How difficult is it to start off in an ICU as a new grad? Is it manageable?

I went directly into the ICU during the pandemic and it was absolute chaos. I had an amazing preceptor and the charge nurses and other RNs were amazing as well. My preceptor was like a super RN he was a level above most ICU nurses. If you have a great preceptor and overall great ICU team you will be ok. The thing I love most about the ICU is the team atmosphere, because when it hits the fan the whole unit has your back and you have theirs. It’s so important to have that especially when ur a new nurse because in the ICU it takes a village. The Charge Nurses are also responsible for not giving you more than you can handle as well as guiding you in the right direction when you are unsure about something. The ICU can be a very stressful place when you have a patient thats unstable and/or crashing. I have seen people succeed and others struggle when starting in the ICU. I would say that if you had previous medical experience you will likely be ok because of the foundational knowledge you can build on. The RNs I have seen struggle were usually new grads with no medical experience which in that case it may be smarter to start in MST or a lower acuity setting.

I started off in the CVICU as a new grad and was able to be very successful. I also know people who started with me and were not successful. I think that it depends on you and you will need to be extremely honest with yourself. If any of the following are true you may want to start somewhere else:

1. Any major change in your personal life (pregnancy, moving, divorce, etc) I found that people who had any of that going on often couldn't focus the way they needed to in order to be successful.
2. Any obstacle that made school difficult (ie language barriers, learning disabilities, etc.) In order to be successful with any of these types of concerns you'd need to be willing to set time aside to really study outside of work too.

Those who treated orientation like another 6 months of school and spent time studying, didn't take long extended vacations, had flexibility to follow a preceptor schedule.... They usually did just fine.

All nurses need a foundation I would suggest starting on a telemetry unit for one year then move on to ICU.

Just my opinion but I feel new grads should start on a med-surg floor learning time management and the basics. As a long time senior critical care nurse I can say the patients, unit and the new grad themselves suffer from their lack of experience. Like they say, you don't know what you don't know. I see a lot of situations spiral out of control because the new grad lacks the experience to address issues before they become life threatening.

I would suggest getting some hospital experience first

Depends on the unit as well as the individual. I started on a tele unit, worked there for a year until I moved to ICU. Then worked in an academic medical center Surgical ICU/trauma unit for 30+ years. Loved every minute of it! We have hired new grads off & on over the years. Some are great, some realize that it’s not for them. I would suggest doing an externship with an ICU your senior year to get the feel for ICU nursing practice. If that’s not available and you really want to work in an ICU, the look for a hospital with a robust orientation program (12 weeks + a formal “buddy” system for 6 months). If you have some knowledge of cardiac rhythms and have taken ACLS, then you’re off to a good start! Best of luck!

This is not going to be the popular answer. However, I personally believe that a new grad should spend at least 6-12 mos in med/surg to build some hands on "real world" experience. I remember being a new grad; you don't want to feel uncertain in a place like the ICU/CCU. Yes, you will get your orientation, but there is nothing like having that basic nursing experience; it gives you more confidence. I know the ratio is less, but the patient acuity is high. But it can be done; manageability depends on the individual nurse, and the attitude of the preceptor.

I started off in the ICU with these strategic steps that were set up by the hospital helped me remain successful and now I am a board certified adult gero acute care nurse practitioner.
1. The first three weeks I had to complete the ECCO modules by the AACN on the computer in the hospital.
2. I was paired with one preceptor for 3 full months, not a new preceptor every shift or every week, the same person every shift you work, you will work their schedule, each month we did a rotation in Medical Surgical ICU then CVICU then Surgical ICU. The same preceptor every rotation, after that I was able to select which ICU I liked the best.
3. So after 3 months of 1:1 preceptor guidance and literally being joined at the hip with the same ICU nurse 36 hours a week plus 3 weeks of computer training on the ECCO modules for the 4th month I was on my own and I always had support note that I had my own patients during the previous three months I had 1 patient and then eventually 2 patients but my preceptor was there 100% of the time, when I finally started getting my own patients my hospital used careful selection by the charge nurse on my assignment during that last month so I wasn't overwhelmed, basically I got the more stable ICU patients before being gradually introduced to more critical patients.
4. Weekly meetings with nursing education, nursing leadership you and the preceptor so that you can get the most out of your training and find out how you feel, it should be according to the ICU checklist you should be required to fill in during your orientation, this checklist should include items you frequently see in your ICU, you get checked off on these items and they should teach you and then watch you perform the task and therefore prove efficiency. Not you go do it and then I check you off. Teach one do one method.
5. The ICU book by Marino is a good resource
6. Uptodate is a good resource
7. AMBOSS app on your mobile phone is a good resource
8. Get used to being prepared ahead of time, come early to get your assignment so you can ask productive questions during report and make sure that you understand what is required regarding the patient during your shift, this can also be a time to find out if you are able to care for the 2 patients you are assigned, set an alarm so you can clock in on time.

I was NOT a new grad but was completely new to the hospital. My initial new grad job was a busy urgent care. I will say that I was scared to death of ICU, but was still compelled to apply. First job in hospital, and I was hired right to ICU! The manager was new and wanted to change things up. It depends on your support. Mine was not a residency or some extremely organized training. I was eager to learn, I faked my confidence ( not arrogance), and I leaned on others who I knew would be truthful. Those that were around me thought I did well ( although I thought I was a nervous/crazy wreck). My mom always helped me since middle school to “fake it till you make it.” I wouldn’t say make errors, or fake your knowledge. But just to be cool, don’t be so wound up about all of it. The looming question is always, but what if they die? What about the arrhythmias? Will I remember this or that? Will I look stupid?

Now I’m 10 years in, have been charge nurse, have trained nurses and senior student nurses, have ran codes, advocated for families/patients when doctor was wrong or not listening, have cried with patients, have navigated a pandemic when there was no rule book. I’ve loved MOST of it. I’m burnt out, looking to different areas of nursing. For now, I work in 7 departments as a critical care float nurse. If you want to do it, you can. Again, depends on your training and having a good team in your corner.

Find
Find a hospital with a critical care nurse residency program

I attended the army critical care course after spending a year and a half in Med surg. I feel it’s extremely important for young grads to work for a year or two, develop critical thinking skills and experience before they venture into an ICU. Personally, I would not want a new grad taking care of me if I were in the ICU. I think it’s dangerous. It’s hard enough for a seasoned nurse to manage in the ICU.

Critical thinking skills are really needed! I was a LPN for 16 years and now I have my RN I started working in ICU, almost a year. I love it. Everyone works as a team here!! If someone sees your patient going bad we all are in the room to assist!!

Started my nursing career in ICU then transitioned to L&D. ICU provided a great foundation to transition into other areas in my opinion

Not very difficult at all. If that’s what you want to do, look for hospitals with residency programs. I went to ICU after a year and had to relearn a lot of things taught on med surg/ step down.

You can start in an ICU at a smaller hospital. That’s what I did. We get a mix of ICU, and step down patients. Has allowed for a good foundation in a not so crazy ICU before going to a level 1 or 2 trauma center ICU.

Either way, I have friends who started off in level 1 trauma ICUs and they’re killin it. Go where your heart desires. It’s hard to work this job in an area you don’t love.

Don't do it. A competent manager would never allow it. If they do they don't they are risking your license. Very few places have a effective orientation program.

Short Answer
IT IS MANAGEABLE ... IF, you're ready for it.

If you want to be a robot and do without thinking, then you'll get this position and be just that. However, one of the best things, in my opinion, about ICU is the freedom, the leeway that one has when it comes to patient care. It isn't just about titrating the meds, its really about assessing and reacting to the pt's needs.
Typically, new grads have a harder time with this because they don't have good foundations, they don't have their basics settled. That's why many would say to hit med-surge for 1-3 years and then transition to Crit Care. I agree with that HOWEVER, it is all about the individual.
If you have strong work ethics, if you have decent amount of knowledge of human physiology and pharmacology then GO FOR IT. The other side of this coin, is who is the person that is precepting you, how much they know and how much they're willing to put into you. A bad preceptor will teach you to read orders, follow to the T, and be a robot. Good preceptor will teach you to understand the orders and answer own questions "what/why we are doing that we're doing". A GREAT preceptor, will make you fall in love with the job, show you the beauty of medicine, of nursing and will light up a FIRE in you to not just become a good RN but to further evolve into GREAT human being!

NOW, go to the mirror (not the selfie mode on the phone), take your phone and set timer for 2mins 15 seconds. Look into the mirror, look INTO YOUR EYES, and ask your self this question - AM I READY FOR IT?

Good Luck

I started in an ICU and was successful. But, I had 2 years experience as a CNA and did my final semester capstone in the ICU. If you’re a critical care nurse, in your soul, you can do it.

That depends on a couple big variables - you (temperament/energy level/willingness to learn) and the hospital you start in. If you’re looking for a job that will fit into your life right away or give you a sense of work/life balance, probably not a good idea. Also a huge difference between onboarding and orientation at a for-profit hospital versus a private hospital that may be centered on teaching or have magnet status.

I started in a peds cardiac ICU at a teaching hospital and it was immensely challenging even with a great and lengthy orientation and residency program. Some friends I graduated with went to other ICU’s in the area and felt like it was too much, too fast, and eventually quit. Some went to acute care/med surg to start and are very content with the work pace and learning process.

Pick the right hospital, a population you want to serve, and be ready to learn!

It’s easy… you’ll get the critical thinking part nailed and the flow of the ICU… when you start in like Med/surg you have to relearn the flow. I’m a believer of starting where my heart is at and not flow a long route. It also depends if you are great with high levels of stress and working under pressure. If your not then starting from ICU or critical care will cause you internal traumas of ur own. 😊

Not difficult at all. I got hired in CVICU as a new grad. 😊

I started in the open heart ICU even before I had taken my NCLEX. It depends on your heart. The effort you put in school. I.e. was a C okay with you. ...then ICU. Is not.. it depends on your capability to focus and time management
CVCICU is easy just waiting for someone to come
The other ICE you need critical thinking skills and a WHOLE LOT OF COURAGE

It really depends on the person and skill level. I have seen new grads succeed in ICU and have seen others who needed to step back and get basic training. The question each person needs to ask themselves is: do I have the organizational skills to be able to prioritize nursing actions in order to save someone’s life. Do I have the assessment skills to recognize in advance what nursing actions I have to take to prevent a critical situation before it happens. Normally that skill set comes with time and experience. My advice would be to get at least one or 2 years of medical surgical experience which will expose a new nurse to a variety of situations and will develop the organization skills to be able to function in a critical care setting.

I started as a new grad in a Trauma/Surgical/Liver Transplant ICU and I have to agree that as long as you treat your orientation as an extension of school and be an absolute sponge, it was more manageable. I do think though you have to have an extra level of attention to detail and awareness of what is happening at all times to be successful in the ICU. I started with a few new grads that were not successful and by observing them I feel it was a lack of attention to detail that made it a difficult position for them. You have to have good communication skills and never be afraid to ask questions at any point in time you don’t understand something or need more clarification.

I went right from school into the Nicu. I wouldn't change my path at all and anything is the work you put into it. You'll be learning new things no matter where you start, and it you start in something you are passionate about, it will only drive you further to succeed. Asks lots of questions, be safe and push yourself to learn everyday.

It was hard but you can do it!

Also, I didn’t have medical experience yet-I worked at USPS as a rural carrier!!!

Is ICU your goal? Then yes, go to ICU-the old tale of everyone having to start in Med-Surg is not true. I started in PCU for 6 mths, then went straight to ICU and so glad I did.

Starting in an intensive care unit as a new graduate is not possible and is not manageable. You must first have the advanced certificate in an intensive care unit, which allows you to train in simulated environments, which offer immersive learning timed to train you for real-life situations. The program of this advanced certificate is oriented towards the main aspects of the management of Critical patients, based on scientific evidence and the experience of recognized specialists.

I did this. I went the the NeuroSurg unit at a Buffalo hospital fresh from school. Learned a lot. Not a lot of good stories from there; very few pt’s who come back to say hi.
It WILL be difficult. In my case, I had two under 3 yrs old, and I was (of course) put on overnights.
Sleep is hard to catch up on.
But day’s are filled with unnecessary drama/intrigue.
If this job is the ONLY thing in your life, then you have a better chance at longevity.
I ran after a year.

Hello gym working

Starting out in the ICU could be a challenge. You have so many things to learn as a new nurse. Knowing basic nursing first helps and then transfer to ICU. Also it depends on your preceptor. The better the preceptor the more successful you will be. I did floor nursing for several years, before going into the CCU and it really helped. But then I am old school. Good luck.

I don't feel that any new grad should go directly into ICU. The things that you are unsure of can be dangerous, and this is not an environment where time is always available for decisions. Better starting on tele or med surg and solidifying your knowledge and abilities prior to.

You must have the personality for it. Go getter, does well under pressure, not afraid to ask questions, and a bit comfortable with the unknown and probably comfortable with what you know.

I know myself and I know I could not have started as an ICU nurse. I probably would have have succeeded but it would have made me hate nursing lol.

I love ICU now and wish I transitioned sooner

I believe it’s easier to start off in the ICU as a new grad because of the pandemic. Before, people could be selective about who they wanted to bring into the ICU. And most new grads were told to start in Med Surg for 1-2 years, then transition. During the pandemic and even now, post pandemic, a lot of nurses left the bedside (and the profession altogether) for various reasons, so more hospitals began to have new grad residency programs include ICU cohorts.

I passed NCLEX in June 2022 and started in Neuro ICU for my residency program and just recently started my job at a level I Trauma hospital in the Surgical ICU. I’ll be a year old RN next month!

This is a loaded question and depends on multiple variables.
It is an option if the organization has a good new grad program with seasoned mentors and a good Clinical Nurse Specialist (CNS).
The entire nursing team needs to embrace the plan to acclimate new nurses into their “world”.
Success may not be fully realized before a full year has passed. It is important to recognize that the individual may drive the pace as well.
Finally, the developed program to train- should be flexible and free to change tactics when needed.
I love new grads!

D

So I would be an advantage for mee to work as a ICU nurse .

That is a lovely Servive I like!I like rescicitation care when a patient is about to die and you seem to add him or her a life.so there is no diffuculty for to work in ICU once I get a job from your company.

Yes it's manageable due to the fact that as a nurse we quick at learning skills

It really depends on the person. Some can grasp all there is in the ICU environment. I encourage being an LNA/ CNA in the ICU while in school.