Tips for new grad looking to be hired into CICU

Specialties CCU

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I will be graduating in May and would really like to work in a cardiac ICU. I love working in a fast paced environment and cardiac is super interesting to me. Does anyone have any tips or advice for me on how to go about seeking an ICU job after graduation? I'm just trying to get a feel for how difficult it will be for me to start in an ICU. I'd be okay with working on a step-down unit or on the floor for a year or two, but I'd rather start where I want to work. Any advice is appreciated!

My resume is decent. I have shadowing experience in the cardiac cath lab, OR, and ED. I worked as a nurse extern during the summer on an oncology unit. I'm currently a PRN float pool patient care tech at a local hospital.

Thanks!

It all depends on when and where you apply. The CICU I work at is in a large university hospital and we have a high RN turn over rate, meaning either people are in NP school, going to CRNA school or move on to something else (get tired of the stress). I suggest you look around and you may have to consider relocating but it is possible. This past year my unit has hired 75% of its new staff as new grads. We went through an expansion last year and are now seeing double the amount of patients. And we got rid of our contract RNs. I thought that was crazy for a new nurse to jump into such a critical area but if you can get into an RN intern program at a hospital that would be your best bet. You can check out different areas (usually 3 to 4) and pick your favorite. This way you get some extra experience and are ahead when you actually start new hire orientation. Good luck in you endeavors, hope this helps.

Specializes in Cardiac.

I agree with the above comment. In my experience though, those who have at least a year of step down experiences do better in the CC area. I did 1.5 years prior to but then again I know plenty if great nurses who did CC right out of school. Connections and personality are key.

Specializes in Critical Care.

Here's the reality and you may not like it, but it's the truth.

You need a year of med-surg, why ?

Lets be honest, I know you probably think you know all this stuff from nursing school and while you probably do, what you learn in school and what you do in real life are two different things. I was exactly like you, wanted to go into ICU right out of school and when people told me i couldn't I was determined to prove them wrong...Well long story short, I didn't prove anyone wrong, I ended up having to suck it up and do 6 months in Step-down. Did it suck? Well kinda. But I'll tell you what, I could handle 5 patients with no problem, I had amazing time management skills and knew how to prioritize things. When I went into ICU, 2 patients was an absolute breeze. On med/surg you are doing a boat load of stuff for 5-6 patients, in the ICU you're doing an equal (and sometimes more) amount of stuff for 1 or 2 patients. In the ICU you need to know how to prioritize and multitask, otherwise you'll be in a hamster wheel, running all over the place but not really getting anywhere. A lot of the 'little skills' that you learn as a med/surg or step down nurse are sometimes invaluable as a ICU RN. Good luck, and keep an open mind. And in the world of nursing, a year is NOT a lot of time and it goes by really quick. Trust me.

Specializes in Critical Care.

Da_Milk is correct in saying that if you go Step-Down or Med-Surg first, you will have amazing time-management skills when you hit the ICU world. However, I will disagree that it is a make or break type of scenario.

I think the most critical aspect of your succeeding in the ICU will be based on 1. the hospital's education (read: internship/orientation program), 2. your drive to learn and be successfull, and 3. (last but definitely not least) your co-workers/preceptor's attitudes towards you as you learn.

I went straight into a CV/CICU from an ADN program and the medical center's internship prepared me adequately. I'm loving it. Good luck, friend!

I am a week old new grad myself, waiting for all the paperwork to clear before I start my new job in the ICU :) I am not sure how much of this will be of use to you and your particular location, but here goes:

1. The nursing recruiters at both major local hospitals flatly refused to consider new grads for the ICU during recruitment meetings conducted at my school, and again during my screening interviews. Not one to be deterred, I obtained letters of recommendation from my critical care instructors and forwarded those along with my cover letter and resume directly to the ICU nurse managers. I was granted interviews at both, and received job offers from both. Persistence paid off.

2. I have heard both sides of the "get a year on med-surg" argument. On one hand, you get time to become comfortable with the basic aspects of being a nurse while on a med surg floor - but on another you are in many ways starting from scratch when you transition in terms of orientation and training. From what I can tell, a lot of the truth in that adage probably depends on where you are personally in terms of time management, organization, knowledge, critical thinking etc before you graduate. Nursing is a second career for me, and my previous experience really helped prepare me in terms of those things. I realize I still have a long way to go, but I think that at least gave me a foot up.

I would recommend asking your instructors who have been with you in clinical for their brutally honest opinion of which route seems best for you. I don't think any one answer necessarily fits every new grad.

3. This is only speculation at this point, since I haven't started myself. However, I think the length and quality of orientation/precept is important. I chose the position I did largely because they have a long ICU orientation, and the nurses working the floor told me they felt prepared and (sorta haha) ready when they were done. The other hospital I had an offer from had a much shorter orientation, and nurses there said they were pressured to end it early! Which leads me to...

4. Talk to the nurses on the ICU floor you want to work on if you can! I was fortunate enough to have a 12 week rotation on the one I eventually chose, and the nurse manager at the other hospital took me around the unit and introduced me to some of the nurses there and left me long enough to ask them about the unit. The clinical manager might promise you that they never run more than a 2:1 pt-nurse ratio, but maybe chatting up the staff a little you realize 3 and sometimes even 4(!) is closer to the truth. You can learn a lot in even a few minutes by talking with the nurses on the floor. If you have a chance to pick their brains, I recommend it.

Thank you! This was very helpful.

Specializes in Critical Care.

Research critical care nurse fellowship programs. I started in the CTICU as a new grad and had an excellent orientation through a fellowship program that prepared me very well. Two years later and I'm still a CTICU nurse. Good luck!

Hello

Specializes in CVICU, CCU, Heart Transplant.
...those who have at least a year of step down experiences do better in the CC area

I disagree. In my experience, nurses who transfer to the Critical Care from tele often have a difficult time adjusting their priorities, which in the ICU translates to bad habits.

Besides, after 3 years of working in the ICU is there really a distinguishably differences between a nurse who started as a new grad or one with previous experience in step down? I don't think so.

Specializes in OR.
I am a week old new grad myself, waiting for all the paperwork to clear before I start my new job in the ICU :) I am not sure how much of this will be of use to you and your particular location, but here goes:

2. I have heard both sides of the "get a year on med-surg" argument. On one hand, you get time to become comfortable with the basic aspects of being a nurse while on a med surg floor - but on another you are in many ways starting from scratch when you transition in terms of orientation and training. From what I can tell, a lot of the truth in that adage probably depends on where you are personally in terms of time management, organization, knowledge, critical thinking etc before you graduate. Nursing is a second career for me, and my previous experience really helped prepare me in terms of those things. I realize I still have a long way to go, but I think that at least gave me a foot up.

I would recommend asking your instructors who have been with you in clinical for their brutally honest opinion of which route seems best for you. I don't think any one answer necessarily fits every new grad.

.

Thank you so much for post this -- I'm juggling the thoughts on it a lot, too and hearing I should do a 1 yr med-surg rotation no.matter.WHAT.

Some new grads really do well in the Icu out the front door. Most have a hard time. I highly recommend getting a job on a tele floor, step down or a very progressive cardio unit. I have been a cardio/intensive nurse going on 17 years and a preceptor for my unit. There is more than just learning the book work, dealing with a critical care patient takes maturity in nursing. Be profiecent during a code. Most places you have 6-12 weeks to be ready to be on your own. Granted the other nurses will help you but... you are responsible for that patient and sometimes within a moments notice you need to make a decision to save their life. This takes Clinical knowledge with skill and sometimes new grads whether 22 or 40 have it when they are fresh out of school.

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