A Day In The Life

calivianya, BSN, RN · Apr 27, 2014

I got hired for an ICU job a couple of weeks before I graduated nursing school. It is definitely possible, tons of people in my graduating class had ICU jobs. You just have to apply a lot of different places and be willing to relocate if necessary if you live in a place where you might have a tougher time getting into ICU as a new grad. Incidentally, I think I'm the only one in my graduating class who relocated out of state for the sole purpose of finding a job. Most of my peers got jobs where they lived.

My pay is $20/hr and the job had a residency. The residency part was mostly a waste of time - learned a couple of things, sure, but 90% of the material was stuff I learned in nursing school that they just felt like telling me again. It was in a classroom once a week and there was nothing hands on or practical. It lasted five months, but I still only had two and a half months of orientation with a preceptor. They said 90 days, but the first two weeks were all classroom stuff unrelated to the residency, so I spent less time than that with my preceptor. Because of the classes being Friday morning and my preceptor being weekend option days, I frequently came in four hours into her shift to work with her on Fridays. Those days were days I was helping her, instead of her letting me do the work, because she'd been flying solo the first four hours of the shift so she liked to finish the work. I like to say the classes really robbed me of a full third of my orientation time with my preceptor. I was there, but really, I was just an extra pair of hands instead of the person taking care of the patient those days. Besides, we usually had the same patients all three days, so I never got to hear much more than updates other than whatever she decided to tell me when I arrived. I never got the full, initial report from the previous nurse unless it was a transfer or admission or a transfer or admission at nighttime when we were off. It was not fun and I think it was a poor decision on the part of management to pair anyone taking the class with a weekend days preceptor, but what do I know?

The residency program is also what allowed the hospital to require me to sign a contract for $12,000 for two years. Other residencies I applied to only had penalties of $5,000 or less. This is not a scientific observation, but some of those lower cost hospitals were places I had clinicals and they were better work environments for nurses than the one I'm working in now. I would love to find out if the cost the hospital charges for a residency has a direct correlation with how much trouble they have keeping staff, i.e. how toxic of a work environment that unit is. Just based on my own experience, I would be leery of a hospital with a high contract dollar like mine figure versus a low dollar figure - it could be an indication the hospital has some real problems. Most hospitals have contracts these days, but perhaps if they're not charging very much, they think they're not going to have a problem with new people staying... less than $5,000 isn't really that much of a deterrent when it's prorated over time. $12,000+ is a lot more money, especially if they have you sign it during your orientation and clock doesn't start ticking down until your orientation is over. Just something for you to keep in mind.

I am very against residency programs at this point based on my own experience and would not recommend them to anyone if you can avoid them, but ymmv.

Oh, and your pay after experience? I saw over a five-year coworker's shoulder that he is only making $2/hr more than me, so at least this hospital seems to give less than $0.50 raises per year. He is a very strong worker, very smart, and his patients like him, so I imagine he probably gets the max on merit raises and still only makes $22/hr after five years. Maybe he started way lower than $20/hr and has actually gotten decent raises, but still. It seems like the only way to make decent money is to get some experience and then get a new job so you get hired at experienced nurse pay instead of new grad pay.

That all sounded really negative but I really enjoy critical care - I just don't like the hospital I work in, I hate the way they handled the residency and essentially ruined 1/3 of the time I had with my preceptor, and I hate that I have a really big stick hanging over my head as far as the contract goes so I can't find a better job without risking having to pay obscene amounts of money. The shifts can be pretty different from one to the next, but as a rule: full assessments every four hours, turns/falls/IV sites/restraints every two hours, any special assessments as needed/as ordered by physician, and hourly urine outputs. You will be in your patient's room a lot. You should really shadow a critical care nurse and experience a day in the life for yourself! I think it would even look really good on your resume that you are so passionate about critical care that you found shadowing opportunities on your own. :)

hopefull1n30188 · Apr 28, 2014

Hi Calivianya,

Thanks for the insight. I guess I never thought about the relationship between the contract amount and the conditions of the facility. You made some pretty interesting point. I'm not sure how I would handle your particular situation. I think that I would get at least a year's experience out of your location, and look else where. At least at that point, you can knock off half of that contract cost. Also, have you considered working elsewhere at least PRN to help pay off the contract in case things go from bad to worse and you have to leave? I guess my concern is that you will get buned out within your first year because of the conditions...

calivianya, BSN, RN · Apr 28, 2014

Hi Calivianya,
Thanks for the insight. I guess I never thought about the relationship between the contract amount and the conditions of the facility. You made some pretty interesting point. I'm not sure how I would handle your particular situation. I think that I would get at least a year's experience out of your location, and look else where. At least at that point, you can knock off half of that contract cost. Also, have you considered working elsewhere at least PRN to help pay off the contract in case things go from bad to worse and you have to leave? I guess my concern is that you will get buned out within your first year because of the conditions...

I am doing exactly that. :) I just got a PRN job, and I'd been signing up for five 12s a week prior to that at my main job just to help get through my contract faster. However, they started calling me off for my extra 2 shifts every week because they were cutting back on overtime so that was no longer a valid option. I have signed up for 2 shifts every single week at my PRN job, so I am doubling my base pay assuming I get to work all of my shifts at both jobs. If I get fed up and decide I can't take it another minute, I probably have enough to pay the rest of it off. It's just so hard to think about sinking $8k or $9k into paying off a contract since my contract only technically started in October when I could be opening new savings accounts, making a down payment on a house, or something more financially responsible than just throwing money into a hole. I will probably stick it out until I have an absolute breakdown, which may just happen because I also don't like the place I live or the type of people that live in it and I have made no real connections here, so... we will see.

That's why I really recommend not signing a contract with a big cost, especially if you are relocating really far away from everyone you have ever known. You never know when the isolation is going to wear you down.

hopefull1n30188 · Apr 28, 2014

I completely understand. That is a hard pill to swallow, no matter how much money you make, to just fork out 9k. The residency program that I am looking at is in Atlanta. I know that the contract is at least 10k, but the actual residency is a full 2 years. It is at a Level I trauma hospital, and the contract is for 2 years of service after completion of the residency. I think, from what I hear, starting salary is $24.50, or close to that. I know that if you are simply hired on as a Staff Nurse, and you choose not to take the benefits, starting salary is $28.

The catch is, however, like you stated previously, it's pretty rough conditions. Not necessarily in the way that you are treated, but rather the circumstances. It is the only public hospital in the area, so they are ALWAYS SWAMPED. I hear that they are usually short on everything from staff to supplies. The bright side, however, is that the experience that you gain is invaluable. And from what I hear, even after only a year of experience there, you are considered the best of the best and can go pretty much ANYWHERE, and have more wiggle room when it comes to negotiating your salary because everyone is familiar with the conditions of the facility. They figure if you can make it there, you can make it anywhere.

I am glad that you are looking at ways out of the situation. I will pray for you if you would like. As the saying goes, we live, and we learn.