New Grad-Leave Top Ranked Hospital For ICU Job?

[CVVH, MSN, RN]

Hi everyone! So I'm having a difficult time figuring out what to do and appreciate any thoughts. I'm a new graduate as of this month, set to take the nclex next month (September). I currently work at a major academic hospital in an assistant position. It's a top 10 usnews hospital, not sure if that means anything. I like working there, and love that nurses there are very engaged. There are lots of meetings, committees, etc. The hospital is working on magnet status as well. Nursing leadership is very visible and accessible, which I also like.

I'm very interested in ICU, and my goal since before nursing school has been to get into the ICU as a new grad. My hospital hires new grads into two of the ICUs, and I have expressed interest to the nurse manager. It sounds like right now there aren't any openings for new grads, though perhaps that could change later this year.

I recently had an interview at another hospital for an ICU position. This hospital is not ranked in usnews, and is not magnet (not sure if they're working on it, forgot to ask). It's a major academic medical center, and is also expanding with a new research center and new hospital tower (my unit would also be moving into that new tower later this year). I had good vibes at the interview, the staff were great, the nurse manager was great, and it sounds like I have the job, once I get my references to them.

I'm not sure what to do. The hospital I interviewed at is in the middle of nowhere, and the new grad salary is about $17k less than where I work right now (it's a state hospital). It has nice facilities, about to open brand new facilities, the staff is great, and it's in the SICU, which is what I want.

On the other hand, the hospital where I work right now is a top hospital, takes very crazy cases (I'd say both are very high acuity hospitals but this one is higher), great starting salary, etc. But I'm not sure if I'd be able to get into one of the ICUs that hires new grads, and it's not clear when I would move forward with the application process there (they're still working on May internal graduates).

Ultimately, I think I'd like to be an ICU nurse at the institution that I currently work at. So I'm not sure which is a good idea:

1) Leave the hospital and start in ICU, which is what I want to do, then try to apply to my current hospital for an ICU position after a year or two.

or

2) Stay at my current hospital, possibly start in the ICU, or possibly start in a step-down unit, then try to internally transfer to the ICU after a year.

I probably answered my own question, but I'd love to hear thoughts from those that read my long rambling post, haha. Thanks.

[MooksterRN]

In my personal opinion, (and experience), whichever you chose it will give you at least a year of experience on the division. There are both positives and negatives to each choice: 1 year of ICU experience is a major plus that not many new grads have the opportunity for, but on the other hand, transferring internally may be easier, since the nursing managers already have an established relationship, as well as you already have an established relationship with the company. It just so happened that I settled on the latter, because of my relationship. And just for reference, I had applied to several hospitals outside of my institution and the hiring process was exceedingly more difficulty than an internal transfer.

It just depends on the type of experience you want during your first year. Transitioning from nursing assistant to RN has a major learning curve no matter which unit you're working for.

[HouTx, BSN, MSN, EdD]

As you gain additional experience, you will become aware of some universal truths for job hunting.

The more "opportunities" (e.g., vacant positions) there are, the greater the turnover. Excessive turnover is an indicator of systemic problems such as excessive workload, poor management, inadequate training, etc. Hiring new grads into specialty units only occurs when a hospital cannot recruit qualified experienced candidates - again, this may be an indicator that experienced applicants are finding out that there is something "wrong" with that department.

Changing specialties &/or moving into a new & unfamiliar work environment is risky because it is impossible to know how well suited you are (for the new setting) until you're actually there. There are factors, such as your emotional reactions, that you just can't always anticipate. I learned this the hard way... when I (expert CCRN) decided that I wanted to work in NICU. I had not anticipated the impact of the huge burden of ethical issues that had to be dealt with in that setting. I was miserable & scampered back to my adult ICU as soon as I was able.

Be sure you are OK with all the "worst case scenarios" that may happen with your choice. If you can deal with them, go for it.

[CVVH, MSN, RN]

Thank you both for the advice. From the interview it sounds like the unit has some turnover from nurses staying a year or two then going on to CRNA programs. Practically all of the hospitals in my area (including the "top" "nationally ranked" ones) hire new grads into specialties, with some having formal fellowship programs with set start dates in critical care/ED/periop/peds/etc). But yes, I definitely understand. I got the official word that I have the job, which makes the decision even more difficult, but I'm leaning towards staying where I am, as one of the managers of one of the ICUs that doesn't take new grads has offered to talk with me about opportunities in other units that could lead to his ICU in the future. My hospital heavily hires internally (the vast majority of the nursing student/grad assistants get jobs in the hospital, it's just a matter of how long you're willing to wait, with some getting it a month or two after finishing school, while others wait a 4-6 months).

Thank you for the advice.

[guest940422]

Accept the ICU job. You can always back out before orientation begins with no hard feelings. If you are really emotionally attached to your current hospital, it is not unprofessional to send a formal e-mail to the ICU nurse manager that you have been offered another position. Just tell them the truth. You would rather work for them, and you want to verify there are no GN positions open before you accept your other offer.

Don't take a floor job just to stay at your hospital because it is ranked higher. You will never get a better orientation for the rest of your career than you will as a new grad. I got talked into the whole "just do acute care for a year to get your feet wet then transfer to PICU" thing. When I transferred to PICU I got 3 weeks of preceptor training. No classes, no in-services, no skills fairs, no formal education at all. If you work in that other ICU for a year or two then apply to your hospital, you will have a leg up on any competition because you are a former employee, and you will have already been trained as an ICU nurse.

Another point to consider is top ranked Magnet hospitals are always growing. By the time you have the experience to return, no one will look at you like a tech or new grad and there will be room for you.