Worried about the future of ICU nursing

[Telenurse1990]

I just recently started a new job as an ICU nurse at a large facility in California and some trends I've noticed over the years have stuck out to me. It worries me when I walk into a new facility, especially in the ICU and see all new and inexperienced nurses. Every new grad I meet wants to be a CRNA or an NP. And after 8 years, I found myself in the same boat. But I started to wonder what it's going to be like in the future if no one stays and gains experience? It's great that people want to advance their educations, but I feel that we've done a disservice in some way by not encouraging people to stay at the bedside. In part I blame hospitals for crappy ratios, caps in pay and lack of ancillary support.

This is just a random thought in my head that I felt like getting out there. What do you guys think?

[Forminsko]

This trend is alive and well in the hospital where I work, too, though there are a lot of veteran nurses on my MICU. It's like you said: the new nurses coming in aspire to NP, etc. I think it has to do with the perspective the new nurses have. I am relatively new, myself, so I have watched it, and maybe my experience is similar to others' (though I do not want to be an NP, myself.) When I started my pre-reqs for my ASN, it was still a viable option to just have an associate's degree, though of course the move toward BSNs was already starting. By the time I finished my ASN, several years later because it was almost impossible to get into the prerequisite classes because they were so in demand, it was clear that a bachelor's degree was going to be a necessary next step. I went ahead and got mine, but by the time I finished that, (this past Spring), it started to look like the only way to open up any career options for one's future--whether near or far future, mind you--would be to get a master's degree. It's like the goal posts keep being moved. This trend is a little discouraging to me as someone who came to this career as a second career later in life. Still, bedside nursing, I am sure I needn't tell you, is so taxing, physically and emotionally.

[KeepinitrealCCRN]

I think it starts in nursing school. A lot of my professors would say things like "when you go to graduate school" or "get some experience and then become an NP", as if being an RN was a stepping stone. This may be a good thing for RNs though, hopefully the salary will increase for us as the demand increases especially for experienced RNs.

[LovingLife123]

Grad school often requires icu experience. If their end game is NP or CRNA, why do they want to spend years on a medsurg floor, the icu, then grad school? I can understand it to an extent. But then it's up to management to ensure a floor has a good mix of new grads and experience.

And let me say, not all floor nurses are meant for icu. I've seen many new grads flourish where floor nurses have a harder time sometimes grasping the speed abs attention to detail icu requires. I've seen both succeed and fail.

Experienced icu nurses are what needs to be retained. But with pay being what it is, the lure of grad school is too great. I can make what an NP makes at bedside, but the family sacrifice is too great.

[mtmkjr, BSN]

There will be a lot of frustrated nurses down the road then, because the market can only handle so many CRNAs... No way are all the ICU nurses going to find their way out through that route.

[adventure_rn, MSN, NP]

There will be a lot of frustrated nurses down the road then, because the market can only handle so many CRNAs... No way are all the ICU nurses going to find their way out through that route.

I think that's where the super-competitive admissions comes in. I've known a few pretty disgruntled ICU nurses who have applied to CRNA school for years without getting accepted.

I wonder if a lot of it has to do with burnout in the ICU. It can be pretty stressful and exhausting (mentally, physically, and emotionally) to care for such sick patients. It may just be an inherent part of the specialty, although hospital factors like crappy ratios and unsupportive management certainly don't help.

I do agree that it's a pretty concerning phenomenon (especially when you work night shift and nobody on the unit has more than a year or two of experience).

[smf0903]

I started in ICU about a year ago. There is one other person working nights in our ICU who has more ICU experience than me. I think that's shameful.

Speaking from my own experience, I have found that my manager seems to poo-poo the idea of staying as a bedside nurse. It's always "where do you see yourself in 5, 10 years? What do you want to be doing?" When I answer that I like bedside nursing and hope to be a pretty darn good ICU nurse in 10 years it seems as though that's some sort of let-down. It seems as though i'm expected to have "higher aspirations" than staying as a bedside nurse. I don't want to be an NP or CRNA, etc. I want to be a bedside nurse, I LIKE doing it. I like the learning. I like the interaction with patients (well, most times ) I think it's sad that there are very few well-seasoned bedside nurses where I work. Who do we learn from when everyone has fewer than 5 years under their belts? Day shift has more seasoned nurses but nights, forget it.

[PMFB-RN, RN]

This is exactly why one ICU where I work actually prefers Associate degree RNs. Sure some of them go on to grad school, but fewer of them, and those who do send more years at the bedside first.

[mushyrn, BSN, RN]

I often see nurses complaining that new nurses "just want to be a NP or CRNA and not a nurse". We don't have this same complaint about biology majors who want to become a PA. Biologists aren't decrying undergrad biology degree holders for getting that degree to pursue their end goal, which is to become a PA. Some people, surprise, have an end goal as an APRN.

To become a CRNA or NP, you have to have the required experience for that level of practice. You can't fault nurses for having an end goal of becoming a CRNA, NP, CNS, manager, educator, etc. They are following the rules.

Be concerned about poor staffing, sad management, the money grabbing business healthcare has become in the face of capitalism, the egregious amount of money CEOs make, etc. I agree with your last few sentences, and these are very valid concerns for the future of nursing and healthcare in general. We keep hearing "there is no money", yet the CEO and board members are making bank, hospital logo's are stamped onto everything, bonuses are given out like candy to management, etc. It's a mess.

[Medic_Murse, BSN, RN, EMT-P]

Hate to break it to you, but this is like any other profession. In the day, if you had a high school degree, you could find a steady profession. Then, more and more professions wanted a four year degree. When I finished my first four degree I was young and dumb thinking I was set for life. Reality set in and realized that a four year degree was the new high school diploma, if I wanted to go anywhere, I needed a masters, doctorate etc.

Now, nursing is catching up to that, but it has a lot more flexibility than a standard job. If you want to be a grunt and stay in the trenches (where I am and love to be) you can. If you want to broaden your scope of practice, or look for something outside of bedside nursing, you have to go to school and get that advanced degree.

There will always be those that love getting dirty and fighting in the trenches, but again, nursing has become a profession like any other professions. There will be those that get their RN and then go for CRNA or NP or DNP. Power to them, but there will always be the backbone of those of us, that just enjoy being RN's.

[ICU/EMTP, BSN, EMT-P]

If conditions in bedside nursing don't improve, this will be the norm. The "money first" attitude while making the RNs responsible for the barely attainable "patient satisfaction" benchmarks along with ridiculous things like the 5 p's and hourly rounding are driving people out at a fast rate. No, everyone can't or won't move on, but the number of people staying at the bedside as a career is definitely declining.

[bryanleo9]

There will be a lot of frustrated nurses down the road then, because the market can only handle so many CRNAs... No way are all the ICU nurses going to find their way out through that route.

Same with NP's. So many schools pumping out grads and the jobs just aren't there in this area. I have searched repeatedly and see few jobs with the vast majority requiring 2 years experience. So the few jobs out there require you to already be an experienced NP. Northern California is flooded with NP's.