First new grad job: ICU vs. other?

[ICU-RN89]

Hi

In May, 2013 I graduated from a registered nursing program in Quebec, Canada. I have been invited to interview for a new grad position in the intensive care unit of a big inner-city hospital. The head nurse suggested that the position was essentially mine, unless I had any requests like "I can't work nights" or "I can't work weekends", since I worked as a student nurse the summer before with the same institution. I did my final clinical placement in the ICU at another hospital in the same city - I really enjoyed this placement and left thinking that I might one day like to work in the ICU. At the same time, I've really enjoyed many of my other clinical placements in oncology and medical-surgical settings. While I think that working in the ICU would be a amazing experience and great learning opportunity, I'm worried that by not starting out on a general medical-surgical unit I'll be missing out on an equally valuable experience and learning opportunity - in particular I was looking forward to learning how to manage my time providing care to 4-5 patients per shift. I always assumed that I would start out on a general medical-surgical unit (I never thought I would or could get a job in the ICU right after graduation) and work my way up to the ICU. So, I'm wondering if anyone has been in a similar situation (**I think, although I'm not sure, that I may be in a unique situation because, for some reason, things work differently in Quebec than they do in other Canadian provinces or in the U.S. in that new graduates can work in the ICU and other critical care and specialized settings immediately following graduation) and if so, what they did. I'm also wondering if anyone who has worked in both a general medical-surgical setting and the ICU (what order did you work in these settings?) has any advice for me. And I'd appreciate anyone else offering their suggestions and advice. Thank you in advance!

[RNnur]

How was your orientation experience in ICU? Did you feel confident to take care of patient's having a higher acuity? How is the team of nurses you will be working with? Are they open to working with a newbie in a supportive way? What will the orientation process be like? I was in the same position however, the organization I worked for had an extremely high turnover rate (68%,although I only found this out later), they were not supportive to a new nurse. I thought I was hired at this facility because I had a solid academic background, was top of my class in nursing school...later I found out it was because "new grad's were all we had to choose from at the time". I am not saying that all ICU's are like this...I did my schools preceptorship at a different hospital that had an awesome orientation program specifically for new graduate nurses (although this facility rarely hired them as they knew it was an investment/ if this is your case than this is a GOOD sign). Personally if I could do it over I would be much more selective about where I started out for my first job (it's about protecting yourself/your license/your patient's) know the team you will be on...talk to newbies that have been successful on the floor. If I could do it again I would start med surg but this is simply because I know the icu's around my location do not have the resources to set a new grad up for success in the critical setting (it was a rural hospital they had 1 nurse with a CCRN but she had taken the cert. exam several times in order to pass), and I feel many med surg unit's are used to newer nurses. But like I said... maybe this ICU is different....maybe they are being selective and are hiring you (red flag for me would be that they are hiring other new graduate nurses)...although if you take the job protect yourself...listen to your gut if you feel you are not getting the right guidance. Be prepared to do a lot of outside learning/reading but again if you get any inclination that you can't trust the team you are working with or that you're not feeling support despite your efforts... listen to your instincts...if you on the other hand are feeling comfortable/safe in your environment and with the majority of your co-workers...you will know you made the right decision and you can be successful in your new job!

[ICU-RN89]

Thanks for your reply, RNnur! You've given me lots to think about, and a lot of great issues to ask about at my interview! I definitely plan to ask about unit environment, openness of staff to new graduates, orientation, and whether the unit has hired new grads in the past and how they have done. Your experience sounds somewhat similar to mine in that there was recently a hiring freeze at the institution that this hospital is part of and although they've started hiring new graduates, they haven't been able to post any new positions, which means that if the unit is short-staffed, new grads might be their only option. I know that the unit is looking to hire 3 new graduates, which could be a red flag as you said, or could mean that the unit regularly hires new grads and is open to investing in their success. Can I ask what you did in the end? Did you stay in the ICU, move to another unit, or an ICU at a different hospital? Thanks again!

[HouTx, BSN, MSN, EdD]

I began my career in ICU - loved it and remained there. My organization hires new grads into ICU via a 12 week residency with very good results. Any department can be "good" for new grads if they can provide the right support; even without a formal transition program.

You are correct though - the only way to become adept at time management for a med surg patient load is to actually work in that area. We (ICU) nurses are pretty hopeless in this respect when we are pulled into those areas - LOL. Our med surg colleagues run rings around us while we are trying to an in-depth, head to toe assessment on each patient. . . been there done that.