I have been lucky enough to be offered two amazing new grad positions and am having trouble deciding which would be a better fit for me.
Option 1: ED position at a children's hospital (level 1)
Option 2: Critical Care Float position an adult hospital (also a level 1) - would float between Neuro ICU, Cardiac ICU, CV ICU, and Surgical/Trauma ICU
Both of these are amazing offers, which is why I am having trouble deciding between the two. I have always been interested in critical care, pediatrics, and gong back to school. One of the options I am considering is CRNA school, which is why the float position interests me. However, I've heard that it's difficult to be in a floating position as a new grad.
On the other hand, I have worked in pediatrics as a nurse tech throughout nursing school and absolutely fell in love with peds. The ED would still give me the critical care aspect I'm looking for, but it's not a prerequisite for CRNA school if I decide that's what I want to do down the road.
I keep going in circles in my head about what the better choice is. Someone please help me!
Here's the problem with the critical care float pool: You don't get much experience with the most critical patients. Generally, they'll give you the softer patients and double you up so that their core staff can take care of the higher acuity patients. This is likely to be even more the case given that you're a new grad.
It will take quite a long time for you to spend enough time in a given unit for them to get to know you - and for you to develop the skills and experience - in order to break out of this.
Personally, I'd do the ED gig for a while and then look to get into one of the units rather than the float pool. The float pool is much better for experienced nurses.
I would not do the float pool ICU position. In my hospital, orientation for an ICU position is 6 months. Here you are getting 2 months and one month on your own. It's not safe.
Honestly, since she is going to be a float I guarantee you she'll be getting the stable patients and that one month "on her own" she'll be watched like a hawk. ICU nurses are kinda like that. Each orientation will build on the prior (there is a lot of crossover) and by the time she's done she will have about a year! Frankly, that sounds like a really good plan. The first 3 month period may be rough for sure but by the end of the process, if she's up to the challenge, she'll be very well-rounded. If not, she'll be weeded out very quickly. There are other concerns, of course, and it would take a really sharp new grad to be successful in a program like this but they apparently saw something in her. I don't think it should be ruled out.
I worked the pediatric float pool for a large, 11 floor children's hospital...floated to PICU, CVICU, Burn ICU, NICU, hem/onc, NPCN, rehab, ortho, med/surg, same day surgery, overflow, yada, yada, yada. I had ten years of NICU/PICU/peds intensive home health experience at the time. Let me tell you...It was pure trial by fire.
Every single unit did things differently, every unit worried about different things, had unique priorities regarding care, every unit's physicians had a different preference of how nurses interacted with them, what mattered in CVICU didnt really matter in trauma, transplant was a whole different ball of wax than the burn unit, and the expectation was that you would absolutely know all of this as a float nurse. You come in, get your assignment, and hit the ground running with minimal help from the core staff. That's how it had to roll.
I'll be honest. I loved floating. I was an adrenaline junky and floating meant that I was always working on a short staffed unit and the pace would be FLYING. Just my thing. Work 4 hours in PICU, move the next four hours to transplant, hop on over to NICU to finish my shift. Or spend 12 hours in one place. You never knew.
I also know that I would have absolutely been completely sunk in that position as a new grad. I would have imploded in fiery flames of self destruction. I was Valedictorian of my nursing class and that would have absolutely meant zilch, nada, zero if I had tried to be a float with no experience. Holy crow, it would have a been a disaster.
Furthermore, I honestly think it's a super bad sign that they are willing to hire a new grad to an ICU pool, in particular. That's just my personal opinion there. That stinks of pure desperation. Maybe it's not, maybe they will orient you properly and magnificently as they promise and that will be enough time for your needs...but big "but" here...float pools are notoriously hard to staff for a very, very good reason. They usually (and should!) pay a premium for experienced nurses because, even with experience, it's a super challenging job. I've always gotten a huge float pool "incentive"...to the tune of around $8 extra above base. I personally wouldn't work float pool again without a premium pay incentive.
I would run away from that option, personally. Run like the gold medal is at stake and your mama is watching in the stands.
I know that's difficult because, on paper, it absolutely looks like a primo golden ticket to get into CRNA school. And in a way, it certainly is. And it IS a phenomenal experience, let me tell you.
BUT!!!! My fear is that if you take it, you may end up not succeeding, or even just bowing out due to the incredible pressure and stress, and then potenially not have the best references from that job due to not being able to perform up to their standard.
Summary: it's a big risk.
I did float for three years and yes, I really loved it. But it wears on you...always, always, ALWAYS, being on a short staffed unit, always having crazy assignments, and unequivically needing to be an absolute Jack of All Trades as soon as you step on the ground.
Can you shadow a float nurse to get a feel for it? Really talk to them and get a feel for how exactly that float pool operates?
I would take ER, get my feet planted solidly underneath me, and then consider transferring at a later time. Or just go straight into one single ICU. Going into ICU is absolutely possible as a new grad; 16 years ago, that's what I did.
But an ICU float pool as a new grad? I wouldn't touch that with a 10 foot pole. I could be wrong...but I doubt it.
Best Wishes,
Eris
You are the "hired hand". Not a member of the regular staff, ever. There is little incentive to get to know you because they never know when or if you will be back any time soon.
Any of your quirks or failures in clinical skills will be magnified because they won't be balanced by familiarity of your winning personality. Unless you are an ICU-savant, you really won't know what you are doing for quite some time and that makes you more of a liability to the regular staff. They constantly have to work around you. You would think they would be grateful for the help but it doesn't work out that way.
I agree, this hospital reeks of desperation to put a new grad through that.
Honestly, since she is going to be a float I guarantee you she'll be getting the stable patients and that one month "on her own" she'll be watched like a hawk. ICU nurses are kinda like that. Each orientation will build on the prior (there is a lot of crossover) and by the time she's done she will have about a year! Frankly, that sounds like a really good plan. The first 3 month period may be rough for sure but by the end of the process, if she's up to the challenge, she'll be very well-rounded. If not, she'll be weeded out very quickly. There are other concerns, of course, and it would take a really sharp new grad to be successful in a program like this but they apparently saw something in her. I don't think it should be ruled out.
In my experience, nobody in ICU or otherwise watched me like a hawk when I oriented to the units or worked float. They didn't ask what I had and had not been checked off on. The assumption was that I could handle a garden variety ICU assignment once I was off orientation. And I only got 3 shifts of orientation per unit, but I was an experienced ICU nurse too..But I certainly wasn't experienced in every ICU prior! Now, they didn't usually stick me with the fresh post op open heart transplant, but I surely did get put in assignments that had an open sternum/chest with an external pacemaker that was a couple days out. Not often, but it happened. I will say, I was never given what I would consider a cupcake assignment either.
And emotionally and professionally having to deal with being the one "weeded" out is hugely traumatic, and not to be discounted. That has to factor into her decision as well.
bgxyrnf, MSN, RN
1,208 Posts
Here's the problem with the critical care float pool: You don't get much experience with the most critical patients. Generally, they'll give you the softer patients and double you up so that their core staff can take care of the higher acuity patients. This is likely to be even more the case given that you're a new grad.
It will take quite a long time for you to spend enough time in a given unit for them to get to know you - and for you to develop the skills and experience - in order to break out of this.
Personally, I'd do the ED gig for a while and then look to get into one of the units rather than the float pool. The float pool is much better for experienced nurses.