Being hired into an ICU

SopranoKris, MSN, RN, NP · Dec 19, 2017

Most ICUs are not going to hire you to do an RN job when you're licensed as an NP due to liability. You're going to be held to the higher license standard. Is there a reason you don't want to be an NP anymore? If you're already an NP and want to be in the ICU, I think ACNP would be what you would want to do. The fact that you don't want to be an NP at all after going through all that schooling is only something you can answer. Honestly, you're going to get a lot of raised eyebrows and a "could she not hack it as an NP?" type reaction by trying to go back to the RN role.

BlondieMSNRN · Dec 20, 2017

Hmm, well, no after 8 years in stem cell I can hack it as an NP. But I understand how people could think that. I'm simply tired of being a provider. And I also don't want to be a career resident as I see the ACNP role (and which some NPs I know complain talk about); thats OK if that's what you want to do, but it's not for me- it's why I did not take that route in the first place. I even if I did, I believe one needs critical care experience as an NP before the ANCP due to the pathetic 500hrs of clinical time required before graduation. I truly think schools do their graduates and the nursing profession a disservice by continuing to graduate unprepared NPs. I'm clearly not a fan of direct entry programs!

ICU_UcMe, BSN, RN · Dec 25, 2017

I stumbled upon this thread, and just wanted to tell you that I work with a bedside APRN. Like you, she didn't want to practice anymore so she doesn't. The hospital couldn't care less about her being licensed as a NP. She's still a nurse, and that's all they cared about. Mind you, she's only getting a RN's wages though. I'm not sure how much more you all make yearly, but if you're okay with our pay then I say go for it.

BlondieMSNRN · Jan 7, 2018

Thank you for letting me know! It's so rare to hear about those "types" of RNs, so it's cool to know that some of them do exist!

BlondieMSNRN · Jan 7, 2018

PS: Depending on the city, NPs sometimes don't make much more than RNs. Where I am now (city hospital with union), the senior RNs definitely make more money than the NPs. This is due to NPs being salary, non-union, so no shift differential or overtime.

WestCoastSunRN, MSN, CNS · Jan 8, 2018

I hear you. I finally realized the NP payoff was just not going to be what it needed to be for it to make sense for me to pursue. I make good money and I love my job. I will still get my master's (I love to learn/teach, etc), but am pretty set at staying bedside as long as I can. CC nursing is for me -- and I know a lot of career CC nurses. In the right employment setting, the job satisfaction tends to be quite high.

I don't see, at all, why you can't pursue a CC position. You are not currently qualified for such a position, so it will have to be some sort of internship or someone who can give you a proper orientation. As a primary care NP, you really don't have a lot of knowledge pertinent to what you will see in the ICU. This is a GOOD thing in terms of liability (as one poster mentioned). You don't have the training or certification to properly diagnose/treat critically ill patients --- therefore no court will hold you accountable for doing so (check with your BON -- I really don't think this is EVER an issue in real life for NPs working bedside -- but could be different state to state). Even if your state has such a rule --- it could apply if you were a ACNP, but as a primary NP -- you really shouldn't know what you're doing in an ICU provider-wise. So you should be fine from that angle.

As far as selling yourself to an ICU? Your young, right? Young people tend to make changes -- it's NOT unusual and it won't surprise an employer, I don't think. Now they may want to know you don't just want the ICU experience for ACNP, so there's that. They want to know you'll be worth their investment, because they are going to have to put a lot into getting you ICU ready (though not as much as a new grad -- so there's another selling point!).

You can also use your master's in other ways in the hospital system, such as in professional development/teaching/research. This is a selling point for you. You come with the focus of CC bedside nursing, but with the ability to contribute in other ways such as with the education department or with research projects for the unit. Be prepared to answer how you plan to 'transition' the use of your master's, so that they don't have to fill in the blanks with their own imaginations. Be very clear about wanting to to focus, though, on growing your bedside practice and learning the new CC specialty.

Talk to local recruiters. Call your local systems and get in touch with those specific ICU recruiters. Have your reasons ready for why you want to make this change. In my area we need CC nurses. I could work as much as I wanted in any of the ICUs around here. At the same time, if you're coming at it from a less-than-traditional angle, you need to bring a very focused A-game to land a position.

Good luck!

BlondieMSNRN · Jan 10, 2018

WestCoastSunRN, thank you so much for such a thoughtful reply to my question.

So many really, really good ideas, especially how use the MSN degree as a strength and to contact recruiters directly. I will be finding out soon if my family and I will be making a big move soon (hence my own desire for career change) and have lots to think about. Thank you for so many great ideas here and for reminding me that I'm still pretty young when it comes to nursing.

Thank you again :)

StillRN · Jan 31, 2018

Just and add on: I worked with 2 girls who were working as regular staff nurses in Labor and Delivery. One was a Pediatric NP and the other was a Certified Midwife. Both had problems finding jobs in those fields. The Pediatric NP did eventually find a job and move on, but the Midwife continued to stay working as a staff RN in L & D. She did not write orders or go outside of orders (tho i think she annoyed several doctors by suggesting orders or questioning orders.. which i can see cuz she annoyed everyone else too..lol), she followed doctors orders and worked with the extra knowledge... I think she spent extra time with the laboring women and was able to help them through their labor and deliveries with a lot of knowledge, but her Midwife degree didnt hinder her position as a staff RN. Good luck! hope it works out for you.