ER to ICU?

Cowboyardee · Sep 23, 2020

It may be more the area and the local job market than an overarching stigma. Some ICUs only want to hire experienced ICU nurses. Some prefer step down or med surg experience. Some really like hiring ED nurses, while some managers have a bias against hiring from the ED. Some units seem to prefer to hire new grads, while others would prefer almost any experience at all over a new grad. And some ICUs are happy for a warm body and an active license.

If you're not getting any interviews at all in your area after applying to a good number of hospitals, it could be that there's a red flag or two on your resume or employment application. Or it could be simply that you're applying into a tight local job market.

Either way, have someone take a look over your resume and make as perfect as you can manage, expand your search, and see if you can contact recruiters or even ICU managers directly rather than just using automated application systems.

And when you get interviews, try not to get preemptively defensive about a bias that may or (likely) may not exist. Sell yourself and your skills as an individual rather than ED experience as a qualification for the ICU in general.

speedynurse, ADN, BSN, RN, EMT-P · Oct 3, 2020

On 9/6/2020 at 11:35 AM, iheartnursing91 said:

hi guys I'm currently an ED nurse with 2.5 years of experience. I'm moving to another state and looking for opportunities. I've always wanted to work in ICU but ended up in ED since being a new grad and stayed there since. Since I'm moving now and have some experience, I'm looking for ICU level jobs. Now the problem is that every ICU job I apply to, I immediately get a "not qualified" status. One recruiter had called me and tried to get me an interview with an ICU manager, and she wasn't interested in interviewing me. So now my question is, is there a negative stigma about ED nurses? Why are ICU (and sometimes even med surg/tele) managers so reluctant to hire a nurse from the ED? I know we may not have the in depth knowledge that ICU nurses have, and to be honest thats why ak want to go there, to further myself and learn more. I've taken care of ICU patients who spent >24 hrs in the ED due to no available bed, and I really enjoyed the challenge. I've even had some people tell me I'd do very well in the ICU. I'm just curious why I'm having a hard time getting an interview that's not for the ED. ?

ER and ICU nursing can be very different types of critical care nursing but I also enjoyed the critical patients as well. In all honesty, it may be that the job market is tight. At one point, I was really considering transferring to the pediatric ICU.....I received 3 PICU offers without any issues. But that was before the whole covid thing. The job market is so different now and I feel like many nursing specialities are still struggling to get their hours many days.

StudentRegisteredNurseofAnesthesia · Oct 6, 2020

Has to be your location. In my area, they'll hire anyone to work ICU right now. Especially with Covid.

mncarlisle · Nov 6, 2020

I'm a nursing student currently but want/need to get an ICU job once I graduate (prequalification for a graduate program) so I asked around about this a little bit. The most common response that I got was they'd rather have baby nurses right out of school in the ICU because they have to be trained (completely) and they haven't learned any bad nursing habits yet (that you would learn from working in a different specialty). In my area, you are way more likely to be hired for an ICU position with no experience vs. someone with years of ED/MedSurg/etc. experience. My mom has been a nurse for about 18 years now, has been charge and/or had some other type of leadership role at every single job she's had, and she applied to numerous ICU/more critical care units last year and she was turned away from every single one because she had been a nurse for so long but had no previous ICU experience. (She ended up getting a job in the ER) I guess the assumption is that breaking the bad habits of a nurse with experience is more difficult, time-consuming, and dangerous (in their eyes) than training a new nurse from scratch.

Cowboyardee · Nov 27, 2020

On 11/6/2020 at 2:56 AM, mncarlisle said:

I'm a nursing student currently but want/need to get an ICU job once I graduate (prequalification for a graduate program) so I asked around about this a little bit. The most common response that I got was they'd rather have baby nurses right out of school in the ICU because they have to be trained (completely) and they haven't learned any bad nursing habits yet (that you would learn from working in a different specialty). In my area, you are way more likely to be hired for an ICU position with no experience vs. someone with years of ED/MedSurg/etc. experience. My mom has been a nurse for about 18 years now, has been charge and/or had some other type of leadership role at every single job she's had, and she applied to numerous ICU/more critical care units last year and she was turned away from every single one because she had been a nurse for so long but had no previous ICU experience. (She ended up getting a job in the ER) I guess the assumption is that breaking the bad habits of a nurse with experience is more difficult, time-consuming, and dangerous (in their eyes) than training a new nurse from scratch.

Hmmm. I think people gave you the kind of answer they usually give to nursing students looking to work in an ICU. The truth is a little more complicated.

Having trained a few dozen ICU nurses over the years, I'd say on average that nurses with med surg or ED experience are easier to train than new grads and become competent and independent noticeably quicker. Of course, individual differences apply, but on the whole it's not even a particularly close race. And I'd even go so far as to say that most people who genuinely understand ICU nursing would readily agree with me on this (note that not every ICU director actually understands the ICU, and certainly not every HR rep hiring for ICUs does).

The whole bad habit line has an element of truth to it - a bigger element once we start talking about experience in specialties that have very little skill overlap with ICU nursing. But it's overstated, and doesn't really apply well to med-surg, step-down, PACU, or ED. If it did, new grads would need shorter orientations than nurses with other acute care experience; in the real world, the opposite is far more commonly true.

However, you're certainly right that some places seem to prefer to hire new grads. There are reasons for this, but not the ones you gave:

- Hospitals, in their infinite wisdom, have mostly abandoned the concept of merit pay or paying for relevent experiece, and almost across the board now pay nurses a scale based on total years of experience. That means that an ICU pays a nurse with 20 years pf ICU experience more or less the exact same wage as a brand new ICU nurse with 20 years of experience working in a doctor's office. So in theory, that means once you put your time in in the nursing profession, you don't need to take a pay cut to change fields. In practice however, it actually means that it's harder to switch fields at all after a while because managers don't necessarily love paying for experience that was not in the specialty they're recruiting for. New grads are cheaper.

- Many hospitals especially like hiring new grads into desirable positions because they can then leverage new grads into signing contracts requiring them to stay for 2 years or so or else have to "pay back" $10K or so for the costs of theor training. This is better than indentured servitude, but not much, and it can make new nurses feel compelled to put up with some real BS. Which is, of course, the point. It's a way to enforce retention.

- Hospitals that are worried about nursing staff pushing back against hospital administration or about the threat of unionization often find it advantageous to keep themselves staffed with a revolving supply of people new to the field.

JKL33 · Nov 28, 2020

On 11/6/2020 at 2:56 AM, mncarlisle said:

The most common response that I got was they'd rather have baby nurses right out of school in the ICU because they have to be trained (completely) and they haven't learned any bad nursing habits yet (that you would learn from working in a different specialty).

That is foolishness. You were fed a line of bull and not a very original one, either.

TexasRN_826 · Jan 18, 2021

I had the exact same problem. but with double your experience. I had 5 years 2 different level 1 trauma centers. peds + tsicu +MICU +ccu + you name we had it - could not get an interview to save my life. I eventually did with a horrible ICU but parlayed that into a transfer into a real ICU.

So best bet - 1 know somebody or 2 start in the ec with new system and transfer within.

But I had the same issue. also ICU and ER couldnt be further apart. like ICU people really hated how I did things so don't be surprised if you get the stank eye for 6 months because you are used to ravenous conditions of the ec. good luck

Devon at Steward · Jan 18, 2021

We are hiring for ICU and that would be enough experience for us at our hospital in Salt Lake City, UT. Give me a call at 801-367-4817

Asush · Apr 7, 2021

Hi ED RN with 7 yrs of ED experience trying to switch to ICU, the hospital told me I have to go through their ICU nurseresidency program. I am really excited to work in ICU as I really like critical care while working in ED but the downside I found was my pay getting cut.

Nurse Pompom · Apr 12, 2021

On 9/6/2020 at 11:35 AM, iheartnursing91 said:

hi guys I'm currently an ED nurse with 2.5 years of experience. I'm moving to another state and looking for opportunities. I've always wanted to work in ICU but ended up in ED since being a new grad and stayed there since. Since I'm moving now and have some experience, I'm looking for ICU level jobs. Now the problem is that every ICU job I apply to, I immediately get a "not qualified" status. One recruiter had called me and tried to get me an interview with an ICU manager, and she wasn't interested in interviewing me. So now my question is, is there a negative stigma about ED nurses? Why are ICU (and sometimes even med surg/tele) managers so reluctant to hire a nurse from the ED? I know we may not have the in depth knowledge that ICU nurses have, and to be honest thats why ak want to go there, to further myself and learn more. I've taken care of ICU patients who spent >24 hrs in the ED due to no available bed, and I really enjoyed the challenge. I've even had some people tell me I'd do very well in the ICU. I'm just curious why I'm having a hard time getting an interview that's not for the ED. ?

She might have thought you developed bad habits from the ED. ICU isn't better than ED and vice versa, it's just a different kind of nursing. I would persevere. There's an ICU for you somewhere.

iheartnursing91, BSN · May 15, 2021

Hi guys, I'd like to give an update.

After trying for so long, I FINALLLLLY landed an ICU interview! I'm so ecstatic as I was so not expecting this! A hospital near my apartment is having an orientation program for experienced nurses looking to train into ICU.

I'll be doing a panel interview with a few different ICU managers. I'm so nervous! Any tips on interview skills, specifically ICU questions/skills?? ?