Need Help in choosing job!! NEW GRAD. ICU or Ortho Unit?

CrufflerJJ, BSN, RN, EMT-P · Dec 3, 2010

Ok, I am a new grad (RN BSN) with some experience in ER from an externship and clinical.
My original goal was to be a critical care nurse in ER. I want CCRN certification. But no offer in ER.
I have a job offer in ICU at a CA county hospital. Just had a clinical rotation in ICU. They have a 3 months orientation. I am willing to do whatever it takes to succeed and learn as much as I can, BUT am still pretty nervous. Don't want to make any mistakes. Don't want to be thrown to the wolves...so to say. Can a new grad succeed pretty easily in ICU. I did great in the ER but the highest acuity pt. was stroke pts. and maybe DKA's. Was easier than I thought in ER. Is icu similar. I mean...what acuity of pt. do they give to new grads.
Next offer:
It is in an orthopedic department. They have a contract, a really good versant program. FREE Benefits. I feel very confident to succeed in this department.
Overall, I like the fact that I will get good experience in ICU and will give me the experience to have the option to go to nurse anethetist program. But right now...just want to work and get some kind of experience. I like both departments.
Any input would be great.

First off, CONGRATS on having not just one, but TWO job offers! In today's economy, that's a wonderful (OK, freakin' amazing) thing.

Follow your heart. I'd suggest that you go the ICU route only if you are drawn to that type of unit, with its inherent hassles (stress, very sick pts, wonderful learning opportunity). For now, please ignore the future possibility of CRNA school. Do what feels right to you.

If your sole reason for looking at ICU is CRNA, please go with something other than ICU.

New grads CAN succeed in the ICU, but it takes the right sort of person. "Anal" is a good thing, not a negative. If the county hospital offers a 3 month critical care residency program, that's good. Even experienced nurses from other units go through the CC residency program (4 months) at my hospital, before being turned loose on unsuspecting ICU patients.

Your nervousness is a good thing. As to what type of pts would you receive in the ICU as a new grad....probably the same sort of pts assigned to a nurse with 1-2 years experience on other units prior to going through the 3 month ICU orientation.

As a newbie starting out in the ICU, my biggest challenges were time management and critical thinking skills. Time management just takes time - you'll get it down after a while. Critical thinking is a tougher thing. You'll need to be able to THINK (even at the end of a 12+ hour shift), rather than just blindly DO. If your pt is ordered 30 units of Lantus at 2100 hours, you'll need to be able to recognize that his tube feeding is turned off due to high residuals, and whacking him with Lantus with a gluc of 110 might not be the best thing to do at the current time. If you blindly follow orders as to scheduled meds, your pt may have some unpleasant encounters with hypotension, hypoglycemia, or bradycardia or any of a number of other potential whoopsies.

Before accepting either job offer, you might consider shadowing in each department for a shift. Talk to the people in each unit - ask them about management, training, and the patients served.

In the end, do what feels right to you.

Good luck!

kbm318 · Dec 3, 2010

Congrats to the job offers! I am still in nursing school with only a year left so I don't have much input but I can say that my fiancee graduated and went straight into a CCU/CTU position and loved it, so if ICU is what you plan on doing I say go for it. I have my clinical on an ortho floor right now and hate it, all the nurses do is pass meds and sit at the nurses station. So I guess it just depends on what type of environment you enjoy and what type of patients you will take care of.

Good Luck!