ICU vs Step-down as a new grad

[Capsaicin`]

I am fortunate to have the choice of starting as a new grad either in the ICU or a Step-down unit at separate hospitals. Some background on each position:

ICU position

- Community-size hospital in a major city

- Mixed ICU/Step-down unit, with 8 and 7 beds respectively

- Usually only 3-4 RNs working on a given shift (depending on census)

- No brain bleeds or STEMI. Only ischemic strokes and NSTEMI. No IR at this hospital

- 6 months of training including didactic/precepting throughout (staggered so more classroom at the beginning, then mostly precepting by the end). 3 preceptors total and I'll be on the night shift.

Cardiac Step-down position

- Large academic hospital; 12 bed unit

- Patients having undergone IR, electrophysiology, and cardiac-thoracic surgery. Require cardiac drips, invasive hemodynamic monitoring, mechanical circulatory assist devices, heart transplantation

- 1 year residency program with at least 24 weeks of precepting

I have a great problem here. Very fortunate to have this choice. But I'm completely torn. Ultimately, I want to be critical care nurse without a doubt. Just unsure which place would be the best place to start as a new grad.

About me:

- around 2 years healthcare experience as an EMT, ED Transporter, and Patient Sitter.

- 3.92 nursing school GPA

- willing to work as a hard as necessary to succeed

To all of you seasoned ICU nurses out there, please share your thoughts. Thank you!

[ronchelednik]

You really answered your own question it's ICU. Why? You will be more knowledgeable, valuable & marketable. After a year or two you will most likely hate where you work. If you don't then the hospital management didn't do their job. Anyhow you will have options such as transfer to another department, go another hospital or what my wife did, become a travel nurse and gone back to school and is 7 month away from being a Family Nurse Practitioner and leave bedside nursing for good.

[FlyingScot, RN]

You will gain much more experience at the large academic CICU. That experience will be transferable to any ICU you might want to apply for. The smaller ICU/step down could very well be more step down than critical patients. And the patient load looks to be at least three patients. Their acuity must not be very high. A job in a high acuity CICU with invasive monitoring and extra-corporeal cardiac support is a door-opener. Plus the year long internship is extremely beneficial.

[HeartRNtoREV]

I was very fortunate as well going to Tele first before going to a Level 1 trauma ED then going to Critical Care. I wouldn't have traded that experience for the world. I don't believe that you need to start out on a Med/Surg floor first but definitely on a Stepdown Tele floor first. Learning how to be a RN first and all the information that you have to take in is overwhelming. Good luck to you and all of you as well.