medsurg or ER experience

[Yuppers21]

For a new grad who wants to end up in ICU (but realizes that this doesn't usually happen straight out of school), what type of experience would better prepare/increase chances for the ICU after a year or so? Obviously I may just be happy with any job offer if hiring conditions don't improve here pretty quickly, but ideally speaking, if I had the choice b/w the two, which one would the figurative "you" recommend keeping in mind that this end goal is ICU (particularly SICU or CVICU; loved loved loved my time spent there during clinicals!). Thanks in an advance for any insight!

[sunnycalifRN]

If you have a choice, I'd say ER over med-surg. In the ER you'll get experience with all types of emergencies, many which you'll transfer to ICU. You'll become an IV expert. You'll learn time management and how to prioritize care (although you'll do that in med-surg, too). You'll get experience with pressors, inotropes and antihypertensive drips.

[edogs334]

I would go to the ER only if their new grad program has a lot of structure and support- ie- a long (at least 4 months) orientation period, formal classes (the ER new grads took the critical care course with us new ICU nurses) and supportive coworkers that you can ask questions of- especially before you hang- say- a vasoactive drip that you're not sure about. Not asking questions (or not being able to ask questions of your experienced coworkers and docs) is how you will make a fatal mistake. So if you interview in an ER where things seem like a total rat race, where everyone's just too busy to help each other out and where the orientation period is minimal, then I'd go straight to med-surg first. Also be wary if the managers and/or HR people don't let you talk openly with any of the staff about what it's like to work there and what it's like to be a new grad in their ER; that should raise a red flag right there regarding employee morale.

Of course, you could also find an ICU that takes new grads. I was one of those senior nursing students who thought that I really needed some med-surg or intermediate care experience before I tackled the ICU- and there's nothing wrong with new grads who go that route because they're strengthening their basic skills with meta-stable patients before they take on the really sick ones. A few months before I graduated, I applied to a hospital (the one I work for now) for a position in one of their intermediate care units. After graduating and passing NCLEX, I hadn't heard from them so one day I decided to call their HR dept to follow up on my application. I spoke to the recruiter and they said that while they didn't have any positions available in the unit I applied for, that there were positions available in some of the ICUs if I was interested. I thought that working as a new grad in an ICU would be stretching it, but decided to interview anyway. I was hired into one of the ICUs at the hospital and have been working there for several months now. Although there are still things I'm struggling with (such as time management), I've learned A LOT and don't regret my decision to start in an ICU. I wasn't one of those students in nursing school who had a sponge brain (getting everything the first time around and getting straight A's), but I am reasonably intelligent, like to be challenged, possess a drive to persevere through difficult situations and don't hesitate to ask questions if I'm not sure of something. Getting a 4-month unit/classroom orientation and having supportive coworkers has also helped (in NO small measure). Hence, if you find an ICU that provides a lot of support to their new grads and is willing to train you, then GO for it. Everyone may say that being an ICU new grad is hard (and it is), but it's really not as impossible as some people make it out to be.

Bottom line- you should never be made to feel like you're completely alone in any unit you work on (med/surg, ER, ICU, wherever). Don't work anywhere you'd feel like you'd be put into that kind of situation- at least not as a new grad.

[Yuppers21]

Thank you very much for the responses, especially to you edogs334. Your personal experience has given me some more to consider. I would definately be open to applying for any ICU positions right after grad school, but don't mind getting there by other means if the opportunity isn't there right away.

[Smiley68]

I have an experienced perspective on this. I'm a nurse of 10 years with 8 of it in the ER. I was a new grad in the ER but had years of tech and HUC exposure prior to that so felt very comfortable. I never worked "on the floor" so always either discharged my pt home or "fixed them up" to send them to the floor or ICU. All things were stat and once and very exciting and challenging nursing. After needing a change, I now find myself as an orientee to the ICU without ever having "floor" experience. I struggle daily to organize my day and anticipate my pt's needs and short/long term goals. I have only 2 patients but find that I regularly fall behind in charting or getting orders processed fast enough to be efficient. I have to ask basic questions about what things require orders and hospital policies daily even though I've worked at the facility for 10 yrs. Although I never had any interest in working Med Surg or PCU, I know that if I had the experience or organizational skills of multiple patients/mult meds/multiple doctors on one case I wouldn't struggle nearly as much as I seem to now. I don't regret one moment of working in the ER but just wanted to share my thoughts.