ICU or IMU telemetry?

In my opinion a one hour commute each way is really hard, especially if you will be working 12 hour shifts, and especially if you work nights (just my opinion, I was always so tired after night shift!). I have also heard it's challenging to start out in ICU, but some people definitely do it and thrive. I am not sure what an HCA hospital is... could you explain? I would recommend looking at Glassdoor reviews, or better yet talking to some current or former employees if possible to get their opinion on working there. If you do take the IMU position, one year of experience before getting into an ICU is not bad, especially since you need a few years of experience before applying to CRNA school.

My advice is to take the job at the hospital that you feel more excited about working at with the better commute and see how you like IMU, then see when you want to progress to ICU, CRNA, etc. But of course the decision is yours! Just my 2 cents ? good luck!

Please research here about starting out in ICU. Learn your skills in a telemetry setting.. then move on. Critical care requires learned critical thinking skills... that takes awhile to learn.

Good luck with your decision.

Thank you so much for responding. HCA is a large hospital system located in many states. I am leaning towards the magnet hospital after reading your comment as I feel I'll be better supported to grow.

11 minutes ago, RNTX1 said:

Thank you so much for responding. HCA is a large hospital system located in many states. I am leaning towards the magnet hospital after reading your comment as I feel I'll be better supported to grow.

Thank you. The only drawback is that I'll be delaying my desired career choice by one year at least. I do believe that I need to improve my critical thinking skills. I also believe nurse residencies should not be offered for new nurses since we lack the critical thinking skills you mentioned. But since it's offered I went for it.

7 hours ago, RNTX1 said:

Thank you for reading my post!

I am a new grad, and I've received an offer at a magnet hospital for IMU telemetry. I've also received an offer at an HCA hospital in my area for ICU. My ultimate goal is to become a CRNA.

I love the magnet hospital, and I can see myself growing there, but they aren't starting me at ICU. I've also heard bad stories at HCA hospitals-hence why I'm undecided. If I choose the magnet hospital, I'll have to wait at least one year before I can apply to an ICU position. HCA is about a one hour drive from my home, and the magnet hospital is about a 30-minute drive.

I'm just seeking some guidance on what path I should take.

From my perspective, the choice for you as a new grad is absolutely clear. Whether or not you agree with it is entirely OK. You have an offer of of an IMU Tele job at a magnet hospital that's 30 minutes from home. Chance are you'll be working 12 hours/day, so with a 30 minute commute, that's 13 hours. The HCA hospital that's 1 hour away means a 14 hour day. It might not seem like much but believe me, when you're exhausted after a full and busy shift, it makes a HUGE difference. You've made it clear you're gunning for a CRNA position, with all that entails. Put that out of your head for now. What you need is a good job that will teach you the basic stuff of nursing while impressing upon your brain the critical thinking skills you'll need. You'll probably have an easier transition to ICU practice by going through an IMU than by going straight into an ICU job unless the ICU job is going to offer you a very extended orientation period. This is because they'll have to teach you how to be a nurse along with being an ICU nurse and that's not easy to do simultaneously. You got a good look at what being an M/S or M/T nurse is during school. The IMU job should reinforce that and give your critical thinking skills a good kickstart.

After you've done IMU for a year or two, then you should be ripe for a relatively fast transition to ICU as it should then be an extension of what you've learned in the IMU job. You'll have also gotten through the most dangerous years: 1 and 2... Then after a year or so of time in the ICU, you'll probably be ready to take the leap into CRNA (or any other mid-level program for that matter) and be ready for all that. It'll also give you time to save money as you'll probably be working less and depending upon loans during school so you can use the time to defray future costs and make your overall student debt much more manageable.

You could also find that you really like something else along the way and end up doing something other than CRNA.

My advice: take the magnet IMU job. You'll likely have a more solid foundation and you'll have room to grow there.

I did the hour commute (a decent bit more than an hour actually) for almost two years. It wasn't fun but it can be done.

Some HCA hospitals have a very poor reputation, some have a good reputation.

Magnet status does not guarantee a good manager or a good learning environment. Also several HCA hospitals have magnet status.

It's really hard to give good advice without knowing specifics of the who hospitals. A couple of things I would recommend thinking about. Which hospital provides a better learning experience for new grads. How easy is it to transfer to the ICU from the PCU unit. Who's hospital actually sees sick patients in their ICU, especially cardiac and sick fresh post ops?

How old are you? It's a year - that's basically nothing. Magnet hospitals are amazing to work at, I would definitely get my foot in the door there.

If it were me, I would pick the IMU at the magnet hospital. I work at a magnet hospital on a mixed CVIMCU/CVICU. I did IMCU level for the first two years and just trained to ICU level. I’m so grateful for that time as an IMCU level nurse before moving into ICU. Plus, I LOVE my hospital and can’t imagine working somewhere else. This is obviously just one hospital and one unit, but my experience has been very positive. I also work nights and would personally find it very difficult to do anything more than a 30 min drive after work.

good luck in your journey ?

18 hours ago, PeakRN said:

Which hospital provides a better learning experience for new grads. How easy is it to transfer to the ICU from the PCU unit. Who's hospital actually sees sick patients in their ICU, especially cardiac and sick fresh post ops?

That's pretty much the order I'd look at things as well. Most important is getting a good foundation as a new grad. After that, the rest is just mapping your way into an ICU where you'll see some seriously sick patients.

If all things were equal, the more distant facility would be a great choice, but my suspicion is the closer facility will provide a better foundation and the OP should be able to transition more easily into ICU after a good run at an IMU/PCU type unit.

I'm not saying a new grad shouldn't go straight into an ICU, far from it! I was a new grad hired into an ED. My orientation took longer than I would have needed had I had experience as a floor RN first. One thing to watch out for is that some people have very strong feelings about new grads being hired directly into a high-performance type of position - particularly that new grads shouldn't be. Those people can often try to undermine the new grad to get them to quit or transfer out, and these people don't want to take the time (literally) to bring a new grad up to speed. I've had the misfortune to work with such people. Fortunately I also got to work with people willing to take the time to bring me up to speed.

I work with several nurses who came to my facility from various HCA facilities. Not one of my former cowerkers who have left have gone to an HCA facility.

As best as I can tell, that company is emblematic of everything that is soulless, evil and wrong in healthcare today.

21 minutes ago, stablesystole said:

I work with several nurses who came to my facility from various HCA facilities. Not one of my former cowerkers who have left have gone to an HCA facility.

As best as I can tell, that company is emblematic of everything that is soulless, evil and wrong in healthcare today.

We have HCA facilities here with a bad reputation as well. One was unionized against the dismay of HCA. However, the union was such that several years into it there was a movement to get rid of the Union that barely lost so the union stayed. A fews later they went on strike over ratios and pay. So the union wasn't very helping in resolving those issues if they had to strike in the first place.

To the OP, seems like you're getting some good advice here and I have nothing much to offer. Good luck.

From what experience I have, and what l've read from your post, I would 100% recommend the position at the magnet hospital...

I have worked at a HCA hospital and it was miserable. For whoever asked, it stands for Hospital Corporation of American and it is a for-profit corporation with healthcare facilities all over the U.S. My experience with HCA was awful (nurse:patio ratios, staffing, pay, culture, lack of management support, poor training) and would never recommend another nurse look for employment there.

The rest of my two cents:

You've already stated you love the magnet hospital--don't overlook the day to day happiness/joy factor in any job. It took me a couple of tries, but have found a great spot now.

The commute will be a factor--an hour difference EVERY DAY will wear on you.

Delaying your ICU start (and therefore CRNA school) will be a blessing in disguise. Your first nursing job is hard enough, to learn ICU on top of that takes an incredible preceptor (or several), an understanding team and a lot of luck--being put out on your own too early will sabotage your confidence and everything else that follows. A year on Med-Surg or Tele will FLY BY...it will take you a year to learn the door codes, phone extensions, printer codes and other people's name just on your floor, let alone coworkers from housekeeping, MDs, radiology, RT, ER, and surgery that you will interact with.

Learn everything you can about your job, and how the hospital runs in general--it will benefit you the rest of your career. Once you're off orientation and have a few months on your own, try and pick up some OT by floating to another floor to see what they do different/better and expand your learning. Your hospital should also have a lot of online learning opportunities and classes you can attend--you'll need to know your cardiac rhythms (and what to do about them) down pat. Then in 12-18 months you'll be coveted by ICU managers--DON'T mention your CRNA goal. It takes a lot of time (and therefore $$$) to train an ICU nurse, and if they think you will be there for 12 months then off to CRNA school, most would be less likely to hire you (although they realize this is a goal for several ICU nurses.)

In the mean time, you might decide you like where you're at (either the first job or ICU) too much to go back to school. Either way you'll be kicking butt at your current job and a great resource for the next group of new nurses to learn from.

Good luck, and welcome to the show!