Advice to an ER nurse thinking of making the leap to CCU

  1. First the backstory...
    I have worked in a small rural ER (8 beds including 2 trauma beds) for the last year, which also happens to be the extent of my nursing experience. While in school and upon graduation it was my aspiration to continue my education and work towards my CRNA. I was offered a job after graduation in a 8 bed ICU that cares for both surgical and medical patients if I was willing to work 6-12 months in their Med/Surg or ED. I declined the position for the current job I have now d/t work being a mile down the road and the match in pay. After spending the last year in the ED I love it! The adrenaline rush is great and I love coming home exhausted! So after about 6 months of working ED I started looking into the Flight Nurse profession. My inner adrenaline junkie is coming out I believe lol! So both career paths, that of Flight Nurse and CRNA require extensive critical care experience and caring for a diverse clientele. My thoughts are that I can get into a CCU now and with more research decide which path I will ultimately choose since CC experience is a requirement for both I wont be wasting any time.

    Present day situation....
    The ICU that initially offered me a job are recruiting me once again. I have talked with nurses from both my current job and nurses at larger hospitals and have received mix opinions. Some feel I should take the job offered now and get my foot in the CC door while others feel I should attempt to get in the CC system of a larger hospital. The question I have for ya'll is would it be wise to take the smaller ICU job to familiarize myself with the setting, equipment, routine and then branch out and seek out a position at a level 1 or 2 trauma hospital? Naturally there are many different factors that exist in this situation. I live in between a level 1 and level 2 trauma center, a 1.25hr and 1hr commute respectively, whereas the ICU with an opening is 35 minutes away. A standing offer of employment vs the grueling application and wait and see process. Just to name two...

    Personally I feel more comfortable with starting at the smaller facility and getting some experience under my belt before venturing out. It seems like sound reasoning; however, I also ask myself if fear of the unknown is persuading me to play it too cautiously.

    Anway Thanks in advance for your postings on this vague and poorly written thread opening lol...
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    About 360jRN

    Joined: Aug '10; Posts: 58; Likes: 43
    Emergency Department Nurse; from US
    Specialty: ER


  3. by   TigerGalLE
    The larger ICU seems like a pretty tough commute. But it isn't impossible. I travel 35 minutes to and from work and it isn't too bad at all.

    One thing you need to consider it that the patients in the smaller ICU are not going to be as sick as the larger ICU. I'm sure anyone that is really sick will be shipped out to the larger hospital. The equipment from hospital to hospital will most likely be very different as well. Unless the hospitals are within the same system. So you can't say you'll go to the small ICU to get used to the equipment. That will change from facility to facility. Practices may be different as well. Depending on if you are dealing with a teaching facility vs a non teaching facility.

    If you want to take care of the sickest of sick, chose the larger hospital.
  4. by   surferbettycrocker
    i agree with above poster. many a floor patients at large- especially urban hospitals- would be critical care/icu in smaller hospitals.
  5. by   360jRN
    Geaux Tigers!
    The drive is a major downside especially after being spoiled to my current commute.
    My thinking is that it would be to my benefit to have hands on experience with art lines, ICP monitoring, invasive hemodynamic monitoring, etc.

    Thanks for the reply TigerGal!
  6. by   elk280
    the patient's in a small rural ICU are not going to be the same patients that you will see in a level 1 or level 2 trauma ICU, and because of that, no matter how familiar you are with the equipment (which changes anyway from hospital to hospital), you will learn to deal with more difficult patients in a larger hospital, and that will ultimately prepare you for your goals of CRNA more...
  7. by   chordringer
    Having been in your shoes once, I can tell you that the drive might be more worthwhile. Here's a couple things to consider:

    Cons of Smaller Hospitals
    - Smaller hospitals have far less in the way of educational resources for you.
    - Acuity will be less than in larger units
    - It can be far more difficult adjusting to higher acuity after working in a smaller, low acuity unit

    Benefits of Smaller Unit
    - You will occasionally see patients with higher acuity
    - More often than not, smaller hospitals will see a broader spectrum of patient problems than you might see in a larger, more-specialized unit (i.e. Larger hospitals will have separate ICUs... MICU, SICU, TICU, CVICU, etc.... whereas smaller units might have both MICU and SICU patients.)

    Honestly, If I were you... I'd go for broke with the bigger hospital. You're going to see the things you will need to see on a much more regular basis... and usually just working for one of the "big guns" for a short amount of time will make you look golden to rural hospitals that have a harder time recruiting experienced ICU nurses.

    Good luck to you!

    Jason, RN