July 2, 2017

Graduate Nurses Working In Critical Care

I've had the luxury of working in critical care my entire professional nursing career. I started on a progressive care unit (PCU) and soon after, I transitioned into an intensive care unit (ICU). With a chunk of my nursing career being solely in critical care, I've had the pleasure of working with and precepting many graduate nurses in my local area. In Central Florida, many hospitals hire graduate nurses right out of school and train them to work in the intensive care setting. There are many components related to this topic, and I wanted to share my opinion on these theories. Let me be clear, I think ANY nurse graduating and working where they have a passion is great. Period. Experienced nurses don't always equal high-quality employees. Graduate nurses don't always equal inadequate employees. Each nurse is different and adapts differently. I refuse to lump people into groups based on experience, because honestly, I've worked with some shitty experienced nurses and I've been impressed by some pretty awesome new nurses. It comes down to the person, their passion, and their work ethic.

"New nurses are dangerous in critical care." 

I've heard this many times, and I disagree. I think with the appropriate staffing, graduate nurses are assets to their respective units. But, new nurses need resources and mentors. You can't just drop them in the jungle and walk away. Every nurse needs help. You wouldn't have an entire floor of only float nurses, with no regular staff or resource nurses, right? You would be begging for someone to code due to the staff's unfamiliarity with the clinical setting and patient population. But often, a floor is filled with nothing but graduate nurses. This is obviously problematic because the new nurses, can't bounce ideas off experienced nurses or seek counsel from veteran nurses. It has nothing to do with graduate nurses themselves being dangerous. It's about inappropriate staffing metrics. Patients code on medical-surgical floors and outpatient settings. There are no "soft" inpatient floors in healthcare anymore. I told my manager once, "Medical-surgical floors are the new critical care floors. And critical care floors are now housed with people who wouldn't have made it a decade ago." People are living longer. Technology and the advances in medicine are assisting people in living longer. We must educate and develop new nurses, not ban them from this aspect of healthcare.

"New nurses do not have the proper skills to do this." 

When I went from progressive care to intensive care, I didn't have the proper skills, hence me being precepted and educated. Each specialty requires its own level of training beyond the Board of Nursing examination. This is the foundation of nursing - to educate and to grow as professionals. No person, experienced or otherwise, would be able to work on a floor with no point of reference or instruction. This comment often isn't about training. It's directed at an individual's intelligence. Some nurses believe new nurses don't have the proper mental capacity to learn what is needed within the training timeframe given. So let me get this straight. You don't think new nurses have the proper mindset to do this, so you want to ban the entire group from even attempting to prove you wrong? That's insane! If you are a nurse and you're discouraging the hiring of graduate nurses on your unit, know that you are missing out on some amazing individuals who could show you a thing or two. I've worked with some graduate nurses who know more than I did (in some areas). Nursing isn't a competition. We all can work together and learn from each other.

"New nurses need to pay their dues first." 

This is a common one I hear from experienced nurses who worked their way up to intensive care. Back in the day, you weren't allowed to start your nursing career in the intensive care setting. You started on lower acuity floors and moved up throughout the years. Graduate nurse in the intensive care setting was unheard of decades ago. It wasn't even an option, even if you were an amazing nursing student with a passion for critical care. This history created an atmosphere of "earning" your seat as an intensive care nurse. The problem is, there is currently a severe nursing shortage. Whether it's from nurses retiring, going to graduate school, or becoming injured, nurses are leaving the bedside. This mass exit has created huge staffing gaps. There are only so many experienced nurses, and graduate nurses are now filling that need. How can we be mad at nurses who see an opportunity and take it? If I could have entered intensive care right out of school, I would have. I can't be mad at someone who was given that opportunity and jumped at it. You can't let your history turn into bitterness toward someone you don't even know. Times change, things change. Graduate nurses are now given this opportunity to prove themselves - allow them to show you they are competent.


I know graduate nurses have huge learning gaps. I'm not saying every graduate nurse will rise to the occasion. I'm also not saying that critical care should be some social experiment where patients are guinea pigs for inexperienced staff. What I'm saying is, with proper training, new nurses can flourish and be that knowledgeable co-worker we all wish we had at our side and wish we were. It comes down to proper training and the individual. I've precepted new nurses - some passed training, and some decided it wasn't for them and transferred. But to not allow them the opportunity to even enter critical care is faulty and closed-minded, in my opinion. I know there are many people who will disagree with me and that's okay. We all have different life experiences and concerns.

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