Help for a newbie RN regarding job placement!

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Hey everyone! I am a recent graduate and passed my NCLEX a couple weeks ago. I have been job hunting and have been offered jobs in MICU and a step down unit. I was wondering if anyone would have advice for me as to which floor may be better suited for a new grad.. I have people telling me that step down would be better as a starting off point but then I have others saying that I should go ahead and do MICU if I feel that my organizational skills are good. I honestly was interested in an ICU job at first but I do not want to bite off more than I can chew. Have any of you started off in an ICU setting but found it to be too overwhelming as a new grad? I know everyone is different but I just would like some opinions from RNs.

Thank all of you in advance :)

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Specializes in Med/Surg/ICU/Stepdown.

I can't really comment as to which is better, but I can share a story:

Myself and another individual from the nursing program which I graduated from both took positions at a major teaching hospital. He had been a paramedic for some number of years. He interviewed for and subsequently was offered a position on the ICU. His orientation period was the same as mine: 12-weeks not counting a 2-week seminar orientation period. Because of how specialized care in the ICU can be and the acuity level of the patients, he found himself so overwhelmed that he became unable to make decisions critically and quickly without input from his preceptor. His orientation was subsequently extended by another 4-weeks. He is now functioning at an RN I status and still feels, most days, that he has absolutely no idea what he is doing. And from what I understand, this is a relatively common feeling among new graduates in spite of the unit they choose to work on. I'm on a 39-bed medical inpatient unit and I FEEL overwhelmed on the daily by how much I don't know.

So while I can't say 1 or more is better, there are definitely challenges to each. It just depends on #1) how much you love the idea of working with critically ill patients, and b) if you think you're up for the roller coaster ride of a higher acuity unit.

Best of luck!

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For a counter view, if they think enough of you to offer you a MICU job, take it. You will learn far more, have more opportunities for observation and mentoring, and spend less time running up and down long hallways.

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Specializes in Med/Surg/ICU/Stepdown.
For a counter view, if they think enough of you to offer you a MICU job, take it. You will learn far more, have more opportunities for observation and mentoring, and spend less time running up and down long hallways.

That's also true. If the specialty I wanted would have hired me right of school, I would have jumped at the opportunity, even if it meant being terrified for a year or so. Never underestimate how difficult it can be to get in if you're not already sought after!

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Specializes in Reproductive & Public Health.

Yes, I would take the MICU job, especially if critical care is something you want to specialize in. It can be difficult for a new grad to get an ICU position! However, if critical care is not something you are really interested in, the step down unit will give you a good med/surg foundation with, hopefully, a gentler learning curve.

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Specializes in Med/Surg/ICU/Stepdown.

Of note, I also think it depends on the hospital. Had I chosen to stay local, at a hospital that I did clinical rotations at, my learning curve would have been exponentially gentler than what I deal with now at a hospital that is gradually incorporating geographic care.

A lot is going to depend on your hospital's individual mission, acuity levels, and specialties!

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You are all great. Thank you all so much for your input. I enjoyed reading all of the responses!

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Do you like medical units ? And do you have any idea what kind of patient demographics/conditions each unit has ?

I think thats really the most important question, especially if the stepdown unit is a surgical stepdown.

In nursing school I thought I wanted to go into the ICU, and did my capstone in the SICU and several clinicals on MICU/medical floors.

I absolutely hated MICU but loved SICU. The types of patients and scenarios were completely different. but you really need to figure out which kinds of circumstances you enjoy better.

Where I went to school I which is where i did my clinicals the MICU patients were generally chronic long term patients that really werent getting better. When on the floor most patients ended up being either withdrawing drug addicts (heroin was extremely common) and a ton of patients who were just massively obese (which was even more of an issue since this hospital also had NO patient lifts, no lift teams, and generally was understaffed so moving a 400+ patient with you + one other person was an excellent way to get hurt) and not getting better. It was generally very depressing.

HOWEVER that was that hospital (which isnt known for being a nice place). Where I work now (a different hospital) is a pretty different environment.

Im definitely NOT saying use my generalizations, because they arent universal at all. Im suggesting that its important to get a good idea of what youd have to deal with on both units, and see which youd enjoy.

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Specializes in Family Nurse Practitioner.

I think it really depends on the hospital, the specialty of the step down floor, and where your heart is. If you want to be a CC nurse go for MICU! If you choose to take the stepdown job because it is in a specialty that interests you take that job with the knowledge that you can easily transfer to ICU in a year if interested.

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I started out in ICU for a level 1 trauma center.. Very busy very fast paced. 16 week orientation on the unit with lots of classes outside the unit. The whole orientation from the time on the unit to classes came out to 6 months. I had to be willing to take policies and such home with me so I was always prepared. I love it!!! I do a lot of reading up on critical care while the family is at work or school. ICUFAQS is a great reference.. We sometimes float to PCU or medsurg if we are over staffed and they are short..so I've had a itty bitty taste of the floor. They are different. Either way you gotta be well organized and have great time management.. It hard to get into ICU as a new grad take it as a honor to be chosen. Which ever you choose remember your fellow nurses, manager, and clinical educator are their to help you along the way. And of course so is AN:) congrats and welcome to nursing!

Sent from my iPad using allnurses.com

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Thanks, everyone!!

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Specializes in Critical Care, Education.

I began my nursing career in a Trauma/Neuro ICU.... and it was a wonderful experience. It felt like "home". If that department hires new grads, chances are they know how to help you with a successful transition from student to practicing nurse.

There is a basic personality 'type' associated with successful ICU nurses. It is characterized by assertiveness, ability to multitask, capable of learning very quickly & comfortable making rapid decisions. If you are more of a sensitive soul - highly vulnerable to the opinions of others & someone who needs to deliberate before making decisions, then ICU is probably not a place where you will feel comfortable.

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