I am a new grad and have been hired in the ICU. I feel like all I do is titrate meds and chart. How do I find where I "fit in"? Transfer to medsurg? Ask to float?
Dear new Grad ICU nurse.
I am giving you my best advice based on my 10+ years as an RN. Stay in ICU for at least a year and then transfer to either L&D, OR, PACU, or Cath lab. DO NOT TRANSFER TO MED-SURG. Why? because once you downgrade it'll be very difficult to upgrade to other specialized positions such as the ones listed above. Once you're a specialized RN you'll be more marketable to other hospitals. Think future!
Your new to nursing. ICU would not be my recommendation for a new grad, but you are already there. I have 35+ years' experience working 12 hr shifts in a surgical/trauma ICU. We are a large teaching hospital in Boston. We take care of a multitude of different types of patients. We have a new grad orientation program in my unit. This is what I tell them,
1. There are no stupid questions.
2. It is 6 months of intense on the job training.
3. Do your homework. Know the reason for your actions.
The ICU is a far cry from just titrating meds and charting. It is the place where you will learn more about medicine and the human body than you ever thought you could learn or understand. Most of it learned by osmosis, as your sometimes so busy you don't realize you've absorbed the information. Once it all comes together you may look at things differently.
If you are not looking for fast paced, or potential life and death situations, moving to a regular med surg floor might be a better starting point. Working with multiple patients helps with developing organizational skills. The work is still very busy but in a different way. Good luck in your endeavors. C Carrigan RN
Ok, so you are brand new to the unit. It’s very understandable that you feel a little lost and bewildered at times, because the ICU is a very difficult place at times. But, I will say, be kind to yourself and allow yourself the time to learn and grow. You may find yourself catching on overtime to the many nuances of the unit and you may start to enjoy it. In my experience, it seems a little early to be making a change, unless you are making consistent errors in care that are jeopardizing patient safety. It’s OK to be unsure. I tell students all the time, if you don’t know, ASK. Know your limitations and be open to learning and experiencing. If you find over time that it still isn’t the best fit for you, then I would recommend shadowing. But, I would give it some time to allow yourself to settle in-it’s only been about 2 months, which isn’t a lot of time on any unit.
Best,
Joe
Hi! I’ve been an ICU nurse for 3 years..I remember when I first started sometimes I was scared to go to work, sometimes I felt like it wasn’t for me but I stuck it out and ended up in Neuro ICU. My advice is do not give up! Keep trying, I didn’t feel less scared/some what comfortable until I was like a year and a half in. Cluster your care, meaning after report check orders, labs, radiology, & meds. Do your assessment and pass meds. Chart once you’re done and have free time. It’ll get easier once you find your lil comfort zone. But you’ll get there, promise. ♥️
Asked to float and you will find what you like.
talk to other RN’s. Medsurge made me want to gouge my own eyes out. But that was just me. I found my home in the ED. You’ll find your place just keep looking!
When I was a new grad I got bored easily so I asked to cross train on other units and worked over time on them I eventually found my home in hospice.
Think about your skills and your interests. Do you like a specific area, such as neurology or oncology? Do you like your patients AOx4 or you don't mind if they are confused? Do you like kids? Do you like the OR, or lithotripsy or cath lab? Or do you prefer to develop a rapport with patients? Those answers may help you find something you like.
How long have you been in your current position? As a currently practicing RN for 12 years in the ICU setting, as well as having been a clinical instructor at the ADN and BSN levels, I would say give it at least 2 years in a specialty before thinking of a transfer. Unless, of course, you are up against inappropriate physical or emotional behavior, then that’s a different situation. The ICU is a fickle place at times; there are days where you do titrate and chart, but there are days where you really utilize all your skills in the assessment and care of the patients. I think it takes time to really gauge what your unit is like on the whole.
If after that time you still feel unsettled, try shadowing in different units or specialties. Shadowing is wildly undervalued I feel, and can do you a lot of good when trying to find your fit in the profession.
Good luck!
I do not believe that ANY new grad should be working in ICU or ER. In those areas you don't really have any experience to draw from. Med-Surg can provide that. I would also suggest finding a reliable mentor...someone who won't make fun of your questions
Ask to float
How long have you been in the ICU? Ask for a more complicated patient. Show them you are handling your patients well. Do you have a trauma ICU? You won’t be bored there. The most important thing to know is why you are doing and how it effects the other organs! Good luck!
That is part of the job. Maybe you are at a hospital with low acuity. Not every ICU is equal. Are there devices you can get trained on like CRRT, Impella, or IABP? Maybe you need an ICU with higher acuity.
Readers are leaders. Ask physicians for recommendations to read about the conditions you see. The small book, How to Read a Paper, can help. Journal your questions and answers. Make learning your hobby and passion. It may take two years or more before you get all benefits of working there. Then, you are quite marketable and may enjoy short term assignments in desirable locations
Not sure what you mean by "new grad" this time of year. But if you have been in your ICU less than a year, stay where you are. As the saying goes, you are "not seeing the forest for the trees". Things will start to come into focus as you get more comfortable and skilled with all the details you need in ICU. If you go to medsurg or float, you will not find your place in ICU. ICU is an enormous learning curve for a new grad. Be patient with yourself, use all your resources, preceptors, mentors. It will happen!
Well being that you are a new grad most new grads are better off in Med Surg so that you get a balance of all types of patients. But today, in our healthcare system that is not necessarily true. If you are in a big hospital then med surg would be a good place to start. But if you are in a small hospital and most patients are geriatric from long term care facilities then I would evaluate what were your interests before you became a nurse? Why did you get into nursing? Is this just a stepping stone career for a bigger career like becoming a physician or DNP? Those questions need answers then you can hone in on what you want to do with your nursing career. I personally when I was young liked trauma and trauma ICU, open heart ICU the higher risk the patient outcome the better I liked my job, now I really like PACU and I am working on becoming a circulator in OR because now that I am older, I like a more calmer quieter environment and OR is the quietest nursing gets. It's busy but quiet. So it really is a soul searching personal choice. I hope this helped.
Good luck and gang in there, we need you to stay, our field is dwindling fast and new nurses like yourself are not staying due to burnout, vaccine requirements etc.
My granddaughter did the same thing. Sadly they are doing this to new grads. Get a year on med surg under your belt they decide if ICU is for you. You will be exposed to a lot more on med surg
I suppose you have to ask yourself what are YOU wanting from your nursing career? I started on tele and am now in the ICU. I have a love hate relationship with it lol but I like it more than telemetry. I do think it’s good work on different units so that you can see what fits for you. Maybe asked to be cross trained?
If you have the opportunity to float to Medsurg, ER, rehab, do it and you’ll see where you can fit better. Medsurg, you’ll see and learn a lot.
Don't be afraid to try something different. As a new grad I like to recommend a skilled nursing facility or med Surg to build basic nursing skills. It is okay to try new things, you should never feel stuck in nursing, there are too many options!
I think you should have started in a Med-Surg unit where you encounter patients just like it says, with medical and surgical conditions, then work your way up to other units afterwards. For me, Med-Surg is a “stepping stone” specialty. You get a better generalized understanding of your patient’s health scenarios and you get to put into practice the basics of nursing that you learned in nursing school before you go into specialized units like the ICU.
I am an OR nurse of 43 years. I started in Med-Surg and had my “aha!” moment for the OR while taking care of one of my surgical patients.
As a new grad, I think it is better to start in MedSurg. You will be exposed to different cases and make you more confident as a nurse in dealing with all diseases and procedures. Experience will make you a stronger nurse.
Med/Surg/Tele is a great place to start. It sharpens your ability to know heart sounds and you work with the entire body there.
Where I fit in
How long have you been in ICU? If not 1 year then you have not given it much time. Floating is a good idea but you must give any area a fair chancer.
I do not believe that
YOU ARE LUCKY TO HAVE BEEN HIRED IN THE ICU. GENERALLY, OUR HOSPITAL TRAINS THE NEW RN FOR AT LEAST 16 WEEKS IN THE ICU. MY ADVICE IS TO STAY WHERE YOU ARE, ASK QUESTIONS, ASK TO FOLLOW AN EXPERIENCED RN, LEARN ALL YOU CAN. ICU LEVEL IS TOP LEVEL NURSING. IT WILL TAKE TIME BEFORE YOU CAN EARN THE TITLE "EXPERIENCED ICU NURSE".
