How to get into ICU?

  1. Hi fellow nurses,

    Do any of you have any tips on working in an ICU setting with not a lot of experience?

    Here's my story,

    I completed my preceptorship in the ICU and took a job offer as a charge nurse in an intermediate care unit. I had connections with the director of nursing and therefore started working there for 6 months. I quit for many reasons with one of them being too much to handle (4 patients total care with and additional patient every now and then along with being a charge nurse). It was in my best interest to leave before I would make a big mistake with one of my patients one day.

    I took a job as a research nurse and have been working there for 6 months but to my dissatisfaction, I think I miss the hospital setting and more so, taking care of critically ill patients. I consider myself an adrenaline junky where I strive in an intense and intellectually challenging environment. I understand that most people think it's better to gain at least 1 year of experience in the floors but I'm looking to pass that, and have a chance at an ICU setting.

    Overall, do you guys have any tips or know of any hospital where they would consider hiring an inexperienced nurse for their ICU? Fellowships would be ideal since I would get training. Learning on the job would be a challenge, but I'm positive I could still become a well rounded ICU nurse. I'm looking to find that career anywhere here in the U.S as I'm also looking to move out of state.


    Any tips fellow nurses?
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  2. 26 Comments

  3. by   lkasticu
    You apply. I don't understand these kind of threads I see sometimes. There is no magic formula or secret to it. Even getting your ACLS or any other certification besides BLS is not strictly necessary, might help a little bit but many people wait and let the hospital pay for it instead. I went from a year of level 3 ER experience to a level 1 inner-city trauma ICU---I applied and interviewed. Some of my coworkers have 4 months of med-surg experience. Several promising ones were hired as new grads. ICUs throughout the country hire new grads all the time, some even preferring them because they don't have to alter a med/surg or ER mentality to an ICU one.

    The myth that you need experience to get into the ICU is most likely propagated by med/surg nurses and the teachers in nursing schools (generally med/surg nurses as well) who say you need to get a "good med/surg foundation" before going into a specialty---more like their floor is understaffed with high turnover so they try to convince new grads to apply.

    It's nonsense. Apply, interview, get a job.
  4. by   Castiela
    I personally can't imagine going straight from being a new grad into icu. Even less so without a full bachelors. I personally think it's a good idea to have a med/surg background to consolidate your nursing skills and critical thinking skills before taking care of the sickest of the sick patients. I don't think it's a ploy to fill understaffed positions. Just because it is frequently done does not mean it is the best way to be done or the safest.
  5. by   lkasticu
    Quote from Castiela
    I personally can't imagine going straight from being a new grad into icu. Even less so without a full bachelors. I personally think it's a good idea to have a med/surg background to consolidate your nursing skills and critical thinking skills before taking care of the sickest of the sick patients. I don't think it's a ploy to fill understaffed positions. Just because it is frequently done does not mean it is the best way to be done or the safest.
    And you say this based on what? Not to mention that ICUs are not always "the sickest of the sick." New grads should not be hired into level 1, extremely high acuity ICUs the vast majority of the time, but the vast majority of ICUs are not that. Even still, my best friend started at a level 1 ICU as a new grad and did perfectly fine. My preceptor/charge nurse and our assistant manager both started on our unit.

    Titrating multiple vasoactive gtts, vent management, CRRT, deep understanding of pathologies, etc. are difficult concepts to grasp at first but with proper orientation are no more vexing than any other skill. Many ICUs won't get more than a few truly high acuity patients at a time. Most deathly ill patients are transferred to a level 1 trauma center, and those aren't the only ICU jobs OP can apply for. Our surgical stepdown unit is the same acuity as the surgical ICU at my old job.

    Sure, it was a big learning curve but me and my colleagues achieved a fairly comprehensive understanding of these skills within a few months. You either underestimate yourself and your peers, or overestimate how difficult critical care nursing is.

    Taking care of two ICU patients is not remotely the same as taking care of 7 floor patients. At most you can gain some skills like inserting NG tubes or starting IVs, but few of my colleagues are great with IVs and placing NG tubes is basically a reflex by, say, the third time. If you are willing to learn then you should be able to knock out tons of these by the time you're off orientation.
    Last edit by lkasticu on Aug 13
  6. by   ICUman
    Quote from Castiela
    I personally can't imagine going straight from being a new grad into icu. Even less so without a full bachelors.
    Uh, why? Are you saying an ADN new grad is less equipped/capable than a BSN new grad in ICU?

    Definitely not true. I was a new grad ADN in the ICU and did very well.
  7. by   LovingLife123
    Quote from Castiela
    I personally can't imagine going straight from being a new grad into icu. Even less so without a full bachelors. I personally think it's a good idea to have a med/surg background to consolidate your nursing skills and critical thinking skills before taking care of the sickest of the sick patients. I don't think it's a ploy to fill understaffed positions. Just because it is frequently done does not mean it is the best way to be done or the safest.

    Wondering the same as previous posters. Been in a very high acuity ICU since graduation. Went in as a new grad with an ASN. Have my bachelors now, but that meant nothing to understanding how to care for those patients.

    I applaud all the medsurg nurses because it is not something I could do. I would lose my mind and sanity. Not everybody is cut out for medsurg as not everybody is cut out for icu.
  8. by   Castiela
    I am Canadian, so our minimum entry level into nursing is a bachelor. Truthfully, I do not know the difference between ADN vs RN in the US. I honestly thought ADN had a lesser scope/less schooling than an RN. I apologize if that comment gave offence.

    I also remember when I first started being a nurse, feeling very overwhelmed. I couldn't imagine going straight to icu with the added pressure. In our province, generally the health authorities wouldn't be considered for icu without a minimum year med/surg and a 5 month full time post degree advanced certificate.

    No offence was meant. Clearly I do not understand your systems. I personally appreciated my time on the ward before going to icu because it gave me a chance to become comfortable with being a nurse without the added pressure of icu and I had some clinical experience to draw on when caring for my patients.
  9. by   DowntheRiver
    Quote from Castiela
    I honestly thought ADN had a lesser scope/less schooling than an RN.
    ADNs/ASNs do not have a lesser scope. We completed the same courses as BSNs, just mostly without the theory portion of the courses. This isn't true for all programs but for the majority of them. Essentially (in my opinion) the theory classes are just "fluff" courses. I'm currently in a RN to BSN program and all I do is write papers about EBP...
  10. by   hawaiicarl
    Wow, the number of red flags in this post is amazing. I would recommend not telling potential employers much of this.

    1. I used my connections with the DON to get a job as a charge nurse as a new grad.

    2. Quit after 6 months.

    3. Went into research (which is ok by itself), quit after 6 months.

    4. I want a job where I leave the state.

    Kristen Wigg from SNL got nothing on you! RED FLAG!

    Cheers
  11. by   LovingLife123
    Quote from Castiela
    I am Canadian, so our minimum entry level into nursing is a bachelor. Truthfully, I do not know the difference between ADN vs RN in the US. I honestly thought ADN had a lesser scope/less schooling than an RN. I apologize if that comment gave offence.

    I also remember when I first started being a nurse, feeling very overwhelmed. I couldn't imagine going straight to icu with the added pressure. In our province, generally the health authorities wouldn't be considered for icu without a minimum year med/surg and a 5 month full time post degree advanced certificate.

    No offence was meant. Clearly I do not understand your systems. I personally appreciated my time on the ward before going to icu because it gave me a chance to become comfortable with being a nurse without the added pressure of icu and I had some clinical experience to draw on when caring for my patients.

    We take the same NCLEX and have the same scope of practice. The biggest difference is the amount of general education credits or liberal arts credits needed. There is an additional math class, writing class, there is a history and philosophy class usually. Then for the actual nursing classes it's a research class and management class. Its a lot of paper writing basically.

    It's often times easier for a new grad to assimilate to the icu because they are a blank slate. I've seen just as many new grads fail in icu as I have seen floor nurses come in and fail.
  12. by   Nurse Beth
    Quote from alli.
    Hi fellow nurses,

    .

    I took a job as a research nurse and have been working there for 6 months.
    Overall, do you guys have any tips or know of any hospital where they would consider hiring an inexperienced nurse for their ICU? Fellowships would be ideal since I would get training. Learning on the job would be a challenge, but I'm positive I could still become a well rounded ICU nurse. I'm looking to find that career anywhere here in the U.S as I'm also looking to move out of state.


    Any tips fellow nurses?
    The most important thing is to get into acute care with your first (but not only) choice being ICU- but keep open to taking what's available.

    Many ICU and ED fellowships are offered to in-house applicants.

    Tailor your application to each individual employer, and create a resume and cover letter that make you stand out. Apply, apply, apply, and you may have better luck in less competitive areas. Best wishes.
  13. by   chacha82
    "I completed my preceptorship in the ICU and took a job offer as a charge nurse in an intermediate care unit. I had connections with the director of nursing and therefore started working there for 6 months. I quit for many reasons with one of them being too much to handle (4 patients total care with and additional patient every now and then along with being a charge nurse). It was in my best interest to leave before I would make a big mistake with one of my patients one day."
    ?[/QUOTE]

    I understand wanting to get back to bedside nursing from research nursing, but ICU patients will NOT be easier than stepdown or intermediate care patients. If you felt overwhelmed by that type of patient, you need to tackle that, then ICU.
  14. by   rescueninja1987
    I had a hard time getting an ICU to hire me with just med/surg experience, so I kind of went from med/surg, to LTACH, to step-down, to ICU. I would've much rather gone straight to ICU but I couldn't get any of them to hire without any knowledge of drips, vents, hemodynamic monitoring etc. so I kind of worked my way up one step at a time.

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