ICU or Stepdown unit first

  1. HI everyone,
    I graduate in December and want to work in ICU, except I have heard some negative things about new grads working in this area. I was wondering if anyone thinks it is better to work on a step down or telemetry unit first and then to move into ICU later on. I really want to work in the ICU but, I also want to get the best experience so that I become an excellent nurse. I would hate to start in ICU and flounder.
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  2. 5 Comments

  3. by   nimbex
    you may find some seriously strong opinions about this!

    I've been training CCU nurses for 4 years now. Some new grads, some from the floor. I've helped MANY people succeed, and have had only a few who couldn't. That being said.. here's my two cents...

    Almost ANY person as a new grad can succeed in the ICU with adequate orientation, at least 12 SOLID weeks, and a preceptor who knows and is willing how to start with the basics of ONE patient and slowly build your skills and confidence.

    This assumes that the orientee will spend hours at home reading articles given by the preceptor, books and watching video's. YOU CAN'T LEARN PATHOPHYSIOLOGY AT THE BEDSIDE, along with the many other complex disorders and technology... the orientee has to have a committment to work at home too!

    But , But , But.... realize that if you start on a step down, you'll have learned all the basic skills, meds, assessments and such that make the transition easier..... putting an nGT down is hard at first... in the ICU you have to do it around the ET balloon... stuff like that.....

    So all that being said, no matter who thinks what is best... YOU are the best person to know what challenge you are ready to tackle, you can succeed in the ICU... but it will take some very hard work on your part, and a committment from a preceptor to get you there.

    Stay away from any facility who offers breif orientations... one of the hospitals near me does.. any new grad to the ICU!!!! Well they all flocked there, Two applied at my facility after they were fired... they had only 8 weeks of orientation, and were used as staff around 6 weeks!!! Dangerous!

    :kiss Best wishes to you- I know what it's like to want ICU badly, you have more opportunities than I did with the shortage... let us know what you choose....Good LUCK!!!!
  4. by   Brownms46
    Whoa nimbex...You don't sound dazed, crazed or confused to me.... Your post rings as being right on the money!
  5. by   New CCU RN
    Hello. I am a new graduate in CCU and although I cannot offer you expertise of a nurse who has been in the ICU for a long time, I can tell you my experiences thus far.

    From what I have been told and what I have observed, there are some who make it and some that don't. This applies to both seasoned RN;s and newbies like you and me.

    Confidence, the ability to ask questions, admit when you need help, willingness to go home and yes study.... just like you do after clinicals while in school is what it seems to make a person.

    When you are looking for a position, be sure to question the orientation process. Mine included didactic one on one sessions as well as larger classroom settings in addition to clinical. Be sure that they have a solid preceptorship program...some units are so young that they will have preceptors who aren't experienced enough to explain the y's and how's.

    I admit that it is a difficult way to go, but if you want ICU go for ICU!! If you are willing to make small sacrifices in the beginning, doing what you really enjoy will be worth it. In addition, many ICU nurses in my unit have said that although floor nursing may increase your confidence, some of the skills, etc, it is a world of difference. It doesn't make it any easier (according to them) to transition into the ICU setting.

    I wish you the best of luck!!!!
    -New CCU RN
  6. by   irismae
    Thank you for all your encouragement and advice. I really want to work in ICU, so I am going to do that. I am just so SCARED I won't be a good nurse or I won't know what I am doing. I have butterflies just thinking about it. However I am determined to suck it up and succeed!
  7. by   susi_q
    I started on stepdown/tele right out of school 4 years ago. It was major pressure, and hard work, but wouldn't change anything at this point. "New CCU" said it... it takes confidence and the ability to admit when your are needing help. You have to be curious wherever you end up, every unit has it's stressors.

    In our hospital, you have to be super organized to work stepdown - it's a 20 bed unit, and not unusual to change 5-8 of those beds during each 12 hour shift. It is a great place to start though if you can swing it because you get to see everything! And the learning curve is huge. In CCU (where I also work now) we also have new grads - there you have to be more willing to learn technical stuff - like all the machines, calculating drips, watching tele closer and for more subtle changes. It all comes down to where you see your strengths and even personality. Good luck - if you want it, you can get it - it's just gonna take some work and humility in the process.

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