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Best New-Grad Job leading to ICU?

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Hi everyone!

I will be starting nursing school in the fall and even though I know that I will likely figure out my passion during clinical rotations, I already know that I am interested in ICU and its sister units (PICU, NICU, etc). I ultimately want to be a CRNA and that does require 1-2 years ICU, however, I have heard it is hard to get hired in ICU as a new grad, and I want to work as a floor nurse for a little while before settling down in ICU and working on getting into CRNA school. My question is, knowing the path I want to take, what is the best job for a new grad that will not be hard to get hired in but also prepare me for eventually working ICU?

I have always been interested in L&D, peds, oncology, PICU, NICU, PACU, med-surg... I like a fast- paced, always doing something, never know what comes next type of job.

I know I'm young and have years to go before this is something to think about, but I am all about being prepared and would really appreciate any advice anyone has!

Also, feel free to tell me which area you work in and what it's like, what you like/ don't like about it, etc. I love to hear about different areas of nursing :)

If it were me I would do everything I can to get to the ICU straight from school, IF you find a hospital with a good residency program. And that is something you can find out at clinical rotations. Watch and see if there are new grad orienting and ask how the training is.

It should be extensive and long.

If you don't get there just about any acute care specialty can garner quality experience to take you to the icu.

Good luck in school!

BSN GCU 2014.

Sent from my iPhone using allnurses

Ideally I'd love an ICU job right out of school, I just hear so often on this site that it's hard to get hired as a new grad and it's best to get your feet wet in another department first. That's my goal though, thanks so much for the advice!

Apply to new grad programs and aim to get into the ICU straight out of school. Give yourself 6-8 months after graduation to find an ICU job, or in a job that appeals to you. (If you can afford the wait). If after 6-8 months you cannot find a job, expand your search to include both the ICU and the units that you don't want.

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

I am speaking from experience.... went right into Neuro Trauma ICU as a new grad & LOVED it.

If you want to do the same, you need to be "that student" - the one that works hard to be the best-of-the-best; GPA and clinical. Do more (way more) than is required. Don't wait for your instructor to hunt you down. Be proactive & seek out opportunities to observe or help with clinical procedures. Make a note of anything new or confusing and seek to understand via study/research on your own. Take responsibility for your own learning & development. Spend a lot of time in the skills lab to ensure you are ready & willing when opportunities arise in your clinical rotations.

You'll need to distinguish yourself to make a very good impression whenever you are in clinical, particularly when you're in ICU. This means doing way more than is required; like noticing when menial tasks need to be done and simply pitching in to do them. While other students are hanging out & chatting about whatever or texting friends.... you're the one helping pick up dirty laundry bags or answering call lights & fetching water. Trust me - the staff WILL notice.

You've got quite a ways to go - take full advantage of it. I wish you the best of luck in your education.

38pearl

Specializes in Pediatrics.

It's definitely not impossible to get an ICU job as a new grad. If possible, try to get a clinical rotation in an ICU for your preceptorship last semester, that can set you up nicely! If you are having trouble getting an ICU job as a new grad, maybe try to find a step down unit where you would work with the ICU as you transfer patients back and forth. Also, I have heard from a friend going to CRNA school that NICU doesn't count as ICU experience for CRNA (I can't personally verify this though), so maybe look into that before accepting a position there! Lots of luck!

BeatsPerMinute, BSN, RN

Specializes in Cardiac. Has 5 years experience.

It can be difficult but it's not impossible! There are many new grad residency programs for critical care nursing out there, it just depends how close you are to them and how willing you'd be to relocate if you aren't. Like others said, go above and beyond. Help other students, nurses, and patients (answer call lights of pts that aren't just your own). Work hard, be proactive, be positive, and willing to do any and every little "undesirable" task, and don't get caught on your phone or surfing the internet even if that's what all the other nurses and students are doing. Get references from your professors/ clinical instructors, and when you're ready to apply to ICU positions, ask for letters of recommendation. If you are unable to get an ICU position, my suggestion would be a Telemetry position (I had friends do this for 6 months and then apply to ICU or ED positions). If you have CRNA as a goal in mind, go for adult ICU (PICU / NICU experiences aren't accepted in many CRNA schools). Also know that if you have to accept a non-ICU position for your first job, you can continue to apply to new grad ICU residency programs if you really want it. You are eligible to apply to new grad residencies as long as you have under a year of experience. You don't have to be fresh out of school with zero experience to be considered.

My first nursing job was pediatric private duty nursing at a foster home for medically fragile children. I never liked home health or pediatrics much as a student, but I did really enjoy this job. I cared for trached babies, kids with severe cognitive deficiencies, kids with temporary (but still chronic) medical issues. Their stories of how they ended up in the foster home were always very sad but it was wonderful to be a part of the supportive and caring environment that this home offered them. I recently quit because I was accepted into a New Grad Residency program in another state for CVICU nursing! I start in a couple weeks.

Just another little thing... I recommend reading the books by Caroline Porter Thomas (she has one for nursing students and one for new nurses). I only read the new nurses one. Whenever I was feeling burnt out, unsure ect reading her books or going to her youtube channel empoweRN helped me stay motivated and positive, and she offers some really great tips!

Good luck!

VANurse2010

Has 6 years experience.

In general, I don't agree with new grads going to ICU. However, if your ultimate goal is CRNA, you should probably look for ICU residency programs - no point futzing around on the floor when you can leave in 2 years for CRNA school after ICU

I know a lot of experienced nurses are not comfortable with new grads working ICU, and I would hate to be put down as a new grad working in the ICU because of that, so that does make me nervous! That being said, I've also heard from many nurses who, like you said, agreed that if CRNA was my end goal, to jump right into ICU because there's no point delaying my goal.

Thanks so much for the kind words and encouragement! I'm so glad to be hearing all of this before I even start nursing school, hopefully it will help me get one step ahead!

There were two people hired straight out of my graduating class into the ICU; one went into MICU, the other into SICU.

What they did:

The MICU guy was the valedictorian, the SICU woman was the salutatorian. They both precepted in their last semester on the unit that hired them. The MICU guy had a new baby and a job and still pulled it off, mainly because he lived and breathed nursing. The SICU woman was super smart and very motivated. They both had tunnel vision from the beginning and decided where they wanted to go immediately, like you have.

If you can be that student, then go for it!

VANurse2010

Has 6 years experience.

I know a lot of experienced nurses are not comfortable with new grads working ICU, and I would hate to be put down as a new grad working in the ICU because of that, so that does make me nervous! That being said, I've also heard from many nurses who, like you said, agreed that if CRNA was my end goal, to jump right into ICU because there's no point delaying my goal.

It's stressful for experienced nurses to have to work with hoards of new grads (especially in a high stakes setting like ICU), even if you enjoy working with newbies and precepting. My old unit hired so many that I was there one night (with a year off orientation in the iCU, although 4 years overall) where I was the next most experienced nurse on the unit after charge. That's not cool.

adventure_rn, BSN

Specializes in NICU, PICU.

Maybe you could consider applying to step-down units as well as ICUs. The ones in my area seem open to new grads, and it gives you a great balance of med/surg and critical care. Plus, once you have step down experience, ICU makes perfect sense as the next step.

I would caution you against going into NICU/L&D right out of school if your end goal is CRNA. They are both very specialized units, and it would be very hard to transition out of them into adult intensive care without any adult experience. Also, NICU generally is not considered acceptable ICU experience for CRNA school (although it does occasionally happen, and NICU can be a good supplement to adult ICU experience in your application).

I work in NICU and I absolutely love it: the patients, the families, the skills, the autonomy, and the nature of the care. Nobody wants to end up in the hospital. Maternity (including NICU) is the only place where I've seen pure joy in the hospital on a daily basis (i.e. a mom holding her baby for the first time).

However, babies are medically nothing like adults since their nervous systems are very immature. When adults are in distress, their respiratory rate goes up; in contrast, babies stop breathing; in distress, adults' heart rates go up, whereas babies' go down. I think that your clinical experience in NICU might make CRNA school harder since adult physiological reactions will often go against your nursing instincts. Just my two cents.

Hi maaadddzzz, I'm a new nurse too (started working in November 2015). I work on a surgical step down unit and I agree with adventure_rn, BSN, RN, I think it's a great place for new grads to start if they want to be an ICU nuse but can't get in to an ICU as a new grad! I love the balance of med-surg and critical care that I get; I get between 3-4 patients, my patients are on tele monitors, I get experience with medicated drips, a-lines, and other kinds of invasive monitoring but without the same intensity of an ICU which personally I did not feel like I was able to handle as a new grad still learning the ins and outs of how to be a nurse. (I know a lot of people who started in an ICU though and loved the intensity!). You also get to know the staff of the ICU's because you accept report from them often, so they would be able to give you insight on when positions open up. I haven't decided if I want to make the jump to an ICU just yet, but the MICU and SICU managers both reached out to me and said they would take me on if I was interested. I feel as a new grad having the step down experience would definitely make an easier transition to get in to an ICU than if I had been going from a med/surg floor. Good luck!

calivianya, BSN, RN

Specializes in ICU.

I would say if ICU is your goal, make sure you get it. There is an ICU somewhere that will take you when you graduate. I did not get hired for my local ICUs because of how competitive the residencies were, so I applied in five different states and accepted an ICU residency 400 miles away from where I lived, packed up my stuff, and relocated.

If it's what you really want, do what you need to do to make it happen.