New grad in ICU

OUxPhys, BSN, RN · Apr 14, 2017

It depends on the hospital and the acuity. Your larger academic/teaching hospitals will most likely have a higher acuity in their units compared to smaller hospitals. Going into the unit straight out of nursing school is doable but it is also a huge learning curve.

To increase your chances of getting in the ICU get a job as a nurse's aid in an ICU or make sure you get a practicum in an ICU.

MurseAt50 · Apr 14, 2017

So congrats on nursing school and best of luck on surviving an accelerated program. I myself recently graduated a 12 month 2nd Degree BSN from a top school and I know how tough it will be for you. I'm an older murse at 50 hence the name and originally thought I wanted ER also but fell in love with ICU and happened to land an ICU job after school. Let me first address what I've seen that made nurses successful in landing that first job in an ICU vs. having to do a tour of medsurg first. Then I will also hopefully clear up or solidify some of your perceptions of what it means to be in the ICU especially as a new grad.

First and most important thing I saw in new nurses in landing an ICU role or even getting an interview was getting relevant experience during nursing school. Ideally you will do a clinical in an ICU you would love to work or even be willing to work in during your final rotation. If you can land this go straight to the charge nurse professionally introduce yourself and make it clear that this is where you would love to work. Work your ass off and at an appropriate time ask the charge nurse if they would introduce you to the director for a short meeting and make your pitch to them on your interest. Don't beat around. This is the #1 way I saw new grads get into an ICU even if the ICU didn't hire new grads.

#2 Start looking now at hospitals you would like to work in that specifically have new grad programs that will hire into the ICU. Find out the process to apply, be ready to apply when possible and do everything you can to stand out. Be willing to relocate. Network if you can with current employees there or anyone you can get a relationship with.

#3 Last and probably least realistic route is to apply for ICU jobs/programs that will accept new nurses but are not exclusively new nurse. Unless you are the top of your class from a great name school its a tough route as they literally have hundreds of applicants including from experience med surge nurses that they already know in their system.

As a backup if all the above fails find the hospital you want to work for and get in med surge and do your time going route #3 above. Depending on your market despite the so called shortage landing a GOOD new nurse job can be tough as any hospital needs to make a SIGNFICANT investment in training you and then hopes you will stay. Those that have extensive new nurse training programs that focus on ICU tells you also a lot about the hospital ... potentially.

It's not clear from your post that you have spent significant time in the trauma ICU. Don't take this as a lecture I just want you understand it a little better at least as I have experienced both. It's not the ER. If you know this just ignore everything else I have to say. In fact if you haven't discovered ER Nurses and ICU Nurses have a 'friendly' rivalry. ER nurses think ICU nurses just fluff pillows and ICU nurses wonder if ER nurses have ever heard of a patient history or realize they have names.

Patients arrive stable generally from the ER or a rapid response but can go downhill real fast. You spend your time monitoring and looking for trends and trying to head off disaster. Doctors actually spend very little time with them you are the primary health care advocate. You will take complete care of them even if you have CNA's who will at best assist. You really need to enjoy pathology and physiology your cases will be complicated. You will be the go to person for the family and will get to know them and the patient and despite the best efforts of all quite a few will die as a normal part of business. If they code in an ICU even if they recover they most likely won't next time or their long term quality of life will not be great. This can be emotionally hard. ICU nurses tend to have the highest burnout especially PICU.

Time management. You will have 2 hope to god not 3 patients and it's not easier in an ICU compared to the ER or MedSurge it's just different. You will chart ... and chart ... and chart ... and in between you will give bed baths maybe several times a day (ICU patients don't ambulate to the bathroom) ... you will give meds ... you will give blood ... you will do doctor notifications ... you will take patients for scans ...you will chart ... you will wonder why you have a headache and realize you haven't had a drink, bite to eat or bathroom break in 8 hours.

If you are younger and a new grad you might have some resentment that you haven't paid your dues but more likely it will be they will wonder if you have enough life experience never mind nursing experience. It takes at least a year or two even for experienced nurses to come up to speed never mind a new grad in the ICU. As the ICU nurse you are the expert and you must be assertive and balance all the family, doctors and various other ego's even more so than any other area. Hard to do as both young and new and without looking foolish or arrogant. Dumbest thing I said to my preceptor was how do you call a rapid response ... rolled her eyes at me and laughed ... you are the rapid response if you need help yell real loud.

If all that hasn't scared you off congrat's I LOVE the ICU and it is a calling and best of luck. I personally don't think spending time seasoning in a med surge is necessary if you have what it takes to work in the ICU. Others may differ.

jj224 · Apr 15, 2017

Some good advice above, so I won't comment much except to say this - bypass med-surg if possible. Some people can make it in ICU directly out of school, and some cant. The only way you'll know is if you jump into it feet first. The ones that'll give you grief about needing to 'pay your dues' are the ones that don't have the confidence to try it or the ones that couldn't hack it.

LissRN07 · Apr 15, 2017

Thanks for the response! I am currently looking for positions in an ICU that I'd be qualified for. Because my program is accelerated our practicum/preceptorship is only 8 shifts and likely not in an ICU (downfalls of an accelerated program) :unsure: but hopefully I'm able to find a position as a student nurse on my own.

LissRN07 · Apr 15, 2017

So congrats on nursing school and best of luck on surviving an accelerated program. I myself recently graduated a 12 month 2nd Degree BSN from a top school and I know how tough it will be for you. I'm an older murse at 50 hence the name and originally thought I wanted ER also but fell in love with ICU and happened to land an ICU job after school. Let me first address what I've seen that made nurses successful in landing that first job in an ICU vs. having to do a tour of medsurg first. Then I will also hopefully clear up or solidify some of your perceptions of what it means to be in the ICU especially as a new grad.
First and most important thing I saw in new nurses in landing an ICU role or even getting an interview was getting relevant experience during nursing school. Ideally you will do a clinical in an ICU you would love to work or even be willing to work in during your final rotation. If you can land this go straight to the charge nurse professionally introduce yourself and make it clear that this is where you would love to work. Work your ass off and at an appropriate time ask the charge nurse if they would introduce you to the director for a short meeting and make your pitch to them on your interest. Don't beat around. This is the #1 way I saw new grads get into an ICU even if the ICU didn't hire new grads.
#2 Start looking now at hospitals you would like to work in that specifically have new grad programs that will hire into the ICU. Find out the process to apply, be ready to apply when possible and do everything you can to stand out. Be willing to relocate. Network if you can with current employees there or anyone you can get a relationship with.
#3 Last and probably least realistic route is to apply for ICU jobs/programs that will accept new nurses but are not exclusively new nurse. Unless you are the top of your class from a great name school its a tough route as they literally have hundreds of applicants including from experience med surge nurses that they already know in their system.
As a backup if all the above fails find the hospital you want to work for and get in med surge and do your time going route #3 above. Depending on your market despite the so called shortage landing a GOOD new nurse job can be tough as any hospital needs to make a SIGNFICANT investment in training you and then hopes you will stay. Those that have extensive new nurse training programs that focus on ICU tells you also a lot about the hospital ... potentially.
It's not clear from your post that you have spent significant time in the trauma ICU. Don't take this as a lecture I just want you understand it a little better at least as I have experienced both. It's not the ER. If you know this just ignore everything else I have to say. In fact if you haven't discovered ER Nurses and ICU Nurses have a 'friendly' rivalry. ER nurses think ICU nurses just fluff pillows and ICU nurses wonder if ER nurses have ever heard of a patient history or realize they have names.
Patients arrive stable generally from the ER or a rapid response but can go downhill real fast. You spend your time monitoring and looking for trends and trying to head off disaster. Doctors actually spend very little time with them you are the primary health care advocate. You will take complete care of them even if you have CNA's who will at best assist. You really need to enjoy pathology and physiology your cases will be complicated. You will be the go to person for the family and will get to know them and the patient and despite the best efforts of all quite a few will die as a normal part of business. If they code in an ICU even if they recover they most likely won't next time or their long term quality of life will not be great. This can be emotionally hard. ICU nurses tend to have the highest burnout especially PICU.
Time management. You will have 2 hope to god not 3 patients and it's not easier in an ICU compared to the ER or MedSurge it's just different. You will chart ... and chart ... and chart ... and in between you will give bed baths maybe several times a day (ICU patients don't ambulate to the bathroom) ... you will give meds ... you will give blood ... you will do doctor notifications ... you will take patients for scans ...you will chart ... you will wonder why you have a headache and realize you haven't had a drink, bite to eat or bathroom break in 8 hours.
If you are younger and a new grad you might have some resentment that you haven't paid your dues but more likely it will be they will wonder if you have enough life experience never mind nursing experience. It takes at least a year or two even for experienced nurses to come up to speed never mind a new grad in the ICU. As the ICU nurse you are the expert and you must be assertive and balance all the family, doctors and various other ego's even more so than any other area. Hard to do as both young and new and without looking foolish or arrogant. Dumbest thing I said to my preceptor was how do you call a rapid response ... rolled her eyes at me and laughed ... you are the rapid response if you need help yell real loud.
If all that hasn't scared you off congrat's I LOVE the ICU and it is a calling and best of luck. I personally don't think spending time seasoning in a med surge is necessary if you have what it takes to work in the ICU. Others may differ.

Wow, thanks for the response! This is some of the best advice I've received yet. I will definitely take all of this into consideration. I have heard a ton about ICU being the place where you'll meet some of the most intimidating nurses you'll encounter in your career. But even after reading all that I still feel just as strong about wanting to pursue it full force!

LissRN07 · Apr 15, 2017

Some good advice above, so I won't comment much except to say this - bypass med-surg if possible. Some people can make it in ICU directly out of school, and some cant. The only way you'll know is if you jump into it feet first. The ones that'll give you grief about needing to 'pay your dues' are the ones that don't have the confidence to try it or the ones that couldn't hack it.

Good to know! I know I have to pay my dues in some respect, which I have no problem with, but I'd rather do it in critical care if possible. I hope I get the chance to dive right in. Thanks for the feedback!

esrun77 · Apr 16, 2017

Looks like you've already gotten some solid advice, but I just wanted to throw this one out there--look for summer internships in the ICU starting in the fall (they close by December), or even just internships at the hospital where there's an ICU you're interested in.

Also, many hospitals have nurse residencies for new grads in the ICU, so start looking and applying early on! God bless :)

Workitinurfava, BSN, RN · Apr 16, 2017

You could try an ICU step down unit. I did and learned I didn't want to work in the ICU at all.

LissRN07 · Apr 17, 2017

Looks like you've already gotten some solid advice, but I just wanted to throw this one out there--look for summer internships in the ICU starting in the fall (they close by December), or even just internships at the hospital where there's an ICU you're interested in.
Also, many hospitals have nurse residencies for new grads in the ICU, so start looking and applying early on! God bless :)

I will most definitely look into that! Thanks!!!

CallmedoBBin · Apr 21, 2017

Have a look at http://www.nu2icu.com.. free, straight forward and made to help the transition to ICU / HDU nursing. Good luck.

MJH3483, BSN, RN · May 3, 2017

If I were you, depending on where you live and what hospitals/health systems offer, I'd do my best to either obtain a job as a nursing attendant (preferably in an ICU setting) or apply for nursing externships. Both seem to be the way to get your foot in the door for a fellowship position. I am not sure where you are obtaining your accelerated BSN but in my experience, some universities produce better nurses than others. With that said, my advice is that as a nursing attendant you will gain more experience and have more chances to network. As an extern, you have these opportunities as well, but I find the attendants make for stronger nurses as they have a stronger base. I do know people that entered critical care and were given maybe 8 weeks of orientation, but you need to be able to hold your own and know what's safe because they had told me plenty of horror stories of new grads in the ICU. Best of luck to you.