New Grads in the ICU?
The career path taken by new graduates from nursing programs usually involves gaining some experience on medical surgical units in hospitals and then moving on to more specialized nursing units. This is not the rule for all new nurses however, as some of them choose to start working in the intensive care units right after obtaining a nursing license. You may wonder just how common is it for new nurses to choose and obtain a position within such a specialized unit, and what skills are vital in order to do well in the ICU.
The shortage of nurses has forced many directors of nursing to consider new nurse graduates for RN positions on specialized units which usually require someone with at least one year of medical surgical or telemetry experience. Examples include the adult intensive care and neonatal intensive care units, both extremely demanding and stressful environments for the novice nurse. When a strong orientation program is in place along with a good relationship between the preceptor and the new nurse, the novice ends up performing very well, surviving the first year on the unit, and eventually thriving in such an environment. In this manner, new graduates end up being a valuable resource for specialized units in any hospital.
At many hospitals the length of the orientation program depends on each nursing unit, with longer orientation periods for emergency departments and intensive care units. Medical surgical units usually offer an orientation of approximately three months while emergency and ICU departments orient the new nurse from four to six months, depending on individual needs, performance, and monthly evaluations.
The preceptor assigned to each graduate nurse usually has prior preceptor experience or has been trained specifically for teaching novice nurses in addition to having several years of experience on that particular unit. The preceptor - novice nurse pair works together for the length of the orientation program, with expected feedback, guidance, and reassurance from the preceptor toward the new nurse. A strong, honest, and professional relationship between the two is vital for the unit integration of the novice nurse. Once the training period expires, the graduate nurse is expected to function independently but is allowed and encouraged to seek advice and clarify any questions with the prior preceptor.
Unit supervisors and nursing directors have noticed that new graduates which have completed a strong orientation program on a specialized unit provide competent patient care and function just as well as an experienced registered nurse. The key to success is providing the correct support system such as helpful and knowledgeable coworkers as well as a positive learning environment. The training of a new graduate nurse in the ICU will turn into a positive experience when the essential elements are in place: the right match between trainee and preceptor and a limited number of new graduates who are being trained every year.
Intensive care units where only two new graduates are accepted every year, and where training of each new nurse takes place on a different shift, have proven successful in training competent nurses. A small number of new graduates that are being trained at a given time helps to keep the focus on patient care and does not create problems on the unit because no matter what issue arises the staff will not feel overwhelmed.
New registered nurse graduates may feel overwhelmed in a fast paced, technology filled, and stressful intensive care unit. Once the training period is completed, the new nurse should be objective and honest about their skills and critical thinking ability and always ask for advice or help when in doubt. This will not only eliminate most errors but will reinforce their knowledge and improve their confidence level. More experienced nurses as well as unit supervisors and directors do not have unrealistic expectations of a new graduate nurse and understand that it takes time and practice to transition from novice to expert.
Additional Nursing Resources
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