Acute Care NP without ICU experience?

Stybring · Jun 30, 2017

Hello!

I worked inpatient for 6 years then in the ED for 4 years prior to getting my ACNP degree and then looked for and applied to a critical care fellowship after I graduated which I'll start in a few months (after certification exam).

Now, the ED is considered critical care, but I was told by my first advisor in my ACNP program that I wouldn't be able to work in critical care at all if I wasn't ICU trained and that is NOT true. Do you want to work in the ICU? There are a lot of jobs outside of the ICU if you just want to stay in the hospital setting that don't require critical care nursing experience. If you want ICU specifically, you may need to bite the bullet and do nights and go to school, it can be done, that's what I did (4 LONG years on nights). You'll really want to have some working familiarity with advanced medications, arrhythmias, codes etc if its ICU you're set on.

Good luck!

AMD88 · Aug 1, 2017

I was in your same shoes a few years back. I got into an adult acute care program without any ICU experience. During orientation I asked the head of the program if my lack of ICU experience would prevent me from being successful in the program and if I should find a job in ICU and she told me they would teach me everything I needed to know and if I am happy with my current job (which I was) to keep it. I have completed the program and passed boards on my first try. I will say I did have to put extra effort into learning how to manage a vent and drips but otherwise, I had no problem. Even in the clinical setting my preceptors were shocked when I told them I was not an ICU nurse. I have worked in just about every specialty Neuro, Ortho, GI, Cardiac...and the list goes on. I felt that my broad knowledge of many different areas prepared me slightly more than the students that had ICU experience. Most of them had very specialized ICU experience such as Neuro/Cardiac ICU and some of them had a hard time learning about all specialties because their nursing career had been so focused. They would do really well when we studied their specialty and then struggle with the others.

AMD88 · Aug 1, 2017

And as far as employment, most of the people that have interviewed me have been more interested in hearing about my clinical experience than my nursing experience. I do think unless you are in an area with a large need for acute care NPs, it can be difficult to start out as a new grad in the ICU. Most places around me want an NP with some experience. My goal is to work in the ICU at some point as an NP. I am starting out doing internal medicine at STR & LTC facilities. After a few years experience, I plan to look for a job in a hospital preferably ICU.

allnurses Guide · Aug 9, 2017

I hire ACNPs for critical care, and I do not think I would hire a new grad with no ICU experience. I would have the same problem with a new grad PA with no ICU experience, although they do more clinical during their course. I just don't think you can assume a lot of basic knowledge in someone that hasn't worked as an ICU nurse. Not saying I definitely wouldn't hire one, but they would have to have really stellar recommendations from their NP clinicals in critical care, and be willing to do extended orientation and learn.

shkpk · May 30, 2018

Hello AMD88,

I am in a similar position as you right now in my career. I work on essentially a stepdown ICU for pediatric GI and solid organ transplants (we get certain drips, bipap, and cpap) and would like to become an acute care PNP in the PICU. I wanted to work bedside in the PICU but it kept not working on because of timing. I have one more year before I graduate with my primary care PNP and I plan to go back for my acute care post masters certificate and train in an ICU to eventually become a ICU PNP.

Do you feel that your training has provided you with the skills and knowledge you needed despite not working bedside as an RN in an ICU? Do you find that you receive the same respect from bedside nursing who knows that you do now have and ICU background?

Any advice you have would be greatly appreciated.

Seasea122 · Apr 5, 2020

On 8/9/2017 at 7:54 PM, ghillbert said:
I hire ACNPs for critical care, and I do not think I would hire a new grad with no ICU experience. I would have the same problem with a new grad PA with no ICU experience, although they do more clinical during their course. I just don't think you can assume a lot of basic knowledge in someone that hasn't worked as an ICU nurse. Not saying I definitely wouldn't hire one, but they would have to have really stellar recommendations from their NP clinicals in critical care, and be willing to do extended orientation and learn.

Hi,

Am in my program and have no nursing experience at all. It's an accelerated program for non nurses where you get your RN and NP in 3 years at Yale, am going on my last year and have been thinking going part to work as a nurse in an ICU setting, would you recommend it, or would you recommend doing residency instead. Thanks

Guest1144461 · Apr 6, 2020

2 hours ago, Seasea122 said:
Hi,
Am in my program and have no nursing experience at all. It's an accelerated program for non nurses where you get your RN and NP in 3 years at Yale, am going on my last year and have been thinking going part to work as a nurse in an ICU setting, would you recommend it, or would you recommend doing residency instead. Thanks

Its very rare for hospitals to hire new grad ICU nurses and even rarer to let them go part time....

allnurses Guide · Apr 8, 2020

On 4/5/2020 at 6:36 PM, Seasea122 said:
Hi,
Am in my program and have no nursing experience at all. It's an accelerated program for non nurses where you get your RN and NP in 3 years at Yale, am going on my last year and have been thinking going part to work as a nurse in an ICU setting, would you recommend it, or would you recommend doing residency instead. Thanks

If you're graduating as an NP, do not go get ICU RN experience. Find a critical care residency/fellowship for NPs.

AMD88 · Apr 9, 2020

So I’m just now realizing people have posted to this forum that I haven’t responded. So everyone knows my nursing experience which was no ICU experience and I landed a job in internal med as a NP one month after passing boards. Well to give you an update, a month later I landed a job in critical care working nights. Although I had no ICU experience, my program fully prepared me and I did really well in that position. 6 months later they gave me a full time job paying very well. I’m now dayshift, half ICU, half pulmonary (I’ve only been doing this for a month) and I can tell you I’m highly regarded and top within my group. Don’t worry about your nursing experience. Get your first job as a NP, bust your butt and then you will get your dream job. It just may take some time. I was very fortunate to get my dream job right away but my acute care education fully prepared me and no one ever questioned my lack of ICU education within a month or two.

Guest1144461 · Apr 10, 2020

On 4/8/2020 at 6:01 PM, AMD88 said:
So I’m just now realizing people have posted to this forum that I haven’t responded. So everyone knows my nursing experience which was no ICU experience and I landed a job in internal med as a NP one month after passing boards. Well to give you an update, a month later I landed a job in critical care working nights. Although I had no ICU experience, my program fully prepared me and I did really well in that position. 6 months later they gave me a full time job paying very well. I’m now dayshift, half ICU, half pulmonary (I’ve only been doing this for a month) and I can tell you I’m highly regarded and top within my group. Don’t worry about your nursing experience. Get your first job as a NP, bust your butt and then you will get your dream job. It just may take some time. I was very fortunate to get my dream job right away but my acute care education fully prepared me and no one ever questioned my lack of ICU education within a month or two.

I am sorry, pray tell how someone with <1000 hours NP experience (school combined and being generous) prepare someone to be a competent critical care provider. I did acute care at a large state school with NP colleagues who came from top 5 programs and none of them felt prepared until they were a couple years into practice.

I am not questioning your intelligence but after being an ICU nurse for years and doing a 1 year internal medicine residency/fellowship, I still feel unprepared on many days as a hospitalist in a metro hospital. Sorry, It just doesn't add up to me.

You don't know what you don't know.....Or the MD residents and fellows are just chumps for doing thousands and thousands of hours for no reason...

AMD88 · Apr 10, 2020

There isn’t a new NP that comes out of school fully competent. As a new NP in any specialty, there is tons of on the job training in the first few years. That doesn’t mean I was not competent for the job and my program did not fully prepare me for the start of my NP career. I was not placing lines and running codes on my first day. But I knew the basics of treating common medical conditions in critical care, managing vents, ACLS and knowing when a patient was about to crash so I could move them to the ICU and get help from my Attending. This would be a normal expectation for a new NP in critical care that did not go through a residency program. I’m basically encouraging people that despite not having ICU experience as a nurse, you can still become a Critical care NP. Would it be better to have experience in ICU? Of course, but like I said in previous post, it didn’t work out for me and it did not hurt my NP career at all.

NP programs do not prepare you to be a fully independent practitioner in critical care or any specialty. That takes many many years-hence residents and fellows are doing thousands of hours so that when they get their first job out of school, they have to be ready to run codes and place lines on day 1. 2 years later, I’m running codes, doing procedures independently and managing critically ill patients.

I’m sorry if my prior post was misleading but what I meant, was I felt prepared by my education and did not struggle when I started in ICU any more than any other new NP, regardless of their experience, struggled. Of course I still had plenty to learn but this is clearly something that can be done if you are willing to put in the work.