How long did you work med-surg before getting an ICU job?

[Lev, MSN, RN, NP]

I'm a med-surg nurse and I want to switch specialties to ICU, preferably SICU or CVICU. For those who switched into the specialty, how long did you work med-surg (or any other type of specialty) before you got an ICU job? What type of ICU do you work in? I work on a med-surg floor with fairly high acuity acute care surgical patients. When my fellow nurses are floated to the other med surg floors we have "good days" and everyone hates floating to us, although most times we can't give them post ops. Our ratio is 1:5.

[Ruby Vee, BSN]

I worked Med/Surg for five years, and ended up being "volunteered" to transfer to MICU by my manager. To my great surprise, I loved it. From MICU, I went to a CCU in another state, which I also loved. Then a mixed CCU, CSICU. Now CVSICU. I wasn't sure at first that I could do ICU, but it seems to be my niche.

[SCBlueICU]

I worked on a Telemetry floor for a little over a year before moving to the ICU. That was a perfect amount of time for me and learning heart rhythms really well helped me out a lot. I think that once you feel comfortable with time management, responsibility, etc., on the floor, you will be fine in the ICU if you are interested. Takes some studying once you get there though! I work in the MICU.

[Lev, MSN, RN, NP]

I worked Med/Surg for five years, and ended up being "volunteered" to transfer to MICU by my manager. To my great surprise, I loved it. From MICU, I went to a CCU in another state, which I also loved. Then a mixed CCU, CSICU. Now CVSICU. I wasn't sure at first that I could do ICU, but it seems to be my niche.

You were "voluntold." I wish that would happen to me. Why didn't you think you could do ICU with five years of med-surg?

And I have even less experience than you did. Do you think that a year of med-surg is enough? I also have some tele and rehab experience. Just shy of 2 years total nursing experience. I am just so sick of running up and down the hall to get water or pillows. I like using my brain. My time management is above average. I chart in real time. I have pretty good analytical skills and I'm good at demanding things for my patients and getting what I want (most of the time and within reason). I think I would like ICU.

[Lev, MSN, RN, NP]

I worked on a Telemetry floor for a little over a year before moving to the ICU. That was a perfect amount of time for me and learning heart rhythms really well helped me out a lot. I think that once you feel comfortable with time management, responsibility, etc., on the floor, you will be fine in the ICU if you are interested. Takes some studying once you get there though! I work in the MICU.

I do feel comfortable. I just started feeling comfortable in the last couple months. I do have a little bit of tele experience. I am familiar enough with rhythms, but not enough that I wouldn't be second guessing my self. I am planning to take ACLS some time soon. Maybe in a couple months. I just started a PRN med surg job and I want to get through orientation. I work days and the job is nights (only 2 shifts a month) but orientation is more condensed so now is the not the right time. I will definitely study. I still study. Even while I work med-surg.

[ChristineN, BSN, RN]

I transferred from the floor to ER after working the floors for almost 5 years. While I don't have critical pts everyday, it was still a transition. You have to be willing to learn, and accept that you are starting at the bottom again.

A good manager will see strength in your background, as you should already have good assessment skills down

[icuRNmaggie, BSN, RN]

I worked one year of Oncology then one year on a high acuity Progressive Care Unit before transferring to ICU.

Both were very difficult positions but both jobs gave me valuable experiences, general knowledge and basic skills that I still use today.

For this reason I am not a fan of hiring new grads into the ICU. I feel that ICU opportunities should go to people who posess the basic skills and have demonstrated competence in a lower acuity inpatient area.

[PMFB-RN, RN]

We hire new grads almost exclusively into our ICUs. Pretty unusual that we could consider a med-surg nurse for an ICU position. When they are hired they pretty much go through all the exact same training as new grads do with the exception of the first month of general hospital orientation.

We have had to recycle (extend their training past the usual 9 months) more med-surg nurses than any other group.

[icuRNmaggie, BSN, RN]

to PFMB-RN,

I just re-read the original post and I am inclined to agree with you about Med Surg nurses making the transition in ICU.

What is your experience with PCU and Stepdown nurses transitioning into an ICU?

I think they are far more successful than the M/S orientees.

Maggie

[PMFB-RN, RN]

to PFMB-RN,

I just re-read the original post and I am inclined to agree with you about Med Surg nurses making the transition in ICU.

What is your experience with PCU and Stepdown nurses transitioning into an ICU?

I think they are far more successful than the M/S orientees.

Maggie

I have two jobs. My full time job is at a smaller (200 bed) publically owned teaching hospital. My other part time job is at a large tertiary care referral center / trauma center that used to be my full time job.

Back in 2006 the larger hospital implemented the 9 month critical care nurse residency program in an attempt to reduce the fantastically high turn over on all their ICUs. It was already unusual for any med-surg nurse to apply for a job in the ICU but at that time they pretty much quite taking applications from any but experience ICU nurses and new grads. The program (after a few hick ups) has managed to dramatically reduce staff turn over. We have found that, when properly trained and supported, new grads make highly effective ICU nurses who are confident in their training and usually stay in the unit longer. New grads go through a 9 month, very intensive program. After that they are assigned a mentor on the unit and they work the same schedule as their mentor. The mentor is compensated for agreeing to mentor new nurses for the first year after they finish their residency. After their first year nurses (21 months after entering the residency) are evaluated and the decision is made whether to continue their training to recover open hearts, serve on the trauma, RRT and code teams, and eventually be trained as charge nurse and preceptor rolls, or if their should remain in the mentorship program for an extended time. It is usually med surg nurses and not new grads who end up staying under mentorship for longer periods of time. This hospital does not have a step down unit.

At the smaller hospital where I work full time they do not make that kind of investment in ICU nurse training, and it shows. They also don't hire new grads into ICU. They do have a very good step down unit though. In that environment the step down nurses are better prepared for success in the ICU, in my opinion.

[DogLover17]

A nurse practitioner I highly respect told me, while I was working in a high acuity step-down unit, that when you start to get bored or comfortable it's time to move on. For me it was about a year and a half, others less time.

We hire new grads almost exclusively into our ICUs. Pretty unusual that we could consider a med-surg nurse for an ICU position.

They pretty much quit taking applications from any but experience ICU nurses and new grads.

I find these statements to be very depressing... not for me personally (I've got a fine job and have no desire nor intention to leave it) but for the multitudes who find themselves forced to take any job that they can find in the hopes of developing themselves and progressing into specialty care.

While I understand completely the data-based rationale, it saddens me to realize how many solid people will be excluded from 'the club.' It's probably because I was nearly in this position myself and essentially got lucky to be interviewed by someone willing to take a chance on me. I likely would not have been hired by the person presently making those decisions and yet I seem to be one of the stronger nurses in our group... I simply needed some seasoning and opportunities to make up for the gaps in my experience base.

As I read the recent posting of the ANA's lobbying to sustain and expand fundamental nursing education, I kept thinking how irrational is that mindset but how beneficial it would be to develop and subsidize a system that would enable more nurses to engage in a magnificent program such as you describe (I'm jealous!!)

It's sad to know that one's entire career may be dictated by the simple luck-of-the-draw in one's initial hiring.