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.

[Ruby Vee, BSN]

Since you know you'd ultimately like to be at your current hospital, take a position there with the plan of transferring to the ICU after 1-2 years (if you still want to.). You may find you love your non-ICU job. Get started on your 401k and start making contacts that will serve you well as you move into ICU in the future.

[CVVH, MSN, RN]

Since you know you'd ultimately like to be at your current hospital, take a position there with the plan of transferring to the ICU after 1-2 years (if you still want to.). You may find you love your non-ICU job. Get started on your 401k and start making contacts that will serve you well as you move into ICU in the future.

Thank you. Yes that's what I'm leaning towards doing. I guess it's hard when my dream to work in the ICU has been realized so quickly (I got the official word that I'm hired).

[MaxAttack, BSN, RN]

I started as a new grad in the ICU and looking back I wouldn't have done it any other way. We get floated to tele and med-surg when our census is low and I can tell you I would've hated every day had I started there. It's an entirely different patient population and an entirely different style of nursing. You sound like you know what you want and you're likely not going to be happy floundering around on a tele floor waiting for a better job to open up.

You have your dream job waiting.

Or you can pray you like where you end up and wait for who knows how long for a position to open, which you won't even necessarily get. Get your experience and when that position opens you already have worked there and know people who can maybe put in a good word for you and, more importantly, you'll have critical care experience.

If the drive is ridiculous then maybe reconsider, but I would personally still look for new grad positions in other units in your area.

Good luck with whatever you choose to do.

[adrnln]

Right out of school, the only job I could seem to land was in the ICU at the hospital where I did most of my clinicals, 50 miles from the city I lived in. I didn't have dreams of working in the ICU right out of school but it didn't seem like I had another option. The city I lived in had several hospitals, including an awesome level 1 trauma center. Those hospitals were all saturated with nurses, though, and nearly impossible to get a job there as a new grad. So, I ended up taking the ICU job, night shift, a far commute from home. It was a pretty high acuity ICU, a level 2 trauma center. The nurses I worked with were excellent. I felt like the experience right out of school was second to none. I stayed there 3 years. It was very hard, especially the first year or so, and sometimes I think back and don't know how I did it. Had to grow some tough skin. The long commute definitely did not make it easier, but I had no desire to lice in that town. I took naps in my car on the ride home pretty frequently. If you have the opportunity to go work in an ICU, I would take it. Get some experience and then apply to your dream hospital. Maintain connections with the level 1 you want to work at and maybe let them know you intend to apply there in the future. They will respect that you went elsewhere for the better experience. After my first 3 years in the ICU, I became a traveler. Lots of options as a traveler for ICU nurses. I now have a very cushy full time ICU job in an awesome location. I respect medical floor nurses as I think their patient loads are often unfair. I appreciate the 2:1 nurse to patient ratio in the ICU and I like having all the information on monitors in front of me. Take the ICU job. It is harder right out of the blocks, but well worth it, in the end.

[RunNP]

I would not concern myself too much with how the facility is ranked. Teaching vs non-teaching hospitals can be very different learning experiences and it may be difficult jumping from one to another. When I began i worked in a non-teaching facility and cut my ICU teeth with some very experienced nurses. Years later I moved and started working in a teaching facility and had a very hard time adjusting. My old job had way more autonomy than the teaching facility and it felt to me that nursing was nothing more than checking off boxes with very little thinking involved plus the staff were all very young and conditioned to the environment, plus being a teaching facility most decisions were left to residents which creates a whole new set of problems.

Bottom line there are pros and cons to both and just depends on what you need from a position. Me I would take a non-teaching position any day over a teaching one. But that is just me!