How and when did you get your first ICU job? Personally,

sway · Mar 16, 2004

I was fortunate and got my first job right out of school in the MICU where I did my senior preceptorship. They already knew me, and hired me right off. From what I can tell from my research in to all of this, I'd advise against doing travel nursing or home health. Instead, I'd go for a step down unit or cardiac floor. Both would provide an excellent basis to learn critical care. Once you're hired, you can always try to transfer to another department (ICU). Some units have a minimum amount of time you have to stay there, before you can transfer, so check in to that. I've heard that most travel companies don't have much in the way of education, and hospitals definetly don't want to spend money orienting or educating a travler. Go wherever will give you the best orientation/education, and I wouldn't worry too much about the "level" of trauma center. If they have open hearts, swans, balloon pumps and lots of drips going in their ICU, you're set. Teaching hospital is definetly a bonus worth going out of your way for.

Just my 2 cents....sway

Trauma Tom · Mar 16, 2004

Roland,

I understand what you are trying to do and I think you should try to work at the Trauma I center. If you missed the deadline for the summer extern program you may want to consider trying to contact the clinical manager from the ICU you want to work in and see if they have any positions available to work as a nurse assistant or a patient care technician or even a clerk's position. I worked as a nurse extern at a major level one trauma center in the ER before transferring to the Surgical/Trauma ICU. The difference between the work of an extern versus the work of a PCT or CNA really depends a lot on the hospital or the department you work in. Most likely, if you are hired to work as a PCT or CNA the clinical manager will realize you are doing so to obtain a position in the ICU as a nurse after you graduate and will work with you to help you achieve your goal. Granted, it is not a glorious job doing PCT/CNA work (e.g., bed/baths, accuchecks, etc.) however if it ultimately gets you the position you want it will be well worth it. I worked part-time during nursing school at two jobs, one as a nurse extern, and the other as an anesthesia tech at another hospital and had no problem doing both while in school. I graduated in December of 2002 and started full time at the teaching hospital as an RN in February 2003. I then gave up my anesthesia tech job to concentrate on completing my BSN. I did my BSN program on-line and will complete the program in May of this year. I applied to five CRNA programs and have been accepted at two and am an alternate at one other. Still waiting to hear from one other school. I am convinced that having only one year of ICU experience would have placed me at a disadvantage had it not been for the fact that my year of experience was at a major teaching hospital with a level one trauma center. As someone has so eloquently said, make yourself as competitive as you can. IMHO this type of experience is well worth working towards and I am sure that you have the tenacity to get into the level one hospital if you put your mind to it.

I am only interested in working at two ICU's in our town. One is a level one trauma center and a teaching hospital, while the other is simply a major teaching hospital. I recently contacted them about Summer student nurse extern employment and was advised that the application deadline had already come and went. I am especially concerned for my wife since she will be graduating next December, and thus wants to start in an ICU ASAP. Right now she has ICU job offers from two major local hospitals BUT NOT, from the level I trauma/teaching hospital. Should she (and me if it comes to that) hold out for the teaching/Level I, hospital ICU or take the jobs that present themselves. If she "held out" she would probably work as a travel or home healthcare nurse until the "right" ICU job opened up. Since my graduation date is not until 2005 I have more time to line up employment.

AmiK25 · Mar 16, 2004

Roland,

If you don't mind me asking, don't you live in Indiana? Are you talking about any of the hospitals in Indianapolis? I am an ICU nurse at Methodist (level one trauma center/teaching hospital). If you are interesting in working there as a student, we hire student nurse externs all the time....I was an extern for a year and half before I graduated and that is how I got my position. Anyway, I wasn't sure if you lived near Indy or somewhere else...just thought I would check.

Ami

kdst · Mar 16, 2004

Roland,

As new grads it is important that you are in a position where you get a good orientation and develop a relationship with the experienced staff. You will need their support to do well as a new grad in an ICU setting. i did my last semester of BSN in the trauma ICU (level 2, our state doesn't have level 1, but we get everything from the entire pacific rim, teaching hospital). I was hired on as a new grad and put through the ICU class. I worked on that unit for 7 years, did a little recovery, a little ER, and finally am doing crisis RN, all in the same hospital. I think travelling is a bad idea as a new grad. travellers are expected to be able to hold their own in any setting, and you wont get good assignments or be able to develop much of a support system. why should staff put much effort into training you when you'll be gone in no time? Home health is also a bad idea because you really have no back up. you are on your own. any responsible company wouldn't take new grads into those positions but i'm sure with the nursing shortage you could find one that will. what you really need is a great preceptor that will take the time to train you and help you find your strengths and work on the weaknesses. good luck to both you and your wife.

UCDSICURN · Mar 17, 2004

Roland

I personally worked as a unit clerk/monitor tech for a year and a half at the original hospital I got hired in the ICU from. I was a new grad but had a very solid foundation to start from. I knew the hospital system I was working in. I knew the doc's and the staff and they knew how I worked. I also had a very solid preceptorship at the end of nursing school in a SICU and I was assigned to the "head" heart nurse.

As far as waiting for anything, I wouldn't. The first year is a very steep learning curve...learning vents, swans, meds, etc etc etc....Even the smallest community hospitals are going to have ventilators, some swans, a-lines, an occasional IABP (waiting to turf it off to an interventional cath lab or for open heart).

The pro's of the small community hospital are real, at least they were for me. I saw everything from medical, surgical, small scale trauma, vascular, MI's, non-operable closed heads; pretty much everything you can think of. You also do not have a resident at your beck and call 24/7. Another good thing where I worked, an ICU nurse always responded to codes. The "code team" was an ICU nurse, ER nurse, and the ER Doc and RT. That's it. You didn't have residents from every single service you can think of responding and a pharmacist drawing up the med's and preparing drips for you. I did that on my own. And if the ER doc couldn't respond, you were running the code. I really know my ACLS because I personally got to use it.

The con's. You don't see the high level stuff you do in a Level I Trauma center teaching hospital. And to be quite frank, if you aren't in the shock trauma unit in the ER or the Trauma SICU then the trauma designation doesn't mean jack. I work in the Vascular/Trauma SICU, if we have a bad trauma coming in, we'll bump our most stable patient out, even if it means sending a vented patient to another ICU.

The pro's of the big hospital is you will see the high level stuff. High frequency oscillating vents, ECMO, CVVH, IABP's, CCO Swans, trips for diagnostic studies with very unstable patients, blah blah blah.

The con's of the big teaching hospital is that you are usually so focused on a single area, for example trauma, that if you get another patient as an overflow you may be stumbling. An example: I was in the Vascular/Trauma SICU and we were getting a vascular patient that was on Reopro. Nobody, not even the charge nurse knew what Reopro is. Because of my experience at the piddly little community hospital I knew what it was, have used it many times and was obviously assigned the patient. This is just one example, there are many others. They can handle a crash and burn trauma like no one but give them a medical ICU overflow and they have to scratch their heads a bit.

That was kind of long winded but I hope it shows the pro's and con's of both, at least from my point of view.

As far as travelling, your wife will need one years experience before they'll consider her. Being after that one year she have the basics down and that will show on her evaluation from the travel agency and her "choice" of assignments will reflect that. She would be better off, in my opinion, just staying put, getting her skills up and getting the sicker patients after she has proved herself competent. Learning a hospital system and getting over the growing pains of being a new grad nurse in an ICU then leaving to travel after one year would just make things more stressful. It would have for me anyhow.

Hope this helps.

Donn C.

Roland · Mar 17, 2004

My wife put in an "online" application at Clarion and has yet to hear back. I will be doing the same. I am hoping that they will be having an open house or something soon. I think because so many students attend IUPUI (ASN and BSN) in addition to Ivy Tech, the University of Indianapolis, and Marion college that Clarion can really take their pick of applicants. They have "top of mind" awareness because of an excellent reputation and an ideal centalized location. The real question is would it be better for her (or me if it comes to that) to take a position at Saint Francis or Community East in the ICU (she doesn't care for Saint Vincent's so that's probably not an option), rather than waiting for an opportunity at a Clarion facility or Wishard (with Methodist or IU Med. center being preferred) that may not come, or at least not for a year or more. The "travel" option would be utilized if she was "waiting" on one of the Clarion hospitals or Wishard.

AmiK25 · Mar 17, 2004

In addition to putting in an online app, I would call a nurse recruiter also...sometimes they are a little slow to answer without prodding. Also, you could ask them about open houses b/c that is how I got my job as a student...at a student nurse open house. Basically, you were allowed to go around and speak with managers from all the different units/hospitals and then write down were you wanted to work. The recruiters then matched you up with managers who wanted you to work for them. I will tell you that SNE positions fill up very quickly just before summer so it is best to try to procure one now. I know that our unit (the Trauma/Medical/Surgical ICU...called Adult Critical Care) just had three SNE's graduate and our manager tries to keep about 6 SNE's on staff all the time so it is possible we are hiring....I have been on maternity leave for 8 weeks so I am not sure. The Neuro Critical Care seems to always hire many students as well...I am not sure about CVCC. As far as a nursing position for your wife, I can't imagine that one of the ICU's at Methodist would not have a position...particularly Neuro b/c they have high turnover (supposedly due to difficulty/sadness of patient population, but I don't know). I will tell you that sometimes you have to hound the nurse recruiters b/c they tend to be very busy! If your wife could not find a position at Clarian or Wishard, I would say that Community would be the next best bet. I did my Capstone in the Community East ICU and it was fairly busy. They had several vents, some neuro, septic patients, and even a CVVH while I was there. I did not see any PA lines, though, and my preceptor said they are rare. Although it was fairly busy, I am not sure that you could get adequate experience for anesthesia school in one year. One other thought might be to try to get a position in a progressive care unit at Clarian and then to an interdepartment transfer in a year or so....I think in house applicants get first pick!

My wife put in an "online" application at Clarion and has yet to hear back. I will be doing the same. I am hoping that they will be having an open house or something soon. I think because so many students attend IUPUI (ASN and BSN) in addition to Ivy Tech, the University of Indianapolis, and Marion college that Clarion can really take their pick of applicants. They have "top of mind" awareness because of an excellent reputation and an ideal centalized location. The real question is would it be better for her (or me if it comes to that) to take a position at Saint Francis or Community East in the ICU (she doesn't care for Saint Vincent's so that's probably not an option), rather than waiting for an opportunity at a Clarion facility or Wishard (with Methodist or IU Med. center being preferred) that may not come, or at least not for a year or more. The "travel" option would be utilized if she was "waiting" on one of the Clarion hospitals or Wishard.

XIGRIS · Mar 17, 2004

Hi ya'll,

I finished BSN in March 1990 from the Philippines. I took boards and passed it right away. Started working in St. Luke's Medical Center, an affiliate of St. Luke's in Houston, CVRR/CVOR settings with 10 beds Open Heart/ Vascular ICU right after school. I had 5 preceptors who were very tough. Minimum requirement to be in that unit is to have a Cum Laude in your BSN. My first day was so intense I thought I was going to quit that following day. I was a fresh grad and I was expected to do or at least know critical judgement. By the way, in our entire fourth year in BSN in our country, you do 10 months of charge nursing role and you have an elective area for your last 10 months. I happened to have an ICU elective where I did my student clinicals 8 hours/day 3 times a week for 10 months. It was a tough year, with clinicals, didactic, thesis writing and defense and extra curricular activities.I was so glad that year was the final year in nursing.

I went home around 2000 that night and I thought I need to ry this one more day and if I don't like it then I'll just say bye bye and start all over again this time work in an ICU or med - surg. I waorked the following day and stayed in a CVICU since then. Came to Texas in 1992 and moving to Fort Worth in August this year.

Roland · Mar 17, 2004

AmiK25, I think that is good advice and will try to implement it ASAP! My wife will have at least TWO years ICU experience by the time she applies (since she is only graduating with her ASN and will go back for the BSN). I will also have two years by the time I apply since even though I will be graduating with my BSN it will not be for a year after my wife (and we cannot move until both of us have our BSN's in hand). Of course the one of who goes to CRNA school SECOND will have approximately five years ICU experience by the time they NEXT apply. What is your feeling between Methodist, Wishard and the Medical Center? I think that the IU Medical center has the "purest" teaching environment. However, I think Wishard has the most "variety" in their ICU. On the other hand Methodist is probably the most "state of the art" (in Indiana) and has the best reputation. I see all others including Community East as distant contenders from an ICU experience perspective. Also, I am concerned that the NICU would not be considered ideal critical care experience. On the other hand working in a NICU with the goal of transferring to the ideal SICU or CTICU would make a great deal of sense given that we have two years "on the job" to work with.

AmiK25 · Mar 17, 2004

Since I work at Methodist, I am, of course, biased but I will try to give you an objective opinion. I did ICU clinicals at Wishard. They do have a good variety of patients because the nurses float back and forth between all the ICU's (MICU, SICU, CCU). They are a trauma center so you get fresh trauma patients, which is great experience. However, they do not have as many ICU beds as Methodist and I would say that their patient population is very similar to the one I see in my unit. I think their nurses are fairly autonomous in their practice and most enjoyed working there. IU Med Center has an MICU and an SICU. For anesthesia school, the SICU would offer good experience because they do a lot of liver transplants on really sick patients and deal with swans, CVVH, etc...Also, the anesthesiologists run their vents and pain management/sedation which would give you good exposure to the way anesthesia providers think. Also, the SICU director is really into education and tries to help nurses further their education any way he can. On the down side, I have been told (have not experienced first hand) by several nurses and residents that the nurses at IU are not as autonomous as nurses at Methodist, even though we are all Clarian. For example, at IU they are not allowed to pull central lines or chest tubes. Whereas at Methodist, we are trained to do so. I think it is because IU has tons of med students/residents around all the time, where we have fewer. As for Methodist, I love my job. Our unit gets the greatest variety of patients because we get trauma, sepsis, respiratory failure, ARF, ARDS, OD patients...basically everything but neuro (except for occasional overflow) and open heart. We have a pretty good relationship with most of our intensivists/respiratory docs and we are fairly autonomous in our practice. There are at least 20 nurses on our unit who have been there for 15 years or more, which is great for new grads b/c they teach you a lot. If you like neuro, NCC is a great unit to work on and is supposedly the largest neuro critical care in the country (so I've been told). Then their is CVCC, which does open hearts, transplants, etc...

Now that I have gone on and on, I will say that any of three hospitals will provide you with enough experience to get into CRNA school. It really just depends on what you like and where you can get a position. One other thing, you could always try calling unit managers instead of nurse recruiters to see if they are interested! As far as NICU experience, if given a choice I would go with adult ICU b/c all CRNA programs accept it. If your wife can't get an adult ICU position straight out of school, I still think the smartest thing to do would be to get a position in a PCU at one of the larger facilities and try to transfer after 6 months to a year. However, I can't imagine that she wouldn't get a position at one of the three large hospitals....all my friends from nursing school got positions in one of three in the units they wanted. Let me know if you have any other questions.

AmiK25, I think that is good advice and will try to implement it ASAP! My wife will have at least TWO years ICU experience by the time she applies (since she is only graduating with her ASN and will go back for the BSN). I will also have two years by the time I apply since even though I will be graduating with my BSN it will not be for a year after my wife (and we cannot move until both of us have our BSN's in hand). Of course the one of who goes to CRNA school SECOND will have approximately five years ICU experience by the time they NEXT apply. What is your feeling between Methodist, Wishard and the Medical Center? I think that the IU Medical center has the "purest" teaching environment. However, I think Wishard has the most "variety" in their ICU. On the other hand Methodist is probably the most "state of the art" (in Indiana) and has the best reputation. I see all others including Community East has distant contenders from an ICU experience perspective. Also, I am concerned that the NICU would not be considered ideal critical care experience. On the other hand working in a NICU with the goal of transferring to the ideal SICU or CTICU would make a great deal of sense given that we have two years "on the job" to work with.

Roland · Mar 21, 2004

I did a followup with the personnel office at Clarion and they indicated that over 200 applicants had applied already for available student nursing positions! I hope this doesn't indicate a trend for the Indianapolis nursing job market (understanding of course that there is a BIG difference between applying as a "student nurse" and as a graduate "RN" nurse).