the icu, but that is usually the calm before the storm. some days it is so busy that you never get a break and you end up working overtime (yep, you can go 17 hours without eating only going to the bathroom once)

any more tips and ideas? if you like the critical care environment, then go for it, i did!! my advice that i give to all new grads is, learn all you can, listen to what your preceptor says, take every opportunity you can, and never give a medication you don't know or say you know something when you don't. never be afraid to look something up! good luck!!!

thanks for taking the time to answer each of my questions in such detail. this is exactly the kind of information i need!

You are so keen and I love that.

I personally would go, if you are able too, straight into ICU.

You will gain your knowledge and skills while working and being preceptored there.

My Daughter went from her training straight into ICU and LOVES it.

She had the desire to do just this but is working on becoming an anesthetic nurse.

I wish you well in your NCLEX and future as an ICU RN. :)