[Old_School]

The nursing shortage is hitting us all hard and we are scrambling for staff. However we are taking newly graduated nurses and trying to teach them intensive care. Personally, I've never been too keen on this idea. I feel that a new nurse needs to be experienced in basic nursing technique and time management before they venture into the specialty areas.

I remember when I started in nursing, the hardest thing was to get my tasks completed be the end of the shift. It was next to impossible for at least the first six months. How can we expect a new nurse to critically think about the patient when they are still trying to schedule a bath and pass the meds, even for two patients. Even with a preceptor, how much of this knowledge is so much wasted energy for the newbie? In the long term, how comfortable are they; really, when they are thrust out on their own?


Is there anyone out there that learned ICU straight out of nursing school that can change my mind on this issue? Is sending a newbie straight into a specialty the wisest thing to do?

O_S

[cassioo]

I've pretty much been with you on the need a broad base before you start a speciality. There is the exception to the rule..what about those people that know a speciality is what they want to do and know they won't want to do anything else. There are a few out there. The problem comes in if they work someplace where they can be pulled to a general unit and have never had to juggle a load of patients instead of a pt or 2 with lots of things to do.

There are more and more people entering nursing school who are over 30, 40 and even 50. They started nursing maybe because of something that happened in their life and saw they wanted to work in ICU, ER, L&D. Why should they spend a few years working in a general unit if they are dead set to work that speciality unit? If they are working that speciality unit they should be all that they could be in that speciality.

[JoeyWit]

Here is my experience with new grads in a CVICU unit:

I was the first new grad in a long time to be hired, but since I had been an LPN for 15 years prior, no one really could tell. Therefore, one caveat would be the prior experience of the new grad.
There was a great deal of prejudice against the abilities of new grads to cope that was expressed when the next new grad came along, but always with the point that I was "different." Yet, she also proved capable.
Since then, all of the new grads we have hired have been Nurse Externs first. They get exposure to our unit and the demands of cardiovascular care, and we get to know their skill level. Of the 5 externs we've had, we have hired 4.
What is more important than any other factor in the survival of a new grad in any area is the orientation they receive. Our new grads get a minimum of 12 weeks, no exceptions. Many classes during that time are required as well. And the ones we've chosen (including myself) came to orientation prepared to be as flexible as necessary for the 12 weeks to benefit from all the teaching opportunities available to us.
The pool of available experienced nurses can only increase if we take chances on new grads, and give them all the advantages possible for them to be successful in their chosen area.

[DMyers]

:39: Hi Guys, I was hired for the ICU before I even graduated from nursing school. I am still in the same ICU and it has been 17 years. Boy, I feel tired all of sudden! Anyway, I am now considered a "strong" nurse and I must say I love being in the ICU.

I feel that any new grad. should have at least 3 letter of references from nursing instructors. I know our local nursing school has eyes and ears for any student that may be mature enough to work in ICU and passes that info. along.

I worked my butt off. I was taking a critical care coarse and working in the ICU at the same time. I worked with women that had at least 15 years of experience and the balls to prove it. They had me doing all sorts of things. I remember assisting a doc with placing a bolt in a pts. head. I helped with PA cath placements. I am greatful to these strong women they gave me confidence and the knowledge to care for my pts.

It is us to your managers to have the guts to allow the staff nurses to sit in when these students are being interviewed. Because bottom line we are the ones with the gut feeling about a situation. We are the ones at the bed side reading and weighing the situation and we have skills time has given us to know if something or someone is going to workout.

Thanks girls for letting this old grad. give her thought. DMyers

[courtney]

I had posted on another site about how I was needing some feedback about being offered a job on a med floor and the NICU. I am still a student nurse. I appreciate your insight on critical care. I think it will probably be best for me to start on the med floor then move into critical care. I have a few fellow classmates who have accepted jobs in the ICU, and they probably will be very good nurses. But as for me... one step at a time. Anyway, thanks again for your insight.

[cityslicker2]

Are we doing the right thing? Well are you giving the nurses support or are you scrutinizing their every move? Are you giving them positive reinforcement or are you giving them those unaccepting glances? Are you talking about them lound enough so they can hear you? Are you chosing to get report from them or are you using the time to chew them up and spit them out? Maybe newer nurses would have an easier time if they had some REAL support. I am a former ICU nurse, I only lasted 6 months after being a nurse for one year. I had such a bad experience I am now questioning every skill I ever had. I'm sure you would give support but I want to remind all nurses....don't use a new nurse to build your self esteem when it's really all about the patients!

[TomB]

I went directly from school to a very large neuro ICU. My biggest problem was time management - but I think that's going to be the case wherever you work.

What helped me was a great orientation program and a preceptor that was very supportive. After I was on my own, my fellow nurses continued to be helpful and supported me 100%.

As the earlier post mentioned, I think it has everything to do with the attitude of the staff to the new grad.

People tend to think that ICU/critical care is "special" or "better" or "more important". I couldn't disagree more. It's just a different skill set.

[connyinf]

All of you have great answers and some of you really proved that with exceptions, new grades in the ICU is a possibility. But, I entirely agree with Old_School, she took the words out of my mouth! We, however, had 2 RN's that were PCA 1st and followed the ECCHO program and are doing fantastic!:houra:
But it is not for everyone, theses nurses are also very inquisitive and have initiative, they also passed the "horror" of the intimidation of approaching patiences and families. The respect and compassionate/human aspect of this kind of work is essential!
Some people can never make it, like I could never be in pediatrics!
To each is own and it is important that people realizes their weakness to improve themselves or get out of the boat, because a lot of people could drawn!

[NEHuskerRN]

I came right out of school to 2 ICU positions simutaneously (one MSICU, one CICU). Althought it was a long 6-7days/wk for 4 months (due to simutaneous schedules), I had amazing preceptors, awesome educational CC courses, and alot of hands-on. After a year, I was able to transfer to Cath Lab (where I had originally done an extended nurse extern position thru school) and CVICU (again at the same time). I am now a travel nurse after "2yrs" experience, and am helping others out as much as possible wit their new nurses-to-the-ICU. We were all new at one time, and just have to help out whenever possible to learn; too many positions are open/unfilled, ect and unfortunately can't go empty; we just have to adjust until the mgmt gets their heads out of their "booty".

[gracie1]

Where I work new grad hires to the ICU must first orient and then work in the stepdown unit for about 4-6 months before moving on to the ICU. They then spend time orienting specifically in the ICU. They usually extern extensively in med-surg during school. And the Manager checks with the floor they extern on to make sure they will have what it takes.