How to get into ICU?

Nurses General Nursing

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Hi fellow nurses,

Do any of you have any tips on working in an ICU setting with not a lot of experience?

Here's my story,

I completed my preceptorship in the ICU and took a job offer as a charge nurse in an intermediate care unit. I had connections with the director of nursing and therefore started working there for 6 months. I quit for many reasons with one of them being too much to handle (4 patients total care with and additional patient every now and then along with being a charge nurse). It was in my best interest to leave before I would make a big mistake with one of my patients one day.

I took a job as a research nurse and have been working there for 6 months but to my dissatisfaction, I think I miss the hospital setting and more so, taking care of critically ill patients. I consider myself an adrenaline junky where I strive in an intense and intellectually challenging environment. I understand that most people think it's better to gain at least 1 year of experience in the floors but I'm looking to pass that, and have a chance at an ICU setting.

Overall, do you guys have any tips or know of any hospital where they would consider hiring an inexperienced nurse for their ICU? Fellowships would be ideal since I would get training. Learning on the job would be a challenge, but I'm positive I could still become a well rounded ICU nurse. I'm looking to find that career anywhere here in the U.S as I'm also looking to move out of state.

Any tips fellow nurses?

I had a hard time getting an ICU to hire me with just med/surg experience, so I kind of went from med/surg, to LTACH, to step-down, to ICU. I would've much rather gone straight to ICU but I couldn't get any of them to hire without any knowledge of drips, vents, hemodynamic monitoring etc. so I kind of worked my way up one step at a time.

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Specializes in Critical Care and ED.

In my state it would be almost impossible to get into ICU without a BSN. I actually got my BSN while I was working in ICU but things have changed and my own unit, for one, no longer hires ADN nurses, nor any of the neighboring hospitals. The tide is turning and it doesn't make sense to aspire to work in critical care and not aim for your bachelors. If you want to remain competitive you need to have it, as there are many others trying to get to exactly where you are, and the hospital will always hire the BSN equipped nurse over the ADN nurse. That's just the way it is.

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Specializes in SICU, trauma, neuro.
I am Canadian, so our minimum entry level into nursing is a bachelor. Truthfully, I do not know the difference between ADN vs RN in the US. I honestly thought ADN had a lesser scope/less schooling than an RN. I apologize if that comment gave offence.[/Quote]

Thanks for explaining. :) Graduating from either a BSN program or an ADN program allows us to sit for the NCLEX and obtain an RN license. So ADN=RN, providing one passes the exam. (Hospital-based diploma programs do too, but unfortunately seem to be going the way of the tan M&M. I say unfortunately because they produced such knowledgeable graduates!)

All RNs have the same scope of practice, and all have had the same clinical training. (Well, not the diploma grads...they had second-to-none clinical training.)

I went the ADN route and got my BSN many years later. The additional nursing classes I had to take were theory, public health nursing, family nursing, geriatrics, informatics, leadership, research... that kind of thing. We had prerequisites in medical ethics and stats, and then any general ed classes that the university determined we needed to graduate. I took classes in linguistics, geography, media studies... and then I had the music, Latin, and math classes from an unfinished music degree transfer.

I didn't learn anything that was applicable to ICU nursing. In theory we did learn about feng shui, but alas those RRTs won't let me move the vent. :cheeky: I DID have a unit on critical care in the final semester of my ADN program, and one of our clinical shifts was shadowing in an ICU. :)

That was probably more info than you needed, but hopefully it cleared some things up.

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Specializes in CCU, SICU, CVICU.

*sigh* I once again feel like many of these posters have such a bizarre image of what ICU nursing actually entails. TBH, true adrenaline junkies would probably be happier in the ED. The rush of that incoming code, STEMI, stroke, etc is a lot less exciting once they get to the unit. Don't get me wrong, it's fun to titrate the drips, manage the IABP, vent, etc but many people find ICU boring and I can see why (I don't find it boring at all, but I understand why some do). The "sickest of the sick" is somewhat laughable because the only difference in care sometimes between a Medical ICU pneumonia patient and and a Med/Surg pneumonia patient is the presence of a vent. That's it. They aren't unstable or crashing. They just are intubated with maybe a Fentanyl gtt and accompanying Levo gtt for sedation-related hypotension.

There really is no secret to getting in. Specific hospitals will list their requirements for what they want. Meet those requirements (exceed if you can) and just prepare for an interview. My last interview into critical care (the job I currently hold) had 0 clinical-related questions, but instead were more focused on my ability to think on my feet, advocate for my patient, collaborate with others, etc. AKA questions any new grad could answer.

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I've seen brand new grads with zero experience get ICU positions. In the case of one particular new grad I encountered this past week- putting her there was a big mistake- but I'm sure there are new grads out there that do just fine in the ICU.

(I informed her of a mistake she made that would kill the patient she sent to me faster -and made her cry -which was not my intent. I told her she needed to slow down and think about what she was doing. I blame her preceptor, which is another story.)

Anyway, like the first person that responded said. Apply. You'll never know unless you do.

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I understand wanting to get back to bedside nursing from research nursing, but ICU patients will NOT be easier than stepdown or intermediate care patients. If you felt overwhelmed by that type of patient, you need to tackle that, then ICU.

Exactly. Sometimes the only difference between an ICU patient and one on my unit is that they had to make room in the ICU for someone else- and I've had ICU level patients on my unit solely because the ICU didn't have any extra beds to spare.
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Specializes in Critical Care and ED.

This is all very area specific. In one state you might be able to get into ICU without experience or a BSN, but in other states (like New England) you will not. You might find you have to move to get the position you want.

Source: 25-year veteran of the ICU here

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A lot depends on your particular job market and the preferences of HR and your manager.

If you don't have the right keywords like "BSN" in your application, the HR computer will filter your application out like it never existed, or so I am told. Read the job descriptions.

I got my position from med-surg to ICU because in the early 2000's the job market was in the favor of the nurses. ADN, no ICU experience, no problem? When can you start? I would never get hired in my department today with my ADN.

Is there anything really wrong with your job now? Why ICU? There really isn't much difference between ICU and stepdown units.

Be sure that ICU is what you really want before you give up a research job.

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thank you @alli., ADN, for posting this question! I'm a non-traditional student looking for this same route, and have no time to waste. I am applying for next school year and i know in a few years I will apply for some advance nursing specialty. I don't want my science classes to expire again.

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"I completed my preceptorship in the ICU and took a job offer as a charge nurse in an intermediate care unit. I had connections with the director of nursing and therefore started working there for 6 months. I quit for many reasons with one of them being too much to handle (4 patients total care with and additional patient every now and then along with being a charge nurse). It was in my best interest to leave before I would make a big mistake with one of my patients one day."

?

I understand wanting to get back to bedside nursing from research nursing, but ICU patients will NOT be easier than stepdown or intermediate care patients. If you felt overwhelmed by that type of patient, you need to tackle that, then ICU.

You are absolutely wrong and I strongly disagree. I don't think you understand what it means to have close to a medsurg ratio with higher acuity patients, have total care, and take 2-4 hours of your shift devoted to charge nurse duties. I believe I was strong to let that go despite being given an opportunity in 1 year to move on to the ICU. I knew my limit and that was not having the ability to care for my patients in a safe matter. I apologize if I offended you but clearly you do not understand the circumstance nor will you ever have the chance to experience it. Thanks for offering such a pointless comment.

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I'm almost certain that I would be absolutely honest with my potential employers about my work history and the reasons for quitting my first RN job in 6 months. It's in my best interest to have an employer who I can be completely transparent about and receive that vice versa. I'm assuming you've hidden things about your work history? "RED FLAG"

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In my state it would be almost impossible to get into ICU without a BSN. I actually got my BSN while I was working in ICU but things have changed and my own unit, for one, no longer hires ADN nurses, nor any of the neighboring hospitals. The tide is turning and it doesn't make sense to aspire to work in critical care and not aim for your bachelors. If you want to remain competitive you need to have it, as there are many others trying to get to exactly where you are, and the hospital will always hire the BSN equipped nurse over the ADN nurse. That's just the way it is.

I completely agree and I am currently on the road to graduating with my Bachelor's. There's so many different views on whether or not an RN with their BSN is better than an RN with an associates. Regardless, more employers are requiring a BSN so that's what we should all be aiming for.

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