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  • Sean Karbach

New Grads in the ICU


For my first post and as an introduction to this website I would like to touch on a subject that many new grads face right out of school: New grads in the ICU.


The intensive care unit (ICU) is just as its name describes: intense. These units are where you will find patients with life-threatening conditions, be it from illness, injury, or surgery. These patients are the sickest in the hospital and require constant management and supervision.


While I was in nursing school I always knew I wanted to end up working in an ICU. Just like you'll read in anyone else's posts on the subject, I was drawn to the adrenaline rush and fast-paced environment. However, I was never really exposed to a true ICU environment before graduation.


There are some schools of thoughts and opinions out there that suggest the ICU is not a place for new grads. I have heard time and time again of professors urging their students to at least take a year to work on a medical-surgical floor so you can work on your time management and "learn the medications". Time management always seems to be that one go to reason that people urge students to work on a floor where you will end up taking 4, 5, and sometimes 6 or even 7 patients at one time.


I find the whole argument to be overly generalized and off topic. Yes, you will learn time management on a med surg floor but you also will on any true ICU.


Imagine having two patients. One is crashing and the other is intubated and sedated. Your crashing patient requires constant calls to the team while medications are being mixed up, hung, and administered. Your intubated patient is starting to wake up and fighting the ventilator and even though they are restrained they are doing their best to reach their hand up to that ET tube. You delegate the best you can but you still have 2100 medications to give. Ultimately, your patient has deteriorated to the point where they need to be intubated. Now you have to juggle all of that all while comforting family and contacting doctors.


Time management is something you will be forced to learn in the ICU. Some will argue that you should have already honed your time management before coming to the ICU but time management on one floor does not equal time management on another floor. Different priorities exist when comparing a less acute floor to an acute unit.

The other argument including medication education is just as misplaced. Depending on the ICU you are in and your hospital system there are some medications you will never hear of unless you are on an ICU. Medications such as vasopressors, inotropes, and certain antidysrhythmics never see any other unit other than an ICU.

Of course, you will learn about your beta-blockers and when to hold them or how you never give anyone metformin in the hospital but you are also capable of learning these things in an ICU. Medication education should not be used as an argument for keeping new grads out of the ICU.


With all of this said there are certain personalities that thrive in the ICU and others that need a little more push. In my mind, there is absolutely no way a new nurse can flourish in the ICU unless they get into some form of residency or advanced orientation program. It is with these programs that you really start to hone your critical thinking and skills. I was personally in a program that gave us 18 weeks of orientation with a senior nurse and classroom days sprinkled in.

In conclusion, can new grads excel in a critical care environment? Yes. Can they do so without a residency program and 8 weeks of orientation? Highly unlikely. While you will learn time management and medications pretty early on you really need the time to develop your critical thinking and that "gut feeling".

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