Thoughts on a new grad RN going straight to ICU?

[Jace_b7]

I am currently a nursing student that is set to graduate in August 2020, as time is approaching to be sort of gauging on where I potentially would like to work and considering my long-term nursing career goals, I am seeking opinions on whether or not a new graduate RN should get a job in an ICU. I have some professors telling me going into ICU straight out of school is not a big deal, and then I have been told the complete opposite. I can very much understand the rationale of not jumping straight into ICU, however, I am looking for more thoughts pertaining to this as it seems to be a very debatable topic.

[CCU BSN RN]

I'd say nurses are pretty evenly split on this. Both sides have valid arguments, and the only way to know if you'll sink or swim is to jump in and find out.

Sure, you can stack your odds with a good manager, adequate staffing, a good unit culture, a long orientation/residency peppered with classroom training, but at the end of the day, it's still a gamble.

The one thing I'd keep in mind is that the margin for error in ICU can be very small. Making wrong decisions, waiting too long to ask for help or page a doctor, not noticing a problem for an hour or two, failing to correctly prioritize your tasks...Yes, plenty of patients have slim odds of survival no matter what you do, but the ones we CAN save...its really hard to make sound clinical judgments right out of school and have the critical thinking necessary. It absolutely eats at you and can really mess you up when you have those cases where you feel like it's your fault someone died or had a bad outcome. It's a lot of responsibility to bear for a new grad. I've known young women who have killed themselves or gotten out of nursing entirely within a year of starting in ICU. And to be fair here, I've known a few who coped well and did fine. But that miserable year or two in med/surg or tele or stepdown...its not that you need to learn to be a great med/surg nurse, you're honing critical thinking and assessment skills, learning how to tell when a patient is in serious distress and about to crump, and how to cope with a job that is often going to try to beat you down. Aggressively. And you're doing it on a unit with generally lower acuity so that the margin for error is larger. In general, patients outside of ICU can be ignored for 30-60 minutes without dying. You can take a beat to decide how to handle something, or to think about WHY their BP is running low or they're febrile or tachycardic or whatever it is that's going on. You'll see plenty of high acuity events almost no matter where you go, I promise.

[KeepinitrealCCRN]

Nope, it is a bad idea. There are very few situations where I think it would be ok.

1. You already work on that unit as a PCA.

2. You have a 6 month orientation.

Outside of these 2 options I think you are doing yourself a disservice.

[CeciBean, ASN, RN]

One hospital I worked at as a traveler had a year-long internship for new grad RNs, which I thought was great. When they got out of that, they were ready for anything that came their way. One was getting out of her internship when I was there and there was a big party for her.

On the other hand, they gave travelers 8 whole hours. Yippee skippee. I got 3-4 DAYS everywhere else I ever went....mostly tele or stepdown units. Never recommended that unit to anyone after that, for a myriad of reasons.

[smf0903]

It really depends on the facility. Where I work, a new grad has zero place being in the ICU for a number of reasons: orientation is way too short (maybe 6 weeks), the support staff can be literally non-existent on shifts as we have many supervisors and charge nurses who have never worked ICU, some of our docs like to dump off hot messes of patients, and there are many times it’s just you and an aid in the unit. This is a setup for disaster for a new grad.

Now, if you have a facility that does a superb job of orienting and has a great support staff then I say go for it.