ICU in the military

Trauma Columnist · Sep 16, 2016

Moved to military nursing

jfratian, DNP, RN, CRNA · Sep 17, 2016

If you do ROTC and join the military as a new grad nurse straight out of college, they will start you in med-surg or labor/delivery. You'll have to do that for a few years, be retrained as an ICU nurse, do ICU for another 4+ years, and then apply to the military CRNA progam. The civilian route is much faster. Many civilian hospitals have new grad critical care fellowships that start you off in the ICU right away. Look up Vanderbilt medical center in Nashville, TN. If you are okay waiting at least through 8 years of bureaucracy, than the military is a great low-cost way to go.

I would advise getting into CRNA school first and then applying to join the military.

dfdgsag · Sep 19, 2016

Wow! That's awesome. I had assumed that landing a job in the ICU as a new grad would be very very difficult that is why i had the military route in mind. Are their certain requirements for the fellowships? Or is it pretty straightforward? Also around how much would i earn in the ICU as a new grad? (Curious to see if it would be more time and financially efficient to pay back loans)

jfratian, DNP, RN, CRNA · Sep 20, 2016

Landing a new grad ICU job is hard, but most major university medical centers routinely hire new grad nurses. They do that because it's cheaper. The pay at a university medical center is usually not as good as your small to medium sized community hospital in my experience. When I was a civilian new grad, I made $4-6 per hour more than my peers that worked at the big university hospitals near me right out of the gate. My patients weren't as sick so I didn't learn as much though.

Pay varies widely by region, so I couldn't give you an exact number. You should be able to find that by searching local hospital job postings.

I would not join the military for money. If you get deployed, you're working almost 24/7. That drops your per hour average pretty quick. You're better off picking up an extra shift each week to pay back your loans once you graduate at a civilian hospital.

carolinapooh, BSN, RN · Sep 20, 2016

Services have loan repayment and a lot of it didn't go away with budget cuts - it's their most valuable recruitment tool. Ask health professions recruiters what's currently on offer with each service.

No one pulls a 24 hour shift, even while deployed. You do typically work 6 days on and one off with 12 hour shifts, but that's for the length of the deployment. In Afghanistan there's really not much else to do....

In the military health care is free, you're paid tax free money for food (just over $200 a month), your housing is paid and not taxed. My base pay was more than my take home from civilian nursing - and even if I'd come in with NO prior service time, my base pay - before all allowances - would have been more than what I was making on the outside. Out of my civilian paycheck, I paid for health insurance and my mortgage. Now the military pays both - tax free. I earn 30 days of leave a year (2.5 days per calendar month served). If I get sick and I can't work, I'm still paid, I don't use sick days (sick time is time served), and I still earn leave. If the doc says I have to go home, I go home. If I get pregnant, I get 12 weeks paid maternity leave - and earn eight days of leave while I'm off. If my husband were active duty, he'd get 2 weeks off, paid and not charged as leave, after I gave birth (and there is talk of extending that).

I'm overseas at the moment on an unaccompanied remote assignment. My housing, as there is nothing available for me on base, is paid (it's called OHA), plus $687 a month for utilities, plus Cost of Living Adjustment because I'm in an expensive area. But they still pay me for my husband back in the States, so our housing at home is paid as well. And I get paid Family Separation Allowance because he can't be here plus Hardship Duty Pay.

Try that in the civilian sector.

Consider the whole picture and not just the bottom line.

jfratian, DNP, RN, CRNA · Sep 21, 2016

As long as we're considering the entire picture, consider that $40K in loan repayment (which is what it was fairly recently) is actually about $24K after taxes. So they essentially pay you $6K per year extra for a 4 year commitment.

I think you have to compare apples to apples on pay. I made about $57,000 my first year as a new grad nurse in suburban NC. My base pay was $34,800 as a new 2nd Lt 18 months later. My total compensation was $61,000 in an area with $600/month in cost of living allowance (COLA). With the tax advantage for the BAS/BAH, my total compensation was about $67,000. New grad civilians in that same area start at $35/hr or $73,000 per year at 40hrs/wk. Captains with 6 years of time in make about $90,000 in total compensation where I am now. There are civilian contractors doing the exact same job next to me making $64/hr or $133,000 per year at 40/wk. I would honestly call it a wash if you factor in the healthcare, pension, and the extra hours military nurses work.

As was pointed out, the average military nurse typically works more than 40 hrs per week due to staffing issues or additional jobs/duties. I probably put in an average of 48 hrs per week, but many people have it worse.

Maternity leave sounds great. It's too bad one wouldn't potentially see their kid except 4 weeks a year if on a hardship tour or not at all for months at a time if deployed.

You move at least every 4 years. Some people like that. I think the average person would consider that disruptive to say the least. Not to mention deployments: Although it's slowing down now, people in certain specialties (ICU, ER, OR) pretty much deploy every 18-24 months when their cycle hits.

If you ever use sick time for something not clearly serious, your co-workers may look negatively on you. Not all but some. I have seen people's looks when they hear you're getting time off for a septo-turbo or lasix. Military facilities don't typically have float pool or prn staff to cover. Your coworkers simply work short. When I was civilian, we had a common pool for vacation and sick days and nobody judged you for using them. There was on-call and floats and prns; everyone wanted to get the overtime for the extra shifts.

I think deployments vary considerably depending on the situation. CCATT (air transport) teams can pull transpacific missions without crew rest between legs. I know someone who averaged 8-10 missions per month. In an EMEDS, mass casualties can wake up the night shift and result in shifts far exceeding 12 hours. Even best case, you're away from your family for months on end in the desert. I don't call that time off.

Also, I want to point out that the critical care experience you get in the military will vary considerably if you don't happen to deploy. Less people deploy these days. Most stateside military ICUs are small stepdown units. Only 3 bases have real ICU patients.

My overall point is that I would never recommend the military to someone seeking purely or largely financial gain. I overall like it but I have many disgruntled coworkers who came in with unrealistic expectations.

jfratian, DNP, RN, CRNA · Sep 21, 2016

And for full disclosure, hardship pay can be as little as $50/month depending on the location. I think it maxes out around $150? Separation pay is about $250 per month. So $4800 tops for being stranded on a remote island for a year without your family. Let's just say I won't be volunteering for Korea any time soon.