First job - step down or CICU

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Hi allnurses,

this sute has been a wealth of information for e embarking on my career path as a nurse. Now, I find useless graduated and fortunate enough to have two job offers that I'm having a difficult time choosing between. I don't have anyone in the field in my family to ask for advice so I thought I would get yours. My passion is cardiac and I've always seen myself in the ICU. I have up until this point planned on relocating to work at the Cleveland clinic Main campus on a cardiac step down. Out of curiosity I applied as a new grad on a cardiac ICU in Florida, and got the job. Im having trouble deciding between working for an excellent institution like the Cleveland clinic and being on a step down, or going for my dream which is the ICU. Any and all opinions would be greatly appreciated :)

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Specializes in Med/Surg, StepDown, Tele, ICU.

So just out of curiosity, have you had an ICU or stepdown experience during nursing school? Did you do a senior practicum or capstone in either of those specialties? If not, I would be doing some research on what the new grad programs at those respective institutions have to offer. Jumping into the critical care setting as a new grad can be unforgiving if you do not have the support to back you up. It's totally do-able, but just be aware that the patients are very susceptible to mistakes, delays, indecision, and naivety. Also you need to know that the patient acuity in a stepdown unit at one hospital, may be the same acuity as the ICU at another.

Don't get too caught up in the perceived prestige of one institution's name. You will find that there is more to your success and happiness as a nurse than what name hangs over the doorway.

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Hello and thank you for the reply. AEB my typos my initial post was done hastily and I should have included this info- I completed my 180 hr practicum on a neuro ICU. This is my second career choice as I'm 29, and one thing life has taught me this far is that not everything is in a name. The Florida hospital does have a lot to offer in terms of training and orientation, and I'll take all of this into consideration as I'm making my decision. Thanks for the thoughtful response.

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Specializes in Cardiology.

I work on a step-down at the clinic. It's my first nursing job and it is a great floor to start on. I wanted to the ICU right out of school but Im glad I didn't. Its pretty intense in our CICU. Heck it can be intense on the step-down Im on right now. We send our pts to the CICU and they send up pts.

If you did your practicum in the neuro-ICU I would work on the cardiac step-down at the clinic first, then go to the clinic's CICU. That way you can get familiar with the pt population and it won't be as overwhelming when you make the transfer to the CICU.

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Thanks, I'm glad to get a response from someone at the clinic. A major deciding factor is also

Uprooting and moving to Ohio which will also play into my decision. Do you enjoy the culture working at the clinic?

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If you haven't worked in an icu before I would go for the stepdown unit, for sure. Learn how to be a nurse, how to interact with the team, the flow, procedures, time management etc, then explore your options. The pressure on a new nurse is intense. I don't know your capabilities or how you handle high stress situations, but since you're asking for guidance I'd say do yourself (and your patients and their family) a favor and don't take on too much all at once. Also, having a recognized/prestigious hospital name behind you definitely does not hurt. Give the stepdown a year or two. Learn, then then hone your skills, get advanced certification, then reassess your situation. Oh yeah, join LinkedIn and start networking.

Best,

Gary

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As a CICU supervisor, I would recommend to consider what kind of course work you received in your nursing program first and secondly, do either of the facilities offer a nurse residency program. The first I recommend due to the fact that if you received a strong curriculum in your critical care semester from an instructor with ICU experience then you should have a pretty solid foundation to draw from literature wise. Secondly, if either offer a nurse residency program then they will set you up education wise to succeed even if you are struggling a little to grasp certain things. (Talk to other nurse residents at the facility tho, some facilities "advertise" a residency program but unfortunately they don't deliver.) Hope this helps and good luck no matter which you decide to go with!

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