ICU in community hospital or Stepdown in academic hospital

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  1. ICU in community hospital vs. Stepdown in academic? (goal: ICU RN in teaching hosp.)

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      ICU in community hospital
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      Stepdown in academic center

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Hi to all ICU RN's/CRNA's,

I'm a new grad with full-time immersion experience in the ICU and am hoping to become an ICU nurse, and possibly a CRNA one day. I know that I'll need to get experience in the ICU as a prerequisite, however I do have a dilemma that I would appreciate some advice on:

I have a job offer in an ICU at a smaller community hospital (where I did my immersion) and a potential job offer on a stepdown unit at a large, university teaching hospital. I am stuck in between the two because I feel that the patient acuity in the smaller hospital would not give me enough learning experience to prepare me for CRNA school (~30% mechanically ventilated, but more opportunities for titratable drips/ART)---most of the very critical patients are transferred out into teaching hospitals and we also get stepdown patients since the hospital doesn't have a stepdown unit. If I take the job offer, I THINK I might have to eventually apply to a teaching hospital's ICU in order to gain adequate experience.

On the other hand, the teaching hospital would give me a wider range of learning experiences but I might have to start on a stepdown unit and not be guaranteed an internal transfer to an ICU. So I might lose some time in the ICU. If I choose this option, I hope to transfer to an ICU in less than a year.

So my question from your experience, is it better to start at smaller hosp ICU and apply to larger hosp later? or it is better/realistic to start at the larger hospital's stepdown and do internal transfer?

which would be a better/quicker/more "guaranteed" option to gaining ICU experience (n an academic center one day) that would ultimately benefit my goal of becoming an ICU nurse and becoming a CRNA one day? This is simply a question of which would be a better option to get to my career goal and not where I can "get my feet wet" as I am very confident I will be able to pick up skills quickly even if I am to start in an ICU immediately.

Any insight would be helpful! Thanks!

Hi Tofu81,

I ended up taking the ICU position in the community hospital because as others have advised, it counts toward my ICU experience. I left for a level 1 teaching hospital about a year later. Although there is definitely a difference in acuity between the ICUs in the two hospitals, I'm glad I initially took the ICU position over the stepdown in a teaching hospital--the ICU at the community hospital still had very sick patients at times, and still had a lot of vents, drips, etc. that opened my world to the ICU. I was definitely more prepared by the time I went to the ICU at the teaching hospital. Also t havthere is some truth about having more autonomy in the community hospital because you don't have residents at your fingertips.

As ICU-BSN stated below, take the path of least resistance to the ICU. Get your foot in the door to any ICU (community or teaching) and transfer when you find yourself ready for more challenging, complex patients. Teaching hospitals do take into account that you already had exposure in an ICU, and will be more willing to take you on into their ICU.

I also saw your post regarding minimum ICU experience. I also asked that question and was hopeful to apply at the 1-2 year mark. However, after starting in the ICU as a new grad, I wanted to focus on being the best ICU nurse that I can be, and placed CRNA plans temporarily in the back burner to focus on where I needed to be -- to learn critical thinking, care compassionately for these really sick patients, manage complex patients, learn new technical skills, multiple drips, etc.

At some point, I realized while it is good to have a plan, focusing on the "time" required was a bit irrelevant as people learn at different paces. Most people don't start feeling "comfortable" as a new nurse in the ICU (or any area) until they reach the 2-year mark. At that point, you are just getting your feet wet and actually understanding what you're doing. I didn't feel comfortable taking the plunge until recently after my 5 year mark, and made it into 2 schools in my area. Could I have applied and tried earlier? Yes. Would I have successfully completed a program? Probably so. However, not gaining enough experience/knowledge & critical thinking in much needed areas, and applying/entering too soon might have been done at the expense of my patients' safety when I become an SRNA/CRNA.

While I wished I applied a little earlier due to time's sake, I'm glad I waited until I felt like I got the ICU nursing out of my system. In short, focus on your learning & development, and being the best ICU nurse you can be; and the timing will work itself out. You'll know when you're ready.

Hope this helps. Let me know if you have other questions. Happy to help.

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Thank you so much. I appreciate your sincere feedback. I'm greatful you replied... as I was curious how it all worked out for you since your post was from so long ago. Best of luck to you!

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On 4/11/2018 at 12:12 PM, SEWRN said:

Hi Tofu81,

I ended up taking the ICU position in the community hospital because as others have advised, it counts toward my ICU experience. I left for a level 1 teaching hospital about a year later. Although there is definitely a difference in acuity between the ICUs in the two hospitals, I'm glad I initially took the ICU position over the stepdown in a teaching hospital--the ICU at the community hospital still had very sick patients at times, and still had a lot of vents, drips, etc. that opened my world to the ICU. I was definitely more prepared by the time I went to the ICU at the teaching hospital. Also t havthere is some truth about having more autonomy in the community hospital because you don't have residents at your fingertips.

As ICU-BSN stated below, take the path of least resistance to the ICU. Get your foot in the door to any ICU (community or teaching) and transfer when you find yourself ready for more challenging, complex patients. Teaching hospitals do take into account that you already had exposure in an ICU, and will be more willing to take you on into their ICU.

I also saw your post regarding minimum ICU experience. I also asked that question and was hopeful to apply at the 1-2 year mark. However, after starting in the ICU as a new grad, I wanted to focus on being the best ICU nurse that I can be, and placed CRNA plans temporarily in the back burner to focus on where I needed to be -- to learn critical thinking, care compassionately for these really sick patients, manage complex patients, learn new technical skills, multiple drips, etc.

At some point, I realized while it is good to have a plan, focusing on the "time" required was a bit irrelevant as people learn at different paces. Most people don't start feeling "comfortable" as a new nurse in the ICU (or any area) until they reach the 2-year mark. At that point, you are just getting your feet wet and actually understanding what you're doing. I didn't feel comfortable taking the plunge until recently after my 5 year mark, and made it into 2 schools in my area. Could I have applied and tried earlier? Yes. Would I have successfully completed a program? Probably so. However, not gaining enough experience/knowledge & critical thinking in much needed areas, and applying/entering too soon might have been done at the expense of my patients' safety when I become an SRNA/CRNA.

While I wished I applied a little earlier due to time's sake, I'm glad I waited until I felt like I got the ICU nursing out of my system. In short, focus on your learning & development, and being the best ICU nurse you can be; and the timing will work itself out. You'll know when you're ready.

Hope this helps. Let me know if you have other questions. Happy to help.

Hi SEWN,

Yours has been an interesting journey,you probably have graduated by now and now living your dream career. So happy for you and quite moved with your story. How I wish  Pinky4 would have come back as well to give her testimony, hope she's still around and doing well too.

 

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