How long did you work med-surg before getting an ICU job?

MallysMama · Sep 5, 2014

I started out in rehab ( for less than a year), moved to med/surg (1:7) and lasted a year (plus some charge nurse time). I am now almost done with my first year in SICU (my hospital doesn't have separate neuro and cardiac units- so we get everything: open hearts, crainis, etc). I am also not a fan of new grads being hired into the ICU. I believe basic skills learned on other floors are incredibly important before transitioning to ICU. Learning the role of a critical care nurse can be challenging enough- it would be even harder if you're also learning to just BE a nurse!

OP- if that's where you want to be- go for it!! It's the best job ever! :)

PMFB-RN, RN · Sep 5, 2014

I find these statements to be very depressing... not for me personally (I've got a fine job and have no desire nor intention to leave it) but for the multitudes who find themselves forced to take any job that they can find in the hopes of developing themselves and progressing into specialty care.
While I understand completely the data-based rationale, it saddens me to realize how many solid people will be excluded from 'the club.' It's probably because I was nearly in this position myself and essentially got lucky to be interviewed by someone willing to take a chance on me. I likely would not have been hired by the person presently making those decisions and yet I seem to be one of the stronger nurses in our group... I simply needed some seasoning and opportunities to make up for the gaps in my experience base.
As I read the recent posting of the ANA's lobbying to sustain and expand fundamental nursing education, I kept thinking how irrational is that mindset but how beneficial it would be to develop and subsidize a system that would enable more nurses to engage in a magnificent program such as you describe (I'm jealous!!)
It's sad to know that one's entire career may be dictated by the simple luck-of-the-draw in one's initial hiring.

I get you but there are a couple things that make me less worried than you. First few hospitals have embraced EBP to the point that they are ready to invest as much in ICU nurse training as some of the elite hospitals do. In that case med-surg experience will still be valued in ICU applicants (as it should be). In fact the trend I see is for hospital to invest less and less into training nurses in anything and instead rely on simply hiring those with the experience and skill they need. Its their pay off for all the time and effort they spent creating the glut of nurses.

Truly effective ICU nurse training programs are relatively few in number, and seem to me to becoming fewer all the time. Those without such programs are going to continue to value med-surg and step down experience.

On the up side many new nurses haven't had to slog it out in a specialty they have absolutely no interest in before getting into critical care, where they knew they belonged.

PMFB-RN, RN · Sep 5, 2014

I am also not a fan of new grads being hired into the ICU. I believe basic skills learned on other floors are incredibly important before transitioning to ICU. Learning the role of a critical care nurse can be challenging enough- it would be even harder if you're also learning to just BE a nurse!
OP- if that's where you want to be- go for it!! It's the best job ever!

When properly trained and supported new nurses aren't trying to learn to be nurses at the same time as they learn to be an ICU nurses.

I will give you an example of what I am talking about. In months 2, 3, and 4 of our nurse residency are spent on a very busy med surg floor working with a trained (and compensated) preceptor. These new grads are expected to spend their first week shadowing and taking maybe one patient, and their final week taking a full patient assignment on their own, that is 5 on days, 6 on PMs and 8 on NOCs, with their preceptor answering questions and providing guidance when needed. Our preceptors choose their own patients and collaborate with the residency director to make sure the residents get all the kinds of patients they need to meet their learning goals. Got a patient with a totally crazy PITA family? I guarantee that patient will have a nurse resident assigned to them. Got a patient who's condition is declining and may need transfer to a higher level of care? They will certainly have a nurse resident who must deal with it (with guidance) ADN take care of her other 4 (or 7!) patients. Dealing with as actively dying patient with family that needs support and education? For sure a nurse resident with have that patient.

They get exposed to things in 3 months that many med surg nurses won't see in a year. Our preceptors are very skilled and trained and all volunteers. We expect them to develop time management and prioritization skills in 3 months that in other environments might take a year to develop. We can do it because of the structure of the residency, and the quality of our preceptors.

Not all make it. About 1 in 6 or 1 in 5 don't make it through the med-surg portion and are not invited to go on to the ICU portion of training.

MallysMama · Sep 6, 2014

PMFB-RN that sounds like a great program!!

icuRNmaggie, BSN, RN · Sep 6, 2014

Med Surg should be considered a specialty area because it is an entirely different skill set than PCU, Stepdown and ICU.

It takes very strong time management, organizational and delegation skills to work Med Surg. Higher ratios with relatively stable patients.

It is hard for anyone to leave their comfort zone. I have to know every detail about my ICU patients and I can't turn that off if I have to work in another unit.

I have all the respect in the world for Med Surg nurses. They are very focused and know how to get the job done.

PMFB-RN, RN · Sep 6, 2014

Med Surg should be considered a specialty area because it is an entirely different skill set than PCU, Stepdown and ICU.
It takes very strong time management, organizational and delegation skills to work Med Surg. Higher ratios with relatively stable patients.
It is hard for anyone to leave their comfort zone. I have to know every detail about my ICU patients and I can't turn that off if I have to work in another unit.
I have all the respect in the world for Med Surg nurses. They are very focused and know how to get the job done.

Absolutely! Med-surg IS a specialty with its owne set of skills and knowledge base. I have never been employed as a med-surg nurse, my first RN job being a burn unit ICU. The only time I have worked med-surg was when floated there and I get my butt handed to me every time I do.

Respect to those med - surg nurses who make 5 total care patients look like a breeze!

twinkletoes53 · Sep 12, 2014

I worked for a year and a half on a Med-Surg floor. It gave experiences with different types of acuities, as well as different diagnoses. Whenever I was floated to the ICU, I enjoyed the challenge. Nurse: patient ratio was 1:1 or 1:2. I transferred units, and worked there for 2.5 years. When our hospital opened a new NICU, I happily transitioned there, and worked NICU for 30 years.

APRN., DNP, RN, APRN, NP · Sep 12, 2014

I started out my nursing career as an LPN and worked in a whole passel of different areas, but never ICU, of course. Then I went back to school to get my RN degree.

I never even considered applying for a position in the ICU right out of the gate when I achieved my RN degree. Instead, I started out on the night shift at a community hospital on the med/surg ward. It was absolutely the most horrific position I had ever been in during my entire nursing career - and that holds true to this day. I hated Med/Surg. HATED. I was miserable and wanted to go to ICU almost immediately after getting hired for Med/Surg, however, I was unsuccessful in attempting to transition over at this particular hospital. I worked there for a year and then moved on to a level II trauma facility which was just opening an ICU step-down unit.

Little did I know that my co-workers in the ICU Stepdown unit and I were going to be despised by our ICU counterparts as the uneducated ICU wanna-be’s that we were perceived to be. I took every educational opportunity to further my education in preparation for my goal of working an ICU “someday”. I even paid $600 out of my own pocket to take a four week long ICU training course. I managed to last an entire year as the red-headed step child of the ICU Stepdown unit before I hired on with another hospital in their Level II ICU trauma/neuro/CVICU unit. That is where I’ve been ever since, and I’m happy in my home.

I fully support the practice of hiring new grads into the ICU. I received absolutely zero benefit from being forced to work in an area which I despised before being deemed “seasoned” for hire into the ICU.

As a matter of fact, I often fantasize about what MY particular hospital would be like if all new hire RN’s were required to start out in the ICU and do an orientation period there before going on to the Med/Surg unit. I think about how much better their assessment skills would be and I hypothesize that there would be fewer RRT calls as a result. (ok, somebody slap me awake now). I digress.....

In summary, it took me two years to get into the ICU after I first started trying while I was a Med/Surg RN. It took me another four years before I took the CCRN exam.

Here.I.Stand, BSN, RN · Sep 12, 2014

I worked my first job--neuro/ENT surgical floor--for 18 months before starting in the SICU/CVICU.

I then stayed home w/ my kids for a while, and when I went back to work my only priority besides a paycheck was working 8-hour days. That meant LTC/SNF.

I did that for a while, but started wanting back into an ICU so badly it made my stomach hurt. The job market also wasn't what it used to be; I'd been hired for my first job before I even graduated from nursing school. Almost all of the ICUs wanted current ICU experience; hospitals wanted current hospital experience for any floor.

Eventually I got a job in an LTACH, which if you haven't been in one is like med-surg on PCP. But they had an ICU which was less acute than a typical ICU, but more acute than a typical stepdown. (Actually, the floor pts were more acute than a typical stepdown.) I mostly worked the floor, but even their floor pts could be on ventilators and bedside monitors. That experience, coupled with my former ICU experience was enough to convince them to consider me. I'm sure it helped that my current ICU discharges pts to my old LTACH all the time.

Anyway, I worked there for a year and a half before taking my current job. It's another SICU; most of our pts are trauma and neuro (medical and surgical neuro, are all on the SICU where I work), with smaller populations of general surgery and CV.

ETA--my NM has hired nurses from the surical floors, medical floor, tele floor, L&D, and possibly psych. Hiring moldable new grads isn't universal :)

Lev, MSN, RN, NP · Sep 12, 2014

I got called to interview for a cardiovascular step down position! I don't think their CVICU hires people without critical care experience, but if I do get a job offer, I could transfer to the CVICU when a position opens.

When I saw that the position was open to new grads, I jumped on it.

melissa.in.san.diego, BSN · Sep 16, 2014

That is very interesting because all of the new hires on our ICU or new grads as well.

Here.I.Stand, BSN, RN · Sep 17, 2014

Excellent! Let us know how it goes :up:

I got called to interview for a cardiovascular step down position! I don't think their CVICU hires people without critical care experience, but if I do get a job offer, I could transfer to the CVICU when a position opens.
When I saw that the position was open to new grads, I jumped on it.