ICU or Step down

[rpresto706]

Hello All Nurses community,

I am a new grad RN that has newly passed the NCLEX. I have been fortunate enough to recieve two job offers. The first one is working in a medical step down unit in a major academic hospital and the other one is a MICU position is at a level 1 trauma center, but it is significantly smaller than the major academic center.

Right now, my goal is to become a really good nurse. Perhaps in the future go into nursing education. I never thought that I would even have these two opportunities as a new grad.

In the step down unit the nurse to patient ratio is 1:3 and in the MICU it is 1:2. I really like the excitement of critical care. On the stepdown unit, I would get some experience with vents, telemetry and insulin drips.

The orientation for both positions both include an extensive orientation period for new graduates with lectures and simulation labs.

I guess does it matter? Do "Brand Name" hospitals produce better nurses? I know these questions are subjective, but I would love to hear thoughts and opinions.

[FishRN]

Congrats! Having too many options is a good problem to have.

I will give you the same advice I was given as a new grad: ask the recruiter for both units if you can shadow for a half day before you make your decision. When I graduated from nursing school, I was stuck between two ICU positions. Once I got on the units and spent (literally) a couple of hours there, my decision was perfectly clear. Sometimes it's NOT the job description or the hospital's reputation - it's the culture, the acuity, and the people that will set you up for success.

[Pheebz777, BSN, RN]

Can't go wrong starting at that academic hospital. Start with a strong foundation and move your way up to ICU when you feel the time is right.

[Mr. Murse]

I recently made the post about new grads in the ICU, and in general I think it's a good idea to get some experience outside of the units first. Stepdown sounds like an awesome way to get some well rounded skills and a taste of critical care without jumping all in. Also, if critical care is your goal, having experience outside of the ICU gives you a better rounded perspective of the whole patient experience and the process, not to mention time management. Many nurses that have only ICU experience have a very narrow perspective of what any other nurses do.

On the other hand, if the opportunity to work at a level 1 trauma center ICU is hard to come by where you're from then it might be good to take the opportunity.

Finally, a lot of this comes down to you individually. Some nurses go into the ICU out of school and excel. Some really need the less acute setting to get their feet wet. I, for one, am really glad I got 3 years of med/surg before jumping into critical care.

As someone else suggested, see if you can go spend a day or at least part of one on the units to get a feel for it.

Too many choices in jobs is a good problem to have though, congrats and good luck.

[nellynel07]

Which one did you end up choosing?