1. Seago, Jean Ann PhD, RN
  2. Barr, S. Jo MS, RN


The cycles of registered nurse (RN) shortage and surplus continues into the new century, and nurse executives, managers, and staff development educators are under extreme pressure to respond to the staffing issues. Specialty areas in hospitals are typically the first to experience fewer than needed RNs. The purpose of this article is to describe how the managers, staff development educators, and staff of one large public hospital created a training program for new graduate RNs so they could function safely and efficiently in the adult intensive care environment.


The number of registered nurses (RNs) in the United States has cycled between shortage and surplus for over 50 years (Friss, 1994). Many scientists have studied the reasons for these cycles (Buerhaus & Staiger, 1997; Seago, Ash, Grumbach, Coffman, & Spetz, 1999, 2001; Spetz & Coffman, 1999), but regardless of the reason, another hospital nursing shortage has begun and nurse managers and nurse executives must find solutions to this problem (Buerhaus, 1999, 2000; Walker, 1999). In the present as in the past, the first hospital services affected by the shortage of RNs are specialty areas, such as critical care, hemodialysis, operating room, and labor/delivery (Bernreuter & Goddard, 1994; Grumbach, Ash, Coffman, Seago, & Spetz, 2001; Seago et al., 1999).


The notion of hiring new graduates to work in surgical and medical intensive care units (ICUs) can be a frightening and risky strategy for nurse managers and staff development educators. Even selecting RNs with other acute nursing experience and training them for the ICU can be unsettling for staff, physicians, and administrators. In the mid-1980s in the San Francisco Bay Area, there was an acute shortage of RNs, particularly in specialty areas such as critical care.


Santa Clara Valley Medical Center (SCVMC) is one of two Level I trauma centers (the third trauma center is Level II) and is the "county hospital" for Santa Clara County. Trauma center levels are designated by the American College of Surgeons, with the lowest designation being able to care for the most acutely ill patients. SCVMC serves as the primary treatment center for all traumatic injuries that occur in the geographic area and often is the facility providing primary care for the county's indigent or minimally insured citizens. In addition to the 14-bed surgical ICU (SICU), there was a 12-bed medical ICU (MICU), a 10-bed burn unit, and a 10-bed transitional care unit (TCU). Nurses who work in the ICUs must be knowledgeable, confident, organized, and flexible. This article describes how the managers, staff development educators, and staff of the ICUs at SCVMC created a training program for new graduate RNs and RNs without ICU experience so they could function safely, and efficiently in the adult intensive care environment. Although describing events that occurred over a decade ago, this article is relevant because once again there is an acute shortage of specialty RNs, particularly critical-care RNs, in the San Francisco Bay Area.