New Nurses Struggling to Transition to ICU

“There are a ridiculous amount of CCRN quizlets you could use. I’d also recommend buying Marino’s “The ICU Book.” It was the book that expanded my understanding the most”

“I am a new grad who has just been offered two completely different roles. Coronary intensive care or Pediatrics with eventual NNICU cross-training. I love kids and its a part time role with less nights which I love.. the ccu position pays for my critical care training, is super exciting with responding to codes doing transports and has a great orientation process, but it is a full time role, 2 days/2 nights rotating shifts.. Anyone with experience in either of these roles/units have any insights”

“My patient did a slow fall against the wall and slid and is completely okay, she is in her 20s, a+ox4, she has some speech and neuro deficits, but on turnover and all day it’s been one person assist her using a walker and she can use the bathroom. Anyway she wanted to bathe she has been ambulating to the bathroom with a walker and an assist so I assisted her to the mega tiny bathroom and stood right outside the door and told her to sit on the toilet to do her hygiene and she got up and fell, I w”

“Hello all! I would like to preface that I have been in the ER for 1.5 years starting as a new grad. I would always like to say that I always wanted to go to the ICU, being that I am absolutely in love with critical care, but my opportunities brought me to the ER. I will say there are many things I love about the ER, I love stabbing people a lot and being able to get a line on every single person that says "they always have a hard time" feels really good. Our codes are always concise an”

“I know, I know this is prob asked a lot, but I'm neurotic so, ya know I just started intern year and sorta still getting my bearings still. I'm FM and my first rotation coming up is ICU. Problem for me is that I never did an ICU rotation in med school, so things like pressors, vents, vent settings are all hieroglyphics for me tbh. It doesn't help that my hospital is also a huge academic/research place too, so there's some really sick/complex patients everywhere. I have like a wee”

“Hello reader! I'm currently working nights in a large and busy medical ICU with an extensive stroke service. I fought pretty hard to land this role after graduation, but unfortunately, wages are falling way behind and some of those administrative red flags are waving. I do like critical care (especially pulmonology) but ideally I see myself working a role with more consistent hours and work conditions in the months or years to come. Does anybody out there have a similar story or recommendati”

“I am currently in my first semester of an accelerated BSN program. I will graduate in August next year. I went into nursing intending to be an ICU nurse after spending several weeks in an ICU with my grandmother and I found the work so interesting. I am starting to get nervous though as I see so many posts about how the best way to get into an ICU as a new grad is by working as a tech/CNA or doing a capstone there. My program has no capstone however and we only spend 2 days in the ICU during cli”

This was probably where is all began tbh

“Yeah if your state has ratio laws and it’s not being followed, report to department of labor, I think? Or refuse assignment, only accept report for 2 patients and state the law is your reason, does anyone else accept 3 patients? Are you guys unionized? If so speak with a union rep asap”

“That’s great to hear! I’m PICU here as well. I know technology that’s meant to improve workflow can actually do the opposite on occasion which is why I’m looking for fellow ICU nursing input. Appreciate the feedback!”

“Hello Friends, Just curious to get your thoughts about EPIC MAR and Alaris Pump integration workflow in an ICU setting. Love it, hate it? Better workflow? Our hospital is considering moving forward with integration rolling out to acute care floors first and then ICU. I don't have much information on exactly how the integration works exactly but my concerns include pressor titration and sedation boluses. Can you still manually program the pump outside of the order parameters: i.e. Going up fa”

“I’ve been offered a position as a new grad RN at both peds and adult cvicu. I like the population and cases on the peds units but the staff and unit culture feels more supportive on the adult unit. same pay, same hospital. what would you do? submitted by /u/Embarrassed-Pin4715 [link] [comments]”

“I’ve been working as a nurse for 3 years in med surg. I feel like I can handle any patient or situation that comes my way because at my last hospital we could take anything…. Peritoneal dialysis, any post ops (GI, ortho, anything), heparin drips, lasix drips, etc. But when I think back to 2 years ago I feel like back then I knew NOTHING. Even though I felt confident at the time. When I think back even 6 months ago I feel like I knew nothing back then I grumble about work and how much it sucks an”

“Hi. Long story short, I was previously an ICU nurse, and was told I'd be hired to a critical care area as an instructor. I expected ICU's. It wasn't communicated to me until after I started that I would be another ED Nurse Educator (they already have one who is very good). This is at a major level 1 trauma center for a massive academic medical center. So! I need some serious advice. The more thoughtful, the better. I obviously will be studying workflows and relevant clinical stuff bu”

“I just started the same type of unit about a month ago, but I am not a new grad. All my experience has been in medsurg (4.5 years). I honestly love this compared to medsurg, it is so much more chill. The people I work with are great. I will echo the sentiment of make sure to not take work home with you. The situations these kids have been in and trauma they have experienced is very sad and can weigh your soul down if you are not careful. Much love!!”

“Hi all! I have just accepted a job offer for a second shift ICU position. I’ve only ever worked in GP (5+ years) and am currently enrolled in Penn Foster so that I can eventually become licensed. I’m a little bit of a nervous wreck about transitioning from GP to ER/ICU and am working on little cheat sheets for myself in a small notebook until I can get comfortable. What would you suggest adding? If you work ER/ICU, is there something you have to (or had to when starting out) reference frequently”

“I’ve been a nurse for 6 years but in the NICU (level III) for four months. I still feel pretty new to the unit and am still learning all things newborn. On shift yesterday, there were approximately 15 nurses for 44 babies. Yesterday, I had an assignment with four babies: Baby A was 2 days old, had D10 going in a PIV, was on a CPAP of 6, and had several bili lights. Parents were there to help but needed to be coached through some things. Ate by NG. Q8 sugars. PIV went bad so had to be replaced. L”

“Hi everyone, I’m wondering if anyone has been in a similar situation with an internal transfer. I’ve been a Patient Care Technician on the same unit for about 7 months. During that time, I never changed units, never changed roles, and never had a break in employment. The only changes I made were from full time to part time, and later from nights to days, so I could balance nursing school. My job duties have stayed exactly the same. The issue is that Workday now shows I’ve only been in my “curren”

“I'm thinking about making a switch out of ICU. Cardiology is my strong suit. I'm comfortable with cardiac ICU and also have experience in a vascular lab. I feel like my heart is in labor and delivery, and I want a big change from ICU. I would be part-time days in either cath lab or l and d (if they would hire me). Which is the better job? Pros and cons? submitted by /u/Cobrawhistle [link] [comments]”

“Yeah I’m really confused. Like, ICU is who we call when we need more help during an MTP or code.”

“We don’t usually get any traumas and we try to ship out really bad GI bleeds so we kinda avoid those patients. We have the machine in the ER but aside from some of the older nurses who’ve worked at bigger hospitals none of us trained at this ICU know how to really work it.”

If you don’t do MTPs then who does??

“We have a mother/baby nurse at the bedside for all pregnant/post partum patients in ICU. I’m not trained to do uteruses (uteri?) and they aren’t trained to do ICU. Our post partum unit doesn’t have the capability for tele.”

“I charge on an IMC/PCU floor on days. Once I was called by staffing right at shift change that they were going to pull our 6th nurse because someone on L&D had a chest tube. 24 bed unit, charge in ratio, with 6 nurses it averages out 4:1 patient:nurse, ideal for most PCU patients. However we also take insulin drips, fresh kidney transplants, and some other high risk post surgical oncology patients (HIPEC, CBI, etc) that are in 3:1. That day we had one assignment in 3:1 ratio. Taking away our”

“My thing is if the patient were to decompensate and it’s an OB emergency then we’re all just sitting ducks here until they code or lose their airway. Like This recent patient has all these prns for hemorrhage that I’ve never given before and the visiting L&D nurse is saying just call us if you have a question about these but wouldn’t it be safer if y’all were monitoring her and giving these meds that are actually in y’all’s omnicell. Our ICU doesn’t even really do MTP so the platelet patient”

“Yep, I applied to any nurse extern positions as well. Same result. Although there were very few available for me to apply to, and some had preference to schools (like HCA with Galen). I already prepared for the possibility that I won't be able to work while in this program and can financially sustain it. However, for networking and potentially increasing my chances into the ICU, I figured it couldn't hurt if I work PRN with flexibility but I may have to take a few steps back and be patie”

How did you avoid getting thrown into the medsurg gauntlet?

“So, I made the switch. I’m going to the ED after five years in ICU, my entire career. The past year, I’ve been doing critical care float pool, which also encompasses our IMCUs. Since they are less staffed, that’s where I’ve been most of the time. Those broke me, haha. Kudos to the intermediate/stepdown nurses of the world, you are stronger than I. Really, I just got tired of the little stuff, mostly charting (Q1 rate/dose verify. Q1 ADLs. Q2 IV assessment. Q4 head to toe) and spending twelve hou”

“Our manager recently hired this ED RN in our ICU. She has been on orientation so far for the past month. I was told she was a student nurse extern at our facility for a year then I'm assuming did the new grad residency program. In total, if you include the nurse externship, she's been a nurse for 4 years. Anyways, I get report from her while her preceptor is listening. She only had 1 patient the whole day. Mind you, she is in her 3rd week of orientation. The patient I'm getting has b”

“I was a tech in neuro for 3 years so I understand from a tech pov, but I just wanted to compare nursing povs.”

“I am a new grad PA and I have an upcoming interview for an ICU position at a location I did 2 rotations with and I thought the team and I clicked really well, and I thought I performed above average too. At the end of the day, I know I am a new grad and have so much to learn, but I want this job or any ICU job very much. So… Any advice from any ICU PAs or anything adjacent on how best to prepare? I’ve been doing some practice interviews with AI and this seems to be helpful, but anything specific”

“I was thinking about this … A guy spent 15 years working in MedSurg in AL. He tried for 3 years to transfer to the ICU, and when he finally got in, some of the senior nurses there did everything they could to make him quit.. The medical field is full of asshole, sataniminded people, and they act in a way that makes you look like you’re the evil one. .”

“I went from a busy and higher acuity medsurg floor like yours to a smaller ICU and I'll say it was a big quality of life jump especially in terms of not feeling like I'm just running around all day having to be so customer servicey. Like I'll have nights where I'm surprised by how little I'm doing despite my patients being "ICU". Idk if it'll make you fall in love with nursing again though cause at the end of the day it is just a job and you're still working”

“I’m from nyc and currently have a little over 3 years of experience at a big hospital working as a medsurg nurse. I tried applying internally and to outside hospitals for the icu and have gotten nothing, not even landing interviews. I also emailed some of the ICU managers at my hospital expressing my interest but didn’t get a response back. I knew the job market was competitive but didn’t know it was this bad. I have attached a photo of my resume if someone is kind enough to give advice on how c”

“Hi! I have the second round of an interview for a new grad medical ICU nursing job tomorrow. The first interview was with staff, and the second one is with the nursing managers. During my first interview, I asked all of my questions! Some questions I asked were "what qualities have you seen in new graduate nurses who are successful on this unit?" and "what are the continuing education opportunities available in this unit and hospital?" What questions did you ask or wish you h”

“I’m gonna be a new grad nurse in a few months and I got accepted for the Neuro ICU at University hospitals in Cleveland and cardiovascular ICU step down pathway program to ICU at Cleveland clinic. Both nurse residency programs pay around the same and give around the same benefits, but I’m more so wondering which hospital would be a better place to invest my time at? I’m looking to go into CRNA school too so I know I need to go into a good ICU which I have for UH. However, I’m hearing that the st”

“Thanks for the perspective it really helps hearing from someone who’s been through it because I’ve been stuck debating this switch for a while now honestly I appreciate it much”

“You’ll be asked how you handle stress/stressful situations. How you prioritize tasks. How you handle interpersonal conflict and difficult patients. Why critical care? Have questions ready for the end of the interview. Look up the hospital. Drop a tidbit from the website. “As a stroke center…” etc. show you give a fuck”

“First and foremost I really hope this is ok to post here! And thank you for any advice you have. I currently work full time in an ICU as a CNA/CCT. I graduate in December. Unfortunately my work does not allow nurse apprentices in the ICU or the ER. Only med surge, and all love to my med surge nurses, I just love critical care. I did however land an interview at a hospital a town away and will be doing a panel interview for ICU and the ER. But the problem is I’ve never done a panel interview. Onl”

“Acute dialysis is its own kind of beast, but ICU will test you in ways you don't expect. You'll learn more in six months there than most do in two years elsewhere. The stress is real but so is the confidence you build after surviving it. If you're already thinking about the switch, that itch probably won't go away until you try it.”

“I’m 1 year in as a new-grad in acute dialysis and thinking of applying for ICU newgrad opening. Is it worth the added stress to do bedside? submitted by /u/Bob_Burgero [link] [comments]”

“Hi! New grad here wondering if anyone can tell me about the Care Initiation Unit?? Is this sort of like medsurg? submitted by /u/Hungry_Bug7728 [link] [comments]”

“I found out I really enjoy psych after my clinicals. But im scared since it’s been pushed down our throat to start at the hospital ER, ICU, MED Surge, Tele , etc. These are my worries: I feel like I have to develop skills but when I mean skills I mean I feel like I’d be more of a critical thinker at the hospital not simply being able to do an IV. But does this matter? What if I work psych my whole life? But also what if I don’t? Can I start in Psych and still develop those hospital skills later”

“I have worked in the ICU for the last 4 years. I really love my job because of the people I work with, my schedule, and the facility is very nice.... but I feel like I am not learning anymore. We have maybe 1 CRRT in a week, I have never done or seen MTP, we intubate someone maybe 2x a week- keeping in mind I only work 2 days/week- I really dont see many procedures or practice many skills other than chest tubes, USPIV, and A Lines. Today my charge made a comment that if something were to happen”

“Please for the love of god just don’t quit without having another job offer that you have accepted. The job market is tightening and you don’t want to be stuck. To claim “critical care experience “ most employers look for 1-2 years in order to satisfy that requirement. If this is how you feel before every shift I would continue looking for other jobs even if it is a pay cut. Good luck. This too shall pass.”

“could really use some advice from people who have been through this. I’ve been in the ICU for about 9 months and I’m trying so hard to make it to my one-year mark, but my mental health is really suffering. I’ve developed severe anxiety, started medication, and I’m still struggling. Every shift feels like a battle, and even waking up on the mornings I work fills me with dread. Before ICU, I worked in med-surg, so I do have previous bedside experience. I’ve been applying to other nursing jobs (PAC”

“fair enough — 6 months of med surg tele will actually make ICU feel easy by comparison. just keep your eyes on the prize and don't let them talk you into staying longer than that. you've got a plan, that's more than most new grads have. you'll be fine”

“When I did CVICU travel, I solely worked at level one trauma centers. Even worked at “the best heart hospital in the nation”, where they were cool with giving anyone a fresh open heart and a secondary true ICU patient. They would double CRRT patients but they had techs to run the crrt. I was run off my feet every shift just about. The other level one I worked at would do two nurses for ECMO patients and wouldn’t double fresh open hearts or CRRT. The workload was more manageable with less microma”

“Union hospital - new hires go to nights and can move up to mids then morning based on seniority and availability. It's a slow process though.”

“Looking back, I think starting off in Nuero Medsurg was not the best idea. There’s so much gray area, things that are gauged by interpretation, as well as TBIs. All nurses on that unit are ::eventually:: put through MOAB (management of aggressive behaviors) class. Powers that be on my unit sent me to that class in my 6th week. As corny as it sounds, I left feeling empowered. Before the MOAB class, during week 3, I had been sent in to administer blood and several push drugs to a young adult with”

“New grads do start in icu, but lacking critical care experience will make that a difficult transition. And they also know this so you won't be a competitive applicant. But you do have good foundational skills, maybe look at step-down or telemetry as a stepping stone.”

“It's not uncommon for new grads to get into ICU, it's just a lot more competitive. I hear it's also a big learning curve and because of that a good amount of new grads wash out. I'd say try anyways but if you're concerned that it will be too much and too fast, start on a med surg unit like Tele or do stepdown. I tried ICU as a new grad and unfortunately had no luck, so I'm getting my experience in Tele. Good luck!”

“I can only speak to my experience and mine is similar to yours. I had 1 year LPN and 1 year RN in SNFs before going to the hospital. I felt like I wanted ICU but ended up doing med surg/tele before moving on to that point for a year. IMO med surg/tele did a lot to build my core nursing skills that enabled me to do well as a newbie to ICU. I now have 2 years into ICU. I could start IVs decently, insert foleys, read tele's, done code blues, learned how to time manage my workload in a hospital”

“Is it a good idea to start in ICU as a new grad RN with 2 years of SNF experience as an LPN or should I do med surg first as an RN? submitted by /u/Key_Sheepherder_6274 [link] [comments]”

“could also request a meeting with the unit manager to discuss the same topic earlier. just say that you are very learning oriented and are looking for what you could improve on. may reflect well on you for taking initiative, too”

“I’ve been in a critical care setting since graduation for about 9 months. Apparently others are talking badly about me because I still haven’t had an intubated patient assigned to me. I guess it makes me seem incompetent. What are your thoughts? submitted by /u/Cschyd [link] [comments]”

“At my hospital DKA/HHS insulin drips are ICU. Standard insulin drips can be done on step-down of the patient is otherwise stable. They had considered allowing standard drips on Med-Surg floors until our union stepped in at the monthly Labor-Management meeting that they should probably get the Med-Surg pressure injury rate under control first before allowing such a critical medical into the Med-Surg floors. Because of nurses don't have enough time/training to get a handle on pressure injuries”

“Hello! Like the title says, I’ll be starting in the MICU after transitioning into nursing following three years on the road as a paramedic in a high call volume urban city. This is a safe space lol, and you can tell me all the things you wish you could’ve said either to new grad you, new grad nurses in general, especially in critical care, or former-paramedic-to-RN folks specifically if you’ve noticed specific pitfalls they’ve encountered that might be too niche for other nursing grads. su”

“Hey, so I got two ICU offers at these two hospitals. I’ve been trying to find info from nurses who have worked there, but there’s barely anything online. Has anybody worked in their MICU or CVICU? Any input will help! Thanks for any info! submitted by /u/Dogecoin17 [link] [comments]”