New Grad. Want to work in the ICU

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    Hi everyone. Thanks in advance for taking the time to help me out. Id appreciate any feedback on getting a critical care job after graduation.

    Im graduating in 2 weeks with my BSN. I had a 15 week externship in a Trauma ICU this summer. I have also been working in the critical care areas at that hospital as a tech since the externship ended. I am scheduled to become ACLS certified this week. I have all of my paperwork for NCLEX (that I can control) sent in to the state so that I can take the test as soon as possible after graduation. What other advice would you give to a new grad trying to get a critical care job? What worked well for you or what would have helped you out?

    Thanks again!
    puravidaLV likes this.
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  3. 27 Comments so far...

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    I have to be honest, I am old school and believe that no new grad should be in any specialty unit, such as ICU. You need to spend time on med/surg getting your feet wet. ICU and ER nurses (any specialty nurse) for the most part have strong personalities. We have too because of the situations that we face. Dealing with physicians in life and death situations are hard enough, being a new grad, we no experience can sit up for failure. I have seen new grads but into the ICU and the ER before they are ready and most if not all burn out.
    This just my opinion. Wishing you well in your career.
    my_purpose likes this.
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    A lot of units have the above philosophy. Find a unit that has a philosophy that considers Med Surg a specialty and ICU a separate specialty thus there is as much benefit to not having to "unteach" the right NG as there is in a Med Surg nurses's experience.
    wbthomas and ktliz like this.
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    I'd rather burn out than not have tried at all. To feel uncomfortable is to learn out of your element. I hated medsurg nursing and almost dropped out because of the attitudes I had to endure by the preceptors. Only when I got down to ICU and OR did I ever get a recharge on the "nursing wanna-be meter".

    Sadly I have to many friends that wanted to go CC yet were so good at MS that supervisors and nurse management kept them stagnant in their positions so they had to quit to get the experience.
    Lennonninja and SummitRN like this.
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    I appreciate all of the comments and understand the reasons for the divide in the topic. Do most of you feel it is too "steep" of a learning curve for new grads? Anywhere new grads are hired on they will have to go through a learning phase and adapt to that specialty, why not be it in a more critical care setting?
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    Get into an internship program. ACLS? My hospital doesn't let new icu grads take ACLS until they are 6 months in the icu setting. I have to wonder whether you are ready for that type of critical thinking to take ACLS. Am sure you will pass it but reality putting together the whole picture is another story....remember the more you show management you have the credentials for all this the more your legal responsibilities increase as a new nurse. Take it easy learn first. ACLS will be there. Don't corner yourself. Sorry if i sound harsh, it is not meant to be. I just don't like seeing new grads panic in the middle of a serious case administer wrong med and boom your career is over before it began.
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    There is a steep curve to CC, yet if you read into your preceptorship and how people get into CC settings just remember it was because of a simple test most schools pay for written by some company to grade you (ATI/HESI). That is really it! Nothing more; people are lazy. It sucks right now being a new graduate, ALCS is just one of four other certificates someone can obtain to make themselves stand out compared to probably 300+ applicants for few residency programs that really are not looking for more than 10 people. Certain parts of the country NGRN are not even considered since laid off ones are chosen first.

    CC is obtainable, but understand your going to be on your toes, working with six drips at a time, multiple disciplinary factors, watching the living fade away with nothing you can do but watch an electronic strip slowly decrease to asystole. A good mentor helps and a great friend is key.


    ACLS is offered Hospitals, but I took mine through AHA by a private company owned by nurses before I had even passed the NCLEX. ACLS just means you have the knowledge to do, not that your ready, or experienced. Any good charge nurse or nurse manager wouldn't throw someone they know isn't ready into a situation without cause or knowing the level of experience they have as well as any new nurse should turn down an assignment they don't feel comfortable doing. The real world the new nurse should volunteer when these events come up to be apart of them so they can build their status among their peers and prove their abilities.

    I think every ACLS test ask the question: "What does the ACLS certificate mean?" and the answer sure wasn't "B: I can run a code".
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    Thanks for both of the thoughtful responses! I know that there will be lots of learning in ANY job for a new RN. I feel confident in my ability to be resilient and adapt to the challenges that await me. That's why I am trying to so hard to start in the area that I value the most.
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    As an ICU preceptor, I do recommend starting out somewhere other than the ICU. The learning curve is super steep, and in addition to learning how to be a nurse, you are having to also cram in tons of other learning i.e. hemodynamics, vasoactive meds, multiple support devices etc. It's often difficult enough for experienced nurses who come from various units, let alone a brand new nurse. Not to say it can't be done, cause there are a few new grads here who have done exceptionally well. But on the same side, there are new grads who scraped by, and are still struggling off orientation.

    One happy medium, might be to start on a stepdown/tele unit instead of med/surg. Patient acuity is higher, you get some exp with vasoactive meds, intro to critical thinking, and overall confidence etc. It's a great way to get you prepped for ICU. Several of the new grads who did not do well in ICU orientation, ended up going to the stepdown, and after a year are now getting ready to come back to the ICU. Way back when, I started on the stepdown as a new grad, and I had a much easier time transitioning to ICU, compared to other people in my group who were new grads.

    If ICU is your ultimate goal, then talk to the ICU manager and see if they would consider hiring you after a year of stepdown experience. If so, it might be possible for them to secure a spot for you. I know it's not always possible, but that's what happened with me. I let them know that ICU was where I wanted to be, and they saved a spot for me, so that right at my 1 year mark, I started the transition process into ICU.
    wmr5 likes this.
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    As a nurse that started in the ICU as a new grad I want you to know that it CAN be done. Just know that you will work very hard.. Probably harder than you worked in nursing school. I graduated school with my BSN in 2010 and spent approx 300 hours of my senior internship at an ICU/CTICU. I knew that working in an ICU was my dream and would've moved anywhere in the country to find a job in one. The hospital in which I did my internship hired me right out of school an oriented me as a new nurse for 6 months.
    If you do want to work as a new grad find a place that will work with you and provide a lengthy and supportive orientation. Some places do a better job than others and some places hire more new grads than others. The place in which I work provided an excellent orientation but did not hire a lot of new grads. I did encounter some supportive nurses and encountered some that didn't think I should be working there and let me know that. I also dealt with some unsupportive docs as well too. Just know that I graduated nursing school with a 3.92 gpa and spent my entire first year doing nothing but studying ECCO, studying books, studying everything I could get my hands on. I did take a rhythm class an get my ACLS certification before graduating nursing school.
    I just wanted to let you know it can be done just find a place that is supportive! I now have my CCRN, finished training to take care of post-op heart surgery patients and am working on my CSC certification. I have been there for 2.5 years now and got accepted into CRNA school at a few very good schools. I am also precepting a senior nursing student from the school that I went to starting in January and couldn't be more excited! It all comes full circle
    neecie242, wmr5, Dtraxler, and 3 others like this.


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