Heather,

This is a very "emotional" issue for me. As a preceptor and as someone who was a nurses' aid, then worked the floor before specializing in Critical Care, I have some very strong opinions regarding new grads in the ICU. Opinions that are not always popular....

Your experience will eventually make you a stronger nurse. For some that experience may be having a child, for others it may be surviving a major accident and/or surgery and for you it may be being a CNA. Please note what I said: "... EVENTUALLY..." because being a nurse is different than being a CNA or any receipient of care. By the time you enter the Critical Care as a nurse (in my opinion) you should already be a skilled nurse who now needs to specialize.

Of course with the nursing shortage, they are taking almost any new grad into critical care. This is to the detriment of the new grad, the other nurses and more importantly, to the patients.

I believe that new grad RN's should NOT go into the ICU. But I know that is like saying that I don't believe in pre-marital sex. New grad RN's will be an ICU issue as long as there is a nursing shortage. So...

If you want to go into the ICU as a new grad RN, keep these in mind:

1. Do I have the prerequisites to work in the ICU?

If the job recommends or "high suggest" that you be ACLS certified, then you should meet these requirements prior to taking that job. If you can't pass ACLS, then ICU is not for you. Also, if you are told that you'll get it during orientation, stop right there because it's too much for most people to handle; orientation with obtaining certifications along the way. If you did not become ACLS certified during you last year in school, then I'd argue that Critical Care can wait.

2. How long will your orientation be? At what point will I get WRITTEN feedback regarding your progress? Can orintation be extended if YOU'RE not comfortable? How many times can it be extended? Also, ask how many new grad's from the last orientation group DIDN'T make it... that will give you an idea of the orientation success rate.

3. How many preceptors will I have?

This question is probably the most important question to ask. When I work CVU at "a major medical center" in LA; preceptors were commonly pulled to take care of the pediatric patients on the unit and that left the orientees to be precepted by OTHER NEW HIRES. Not ideal. In fact it was terrible. It's the blind leading the blind. If they promise two preceptors or less, that's super, but GET IT IN WRITING! Remember that orientation is the time for you to learn the skills of another; not be confused by the shortcuts of a dozen or more....

4. Will I get a formal, PAID, Critical Care Course? What are the requirements in order to pass the class? How much do I have to score on the final?

5. Demand that you work in the ICU for ONE SOLID YEAR before you move on to learning Swan caths or other high rish invasive devices. And then get it in writing!

I know that Swan caths are going out of favor, but it's the major tool that seperates ICU nurses from everyone else. If you can just forcus on being an ICU nurse for a year, then dealing with Swan's will be easier. During orientation is too much. Trust me.

I think I have a million other suggestions for questions/request to make prior to taking a job in Critical Care for the first time, but I will stop here.

I hope this helps..

I have to agree with Bossy. When I first graduated I thought critical care nurses only wanted to keep us out b/c they wanted us to suffer through medsurge just as they had. I went to medsurge and pcu to gain some baseline experience with the goal of going to the unit. I enjoy what I do and so have worked here for a while but here is the point. I have seen critical care nurses leave the unit for whatever reason and try to go to medsurge, pcu anything with more than 2or 3 pts and if they have not had floor expereience they always fail. Critical care is a specialty and it is very hard to go backwards to caring for 8-10 pts. The assesments are less in depth but you have to be fast. You may think but I would never leave the unit but you may. Suppose you were to transfer somewhere and cc was full so you had to take a floor position until something opened up. I promise get some experience first. I worked as a CNA prior to nursing school too for a long time but that initial nursing experience is completely different. At least get six months or so than go to the unit as a better nurse.

ICU vs. FlOOR nurse.
I, too, agree with Bossy in most of her points. I have been an ICU nurse for 17 years. It is totally different from floor nursing. In a "real" ICU, the patients are much, much sicker, with several or more gtts going. In the ICU where I work, almost every patient has a Swan-ganz catheter, a balloon-pump, or something that requires experience. They wouldn't hire you if you refused to manage a Swan! With med-surg nursing, you learn to organize your time, learn the medications, learn the basics of nursing. As an ICU nurse, you are expected to already know how to accurately assess the patient, manage the critically ill patient, and know how to manage and quickly titrate gtts that affect blood pressure and heart rate. How on earth could you work in a real ICU without ACLS!? That is a minimum requirement! I have also done emergency room nursing, and it is a lot easier than ICU. There, you focus on the reason they came into the ICU, stabilize them, and send them elsewhere. The paperwork is a lot less in the ER, too.

Re: New Grad ICU Internships


Don?t confuse CNA experience in any setting with the ability to be a skilled nurse in that setting. The day you get your RN license, you?ll be one of the best educated and highly certificated CNA?s, but the newest of the new RNs.

It?s never popular to say that new grads should get experience within their realm of expertise (Med Surg) before branching out. The real life truth is that we have fewer and fewer critical care nurses with sicker patients and we need the absolute best of the best crusty bitchy nasty hard to get along with smart as hell critical care nurses running the show.

Don?t be discouraged. You can get there. You need to become an incredibly well educated nurse capable of sophisticated thought and instant decisions, but that takes many many poor decisions and many many patients to figure out. Work out your time management issues, your insecurities, and your confidence in your expertise first.

I grew up hard and fast in ICU after school with a great preceptorship and didactic, but later realized my patients would have benefited from me being an all around expert before being a specialist. I also remember someone telling me that in the ER and in critical care ?you don?t have to always be right, you just can?t ever be wrong?.

I have to agree.
I my self am a nursing student (hopefully a grad in May06) and currently doing my preceptor ship in CCU. It is very interesting and provides a continuous learning advantage, however, a new nurse does not have the assessment skills and medical know-how that even a year graduate may have. I am an LPN and still feel that there is so much I would not know in that unit. A solid nursing base is a start and CCU is definitely attainable with a little experience. That little you learn in a year can save your patient and even maybe your license. :wink: