ICU vs OR Residency

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by NC_24 NC_24 (New) New

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I am a new grad (just graduated this month) and in the process of getting my NCLEX scheduled. I rotated at a local OR in a hospital for my recent / final clinical rotation which I loved. Since ending this rotation I have applied here and other places however I’m finding that I’m stuck in deciding between both. 

I like the idea of working in the ICU because I will be constantly challenged and can gain a lot a great skills. However I know this can be a hard job. I currently have a job offer in an RN Residency in the ICU at a level IV hospital.

At the same time I am awaiting to hear back if I will be offered a spot for the OR RN Residency program at the hospital I did my rotation. I feel this could also be a good option for me (schedule, know the staff, familiar with the unit and routine). But I feel that I may be putting too many eggs in this basket if I pass up the ICU offer to wait for this and end up not getting in. I do see the downsides here like being on call on days off & weekends. And I won’t be utilizing my nursing skills I learned in school as much as I would in an ICU unit.

I'm stuck in this decision because I am not sure if going in the ICU as a new grad is a good option but I know this can also make me a stronger nurse…. But what if I’m not cut out for this..( I do think about this).. On the other hand the OR won’t be as stressful and somewhat a nicer schedule except being on call.

Anyone with experience in going into the ICU or OR as a new grad have any opinions? I would love to hear your experiences. I would also love to hear from people who have worked in these units for awhile too!

Thanks! 

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,983 Posts

I may be just a tad biased. Team OR here. Started as a new grad, and while I’m leaving my current position, it’s to go to another OR in a new location. 

Psychnursehopeful

Psychnursehopeful, ASN, RN

Specializes in ICU. Has 1 years experience. 155 Posts

ICU would make you a more well rounded nurse. OR is specialized and harder to get into though. If you want to develop skills and open doors ICU hands down. OR nurses can't work stepdown, medsurg, ED, cath lab, ecmo or go to CRNA school. Be aware the learning curve is steep.

NC_24

NC_24

11 Posts

Thanks for your input! I know that I don’t want to do OR forever which is why I’m worried about being able to be looked at as a good candidate later in my career if I were to want to go to the units you suggested. 

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,983 Posts

Just now, NC_24 said:

Thanks for your input! I know that I don’t want to do OR forever which is why I’m worried about being able to be looked at as a good candidate later in my career if I were to want to go to the units you suggested. 

I have worked with many over my years as an OR nurse who moved on to other areas, including med/surg, ICU, L&D, and NP school. It’s not so much about being in the OR as it is about the support provided by the new unit. 

NC_24

NC_24

11 Posts

On 12/14/2021 at 12:00 PM, Psychnursehopeful said:

ICU would make you a more well rounded nurse. OR is specialized and harder to get into though. If you want to develop skills and open doors ICU hands down. OR nurses can't work stepdown, medsurg, ED, cath lab, ecmo or go to CRNA school. Be aware the learning curve is steep.

I really feel like the ICU would help me become more well rounded as you said. Do you have any tips for someone new in nursing going into this unit? The hospital I’m considering is a smaller one level IV place. I think the residency is about 6 month long.

subee, MSN, CRNA

Specializes in CRNA, Finally retired. Has 50 years experience. 3,906 Posts

On 12/17/2021 at 11:44 PM, NC_24 said:

I really feel like the ICU would help me become more well rounded as you said. Do you have any tips for someone new in nursing going into this unit? The hospital I’m considering is a smaller one level IV place. I think the residency is about 6 month long.

I think you are right.  OR nursing doesn't give you direct patient skills(comparatively speaking).  ICU could be a useful background if you ever go to the OR but OR doesn't help you much in the ICU.  Starting off in a smaller place sounds a smarter move for a new grad.  If you ever did evidence to go the CRNA route. OR does not count as the critical care requirement.  Good luck with your career.

 

tg2125

tg2125

34 Posts

On 12/20/2021 at 9:25 PM, subee said:

I think you are right.  OR nursing doesn't give you direct patient skills(comparatively speaking).  ICU could be a useful background if you ever go to the OR but OR doesn't help you much in the ICU.  Starting off in a smaller place sounds a smarter move for a new grad.  If you ever did evidence to go the CRNA route. OR does not count as the critical care requirement.  Good luck with your career.

 

Listen the OR will not really help you at all going into the ICU if you start in the OR then go ICU  but I had a colleague who was an OR nurse mainly specialized in Ortho/ortho trauma that later went to the CTICU and killed it and is now an SRNA he told me straight up that coming that the only nurses that start out ahead in the CTICU are the tele nurses (which makes sense) OR, med surg, etc all have a rough learning curve, Which is the same as any nurse coming into the OR ( the only people who transition easy into OR nursing are Scrub techs). One thing the OR will do in the ICU is that the nature of OR nursing makes you very meticulous (like ICU nursing) and makes you move and get things fast as well as preparing yourself beforehand so you're not flustered. Im sure the ICU has things like that which would probably help in the OR but starting in the ICU would not make the learning curve of the OR easier. Don't take advice from a CRNA they are GREAT at what they do and were GREAT ICU nurses but they don't know that much of terms of being able to circulate and KNOW NOTHING in terms of being able to scrub especially the more specialized ortho, neuro, and cardiac services.

In my opinion start in the ICU if you get the offer. Thats only because of a lot (not all) nurses in general are ignorant to what OR nurses can do and do. With a lot of nurses being ignorant to our job they might look at an OR nurse as not good enough to become an ICU nurse if you want to make the switch early on from OR to ICU. 

wishing you the best of luck!

Leader25, ASN, BSN, RN

Specializes in NICU. Has 39 years experience. 1,263 Posts

On 12/14/2021 at 12:13 AM, NC_24 said:

And I won’t be utilizing my nursing skills I learned in school as much as I would in an ICU unit.

Why are you trying to  put those areas into little neat bundles like ABC?You DONOT know what each one will be like exactly,there are good and bad events in every area,Which one do you want the most?The Or is a good  learning opportunity but what makes you think you will not be practising your nursing skills much?

Pick one!!

Living2Learn

Living2Learn, BSN, RN

Specializes in Cardiothoracic ICU. Has 3 years experience. 127 Posts

I'd definitely recommend ICU. You'll learn a lot more about patient care, build more skills and it's more versatile. 

tg2125

tg2125

34 Posts

On 12/14/2021 at 3:39 PM, Rose_Queen said:

I have worked with many over my years as an OR nurse who moved on to other areas, including med/surg, ICU, L&D, and NP school. It’s not so much about being in the OR as it is about the support provided by the new unit. 

Thank you Rose_queen. Yes the OR is a different type of nursing but I too know OR nurses that transitioned to more “traditional” nursing. It’s all about the support from the unit and the determination of that nurse to learn. 

newnursewhodiis

newnursewhodiis

29 Posts

I had my preceptorship in an OR. I think state wise and depending on the hospital your OR experience will vary. The OR I was in, the surgical scrubs and the surgeons/resident surgeons and anesthesia did the bulk of the work. The nurses at this facility were not trained to do the work as a surgical scrub/tech. The role of the circulating OR nurse was to ensure safety, best practices, documenting, and gathering additional supplies and pretty much overseeing the surgeries with patient advocacy in mind. So the knowledge regarding infections, advocating for patients, patient safety, charting all that is a skill you will have in the OR. The hospital I was at was a teaching hospital so sometimes I was even on the sidelines when it came to Foley's etc  because they wanted to teach others how to do it. The meds you pretty much pulled, used the five rights, then handed them over to anesthesia. 

When making your decision I would write out all the duties for both jobs and make your own decision. 

I would like to state that when I was talking to the nurses I was precepting with they said when the OR was shut down peak Covid that they had to help on the floor and  felt lost. I am sure an ICU nurse going into the OR would feel the same- because most schools do not allow clinicals in the OR and it is a different skillset. It is like comparing apples and oranges- both are fruits, but different. OR and ICU are both nursing specialties, but different.

Good luck with your decision