New grad - critical care or elsewhere?

YanMinor · Mar 8, 2015

So, it sounds like you're asking two questions. First, is critical care the right move for you and possible as a new grad? Second, what can be done to improve your chances of getting into critical care as a new grad?

The answer to your first question is based a lot more on personal preference. What do you know about critical care? Have you had a clinical on an ICU? I was personally attracted to it because of a sicker patient population, less task-oriented work, and a desire to know my patients at a more complex level than was feasible at the med-surg or even stepdown levels of care. That is not to say that med-surg or stepdowns are easier levels of nursing. One of the main reasons I avoided med-surg is because I wouldn't be able to handle having six patients at a time, and I would feel like a chicken with my head cut off. Some nurses absolutely enjoy it. I prefer to care for one or two patients and know as many details about that patient as possible, critically thinking and considering concepts of critical care pathophysiology as a I care for them.

As for your second question, you're right. It's been asked and answered. But as a December graduate recently hired to an HVICU, I'm happy to share my strategies, as well as the strategies of a number of us who have been hired into critical care.

1. In a class of 88 second-degree students, seven of us have landed adult critical care jobs since graduating in December. Four male, three female.

2. All seven of us had senior clinicals on an adult ICU. I will repeat that: no one from our class without ICU clinical experience has been hired onto an ICU. I imagine a nurse manager would be hard-pressed to hire not only a new grad, but one that has never stepped foot onto a critical care unit. If possible, try to get clinicals on a unit that hires new grads, or at least a unit in a hospital that hires new grads. You don't want to do all of this work to impress people and build a great reputation at a place that won't hire you anyways.

3. On that note, all seven of us worked our asses off to be active during clinicals and impress the crap out of fellow nurses, nursing instructors, and especially the nurse manager. Ask questions and be involved. Do your homework so you can answer questions when your preceptor quizzes you. If you can't answer them, say you'll find out. Look up meds. Draw and help interpret labs. Be clean and organized. Run towards codes, not away from them. Be vigilant about the monitor and catching changes in rhythms. Always show up on time. Don't take shortcuts. Always be safe. Treat every day as a job interview.

4. Of the seven, all of us "knew someone". Nurse managers talk between each other like crazy, and if you leave a good impression, they'll be willing to put in a good word for you. Nurses on the unit are the same way. If I could tell that I was doing a good job, impressing them, or if I received a compliment from them, I would let slip that I would like their recommendation. It would usually go, "Thanks. Hey, I was thinking about giving my resume to [Nurse Manager], would you mind putting in a good word for me?" Towards the end of my clinical, I submitted my resume to the nurse manager at the time. Due to some restructuring issues in the hospital, he wasn't able to hire anyone new for several months, so he recommended that I apply to the HVICU. When I made it down to that NM's office two days later, she said, "Are you that student everyone's talking about upstairs? It's funny, we wouldn't even be talking right now (she doesn't hire new grads) except your nurse manager insisted that I hire you!"

5. People often insist that grades matter. They didn't matter for us. None of us seven were required to submit a transcript. Rather, we had the option to submit our diploma as proof that we have our BSNs. Now, if you're considering graduate school or advanced practice (which we all are), getting into a program is a different story. Purely for being hired as a BSN, RN, our grades weren't looked at.

6. If you don't have it already, get CNA experience. It's the one thing I regret not doing during nursing school, and nurse managers in both of my interviews asked if I had CNA experience. Absence of it won't eliminate you from the pool, but having done so will make you stand out among non-CNA applicants.

7. Fill in lines on your resume. If you're not a CNA, what else are you doing. I had teaching experience from my last job, so I TA'd some basic nursing classes. I also volunteered at some easygoing events that took very little time. Without those, my resume would have been half-empty.

8. Another two nursing students got hired into NICUs. It's pretty detached from my world, so I don't know much about them. All I know is that they moved far away from our state to get those jobs.

Some extra vignettes:

- A student who ended up in a pediatric cardiac ICU did his senior clinical there. He got the job before he even graduated.

- One now in the SICU had EMT-B experience, CNA experience, and was acquainted with the nurse manager. He essentially had the job before he graduated.

- One now in the neuroICU impressed the nurse manager on his neuro stepdown and aced the interview - no CNA, volunteering, etc. He just knew someone. It's that important.

- I was on the SICU in the same hospital where I now work in the HVICU. I was a TA and volunteered some, but no CNA.

- One now in the MICU worked at another MICU in the same hospital system.

- Two of them now in the CCU had critical care clinicals in the same hospital.

jj224 · Mar 9, 2015

^ what he / she said. If you land an ICU job, make sure it's at a hospital that has a good new grad programs. I was fortunate to start at such a hospital. I had a classmate that did not and was on his own after a month. After a few shifts on his own, his manager recommended he work on a different unit. So when interviewing, make sure to ask what type of new grad program / orientation they offer. Good luck.

buspar · Mar 11, 2015

Im a new grad, recently hired onto an ICU in a community hospital. I took EKG, Pharm, PALS, ACLS, Stroke Scale Cert, IV Cert, and Critical Care Course...I had my preceptorship done in ICU/CCU. Volunteered (as CCE intern) in ICU setting for 200 hours. Also, all of these classes costs me almost 1.5k $ but it's worth it.

Good luck

icuRNmaggie, BSN, RN · Mar 11, 2015

A couple of years in an ICU, PCU or step down is a springboard for many other opportunities such as CVICU PACU or ED or CRNA school or a career in travel nursing.

Bluebolt · Mar 12, 2015

So, it sounds like you're asking two questions. First, is critical care the right move for you and possible as a new grad? Second, what can be done to improve your chances of getting into critical care as a new grad?
The answer to your first question is based a lot more on personal preference. What do you know about critical care? Have you had a clinical on an ICU? I was personally attracted to it because of a sicker patient population, less task-oriented work, and a desire to know my patients at a more complex level than was feasible at the med-surg or even stepdown levels of care. That is not to say that med-surg or stepdowns are easier levels of nursing. One of the main reasons I avoided med-surg is because I wouldn't be able to handle having six patients at a time, and I would feel like a chicken with my head cut off. Some nurses absolutely enjoy it. I prefer to care for one or two patients and know as many details about that patient as possible, critically thinking and considering concepts of critical care pathophysiology as a I care for them.
As for your second question, you're right. It's been asked and answered. But as a December graduate recently hired to an HVICU, I'm happy to share my strategies, as well as the strategies of a number of us who have been hired into critical care.
1. In a class of 88 second-degree students, seven of us have landed adult critical care jobs since graduating in December. Four male, three female.
2. All seven of us had senior clinicals on an adult ICU. I will repeat that: no one from our class without ICU clinical experience has been hired onto an ICU. I imagine a nurse manager would be hard-pressed to hire not only a new grad, but one that has never stepped foot onto a critical care unit. If possible, try to get clinicals on a unit that hires new grads, or at least a unit in a hospital that hires new grads. You don't want to do all of this work to impress people and build a great reputation at a place that won't hire you anyways.
3. On that note, all seven of us worked our asses off to be active during clinicals and impress the crap out of fellow nurses, nursing instructors, and especially the nurse manager. Ask questions and be involved. Do your homework so you can answer questions when your preceptor quizzes you. If you can't answer them, say you'll find out. Look up meds. Draw and help interpret labs. Be clean and organized. Run towards codes, not away from them. Be vigilant about the monitor and catching changes in rhythms. Always show up on time. Don't take shortcuts. Always be safe. Treat every day as a job interview.
4. Of the seven, all of us "knew someone". Nurse managers talk between each other like crazy, and if you leave a good impression, they'll be willing to put in a good word for you. Nurses on the unit are the same way. If I could tell that I was doing a good job, impressing them, or if I received a compliment from them, I would let slip that I would like their recommendation. It would usually go, "Thanks. Hey, I was thinking about giving my resume to [Nurse Manager], would you mind putting in a good word for me?" Towards the end of my clinical, I submitted my resume to the nurse manager at the time. Due to some restructuring issues in the hospital, he wasn't able to hire anyone new for several months, so he recommended that I apply to the HVICU. When I made it down to that NM's office two days later, she said, "Are you that student everyone's talking about upstairs? It's funny, we wouldn't even be talking right now (she doesn't hire new grads) except your nurse manager insisted that I hire you!"
5. People often insist that grades matter. They didn't matter for us. None of us seven were required to submit a transcript. Rather, we had the option to submit our diploma as proof that we have our BSNs. Now, if you're considering graduate school or advanced practice (which we all are), getting into a program is a different story. Purely for being hired as a BSN, RN, our grades weren't looked at.
6. If you don't have it already, get CNA experience. It's the one thing I regret not doing during nursing school, and nurse managers in both of my interviews asked if I had CNA experience. Absence of it won't eliminate you from the pool, but having done so will make you stand out among non-CNA applicants.
7. Fill in lines on your resume. If you're not a CNA, what else are you doing. I had teaching experience from my last job, so I TA'd some basic nursing classes. I also volunteered at some easygoing events that took very little time. Without those, my resume would have been half-empty.
8. Another two nursing students got hired into NICUs. It's pretty detached from my world, so I don't know much about them. All I know is that they moved far away from our state to get those jobs.
Some extra vignettes:
- A student who ended up in a pediatric cardiac ICU did his senior clinical there. He got the job before he even graduated.
- One now in the SICU had EMT-B experience, CNA experience, and was acquainted with the nurse manager. He essentially had the job before he graduated.
- One now in the neuroICU impressed the nurse manager on his neuro stepdown and aced the interview - no CNA, volunteering, etc. He just knew someone. It's that important.
- I was on the SICU in the same hospital where I now work in the HVICU. I was a TA and volunteered some, but no CNA.
- One now in the MICU worked at another MICU in the same hospital system.
- Two of them now in the CCU had critical care clinicals in the same hospital.

So this guy wrote pretty much everything I was going to say. Good job. I'm currently an ICU travel nurse and preparing for CRNA school. About three years ago though I was in your same position. I was graduating from my BSN RN program, precepting in an ICU and working my butt off to impress the staff and nurse manager. When I was a staff ICU nurse we would watch the precepting students and assess for a few different qualities. Critical thinker of course, this is a big one. Some people are better and more natural at it than others. If you're not the fastest at it or don't really enjoy the stress, stay out of the ICU. It's really for your own happiness because I've watched a few new grads who just knew somebody and slipped in the door and left for med surg within 3 months completely burnt out. My other advice is don't be lazy, work the whole time you're there, constantly ask thoughtful questions and always volunteer as an asset.

Good Luck, in my opinion it's the best place to work in a hospital.