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This is a guest post.

The purpose of this episode is to offer tips and advice to new graduate RNs starting in an ICU.

This post contains affiliate links.

All opinions in this post are that of the guest author and not those of their employer.

New Grads in the ICU may find themselves overwhelmed and feeling afraid. This guest post deals with tips for new grads in the ICU to help you acclimate.

In the beginning… Hopefully you did your homework by learning what to expect in a critical care unit. Bonus points for you if you had the opportunity to observe nurses in a critical care setting. Extra credit + Bonus points if you were able to do an extending preceptorship/internship during nursing school. Those students who did that will have the best idea of ICU reality.

Still, all is not lost if you didn’t have those opportunities. Or, even if you DID have these opportunities, reality as a student nurse is very different than reality as a credentialed nurse. Which leads to…

Come in with an open, actively engaged mind

You will have to pull together/brush up on every skill you learned in school and then add many more. Expect to be overwhelmed for a while. Seriously. A minimum of 6 months.

Be aware typical ICU Nurse Characteristics

  • Assertive – We have a reputation for being “bossy,” but there is more to that. We have to be advocates for our patients (or sometimes families). Sometimes we need to be more direct with doctors when the patient is showing early signs of decompensation. Maybe the doctor orders a chest x-ray for a patient who is short of breath and confused, but we think the patient may need a blood gas to check for hypoxia not detected by simple pulse oximetry. Or, a patient’s family expresses concerns regarding aggressive treatment when the patient had previously indicated they did not want “life support”, and you need to help the family communicate this to the MD.
  • Detail oriented – This is more than Type-A or control freak personality, although there really is no denying its presence. ICU nurses need to know their patients… their lab values, their x-ray results, what medicines the patient is on, their head-to-toe assessment. We need to know it all because it helps us anticipate complications and respond quickly.
  • Critical thinkers/problem solvers – Successful critical care nurses have a good grasp of pathophysiology. This helps us recognize early changes and anticipate/direct the necessary treatments.
  • Intense – Here is where I’d say the term “adrenaline junky” applies. Many critical care nurses thrive on challenging situations. We want the sickest patient with the most invasive lines. A code blue? Let’s go! (As long as it’s not our patient, whose AM assessment we still haven’t documented because there was too much stuff to do!)
  • Autonomous – We are self-directed, independent workers. We thrive on doing as much for our patients as we can (within our scope) BEFORE we have to call a doctor.

You will likely come across many nurses with these characteristics; some will be easier to interact with than others. Identify those with whom you feel comfortable and take the others with a grain of salt. We recognize that experienced nurses can be intimidating, but remember that does not make them any more or less valuable to the team than you. Everyone has something to bring to the table, and that includes you!

More resources for new ICU nurses

This is Part I in a 3-part series. Check out Part II, Tips for New Grads in the ICU: Showing Initiative and Part III, Tips for New Grads in the ICU: Be Your Own Advocate

Melissa is one of the co-hosts in Season 2 of the FreshRN Podcasts.

Become a member of the American Association of Critical Care Nurses (AACN) here.


Tips for New Grads in the ICUMelissa Stafford, BSN RN CCRN SCRN graduated from nursing school in 2000, and after a short time on a medical surgical floor transitioned to neuro critical care. During her career, she has precepted multiple nurses, taught classes ranging from neurological/neurosurgical specific subjects to general critical care medicine, been involved in shared governance and resides as chair for nursing peer review. She has received various recognition’s, including the Great 100 Nurses of North Carolina and DAISY Award. Melissa enjoys spending time with family, painting, watching sports, visiting the beach whenever possible, and vacationing at Disney World

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