New Grad SICU or Cardiac Stepdown?

Specialties MICU

Published

Hi All,

I've stalked this forum for some time now, and I finally took the plunge to make my own account. I'm looking for insight/advice/whatever you're willing to offer in regards to which unit might be a better fit for me.

A little about me: I'm in my last semester of nursing school, just about to start my preceptorship in L&D then community. I will graduate in May, and I plan to sit for the NCLEX by mid-June.

I just started applying for jobs, and I interviewed with and was officially offered a position in a cardiac step-down unit at Cleveland Clinic (pending me passing boards of course). However, I am also set to interview with the unit manager for the SICU next week. Both of these positions are for a nurse residency program which I think will be very beneficial as a new nurse. But I'm wondering..what are the pros and cons of working in each unit according to your experience? and as a new grad? what can I expect on each unit compared to one another?

I appreciate all the feedback as I'm obviously brand new to this.

Thanks in advance!

Congratulations on your upcoming graduation!! I'm a new grad and I just started working on a step down unit a couple of months ago. I think it is similar to the cardiac step down that you have a job offer for except of course my unit doesn't focus on cardiac. I think it's a great place to start. I've learned so much in the short time that I've been there and it's fast paced, but not so fast that I feel like I'm in over my head. With that being said I think that either unit would be great. You just have to go with what's best for you

Specializes in Anesthesia.

I went from step down to ICU. I suggest biting the bullet and starting the ICU if you can. After starting out in step down getting into ICU wasn't a walk in the park. I really had to sell myself to managers. With a couple years of SICU experience anybody will take you.

ICU pros: you will learn a lot of patho and gtts, can transfer anywhere after a couple of years if you don't like it, looks good on a resume, 2 patients, working on any other unit won't intimidate you after awhile, physicians generally respect your opinion more, you have a lot more autonomy in the ICU, flexiseals, and you can go onto anesthesia school if that ever interests you.

ICU cons: Steep learning curve which is not always easy for a new grad and if you are not coachable and don't have good situational awareness you will drown, dead bodies (you get used to it though), hovering families, less CNAs (if any).

SDU pros: less critical patients (if that's a pro to you), not as steep of a learning curve, sets up a good base for ICU

SDU cons: Maybe more difficult to get into ICU later on if that's what you want to do, physicians don't respect your opinion as much, you don't learn as much, you're working in a transitional unit and patients can either be upgraded or downgraded which makes things really busy. You may get comfortable in SDU and get stuck.

Good luck. Do ICU if you can, but take the SDU job if you don't get into ICU.

Specializes in Trauma Surgery.

To be completely honest with you, it would be in best interest to definitely be able to shadow each unit to get a feel of what both units are like. It also comes down to, what unit do you see yourself working on? When I first started in 2014, I started precepted on a surgical floor, fell in love with it and got my first job on the same floor. After a little over a year, I transferred to our SICU. I'm now 7 months on SICU and love it (most days haha). My husband on the other hand started on telemetry (but in all reality was pretty much stepdown) and transferred to CVICU a week before I transferred to ICU.

Pro: From my husband, he stated that (obviously) 99% of the cases were cardiac but were interesting... MI, syncope, CHF, etc. Then again, he loves cardiac and loves the complexity. Don't get me wrong, you'll still get patients with different issues and comorbidities, but its mainly cardiac issues. He was able to titrate drips like NTG, cardizem, and cardene as long as the patient was "stable". It also seemed as if that was a great start to higher acuity patients because they were pretty sick and also, they had a good amount of codes on the floor (which made me jealous lol!!)-- my husband started on this floor right out of nursing school and was really glad that he did. He did love it for a long time.

Con: What he hated (which is pretty much just like every other floor and hospital) was staffing. They would receive 4 to 5 patients and would give him more "stepdown" patients than telemetry patients. This was also one of the main reasons why he left.

As for SICU, I think my favorite thing is that you can get a variety of different patients. Then again, it really depends. I say that because each SICU is different. For example, I have heard some hospitals have SICUs which are strictly for general surgical patients and then have another ICU for ortho, trauma, neuro etc. My floor is Trauma-SICU and is the only Level 1 trauma center so we can literally get anything or everything. On a daily basis we see trauma (falls/gsw/motorcycle/mva/suicide), neuro, ortho, any gen surg excluding cardiac, and we do get medical patients every once in awhile. We normally don't have any cardiac patients on our floor since we have a CVICU. It's a nice variety and I feel like I am able to handle many different types of patients at any time. Another favorite of being on my floor is that we have an NP/PA/residents on the floor during days and on nights we have an NP or resident available right on the floor that are easily accessible and rounding frequently throughout the shifts. When I first started, I thought that the floor would always be fast-paced all the time but its about half-half for me, some days are hectic and crazy and other days can be slow. If I had my chance, I would have LOVED to start on SICU when I first graduated. Then again, I still was kind of a newer nurse when I transferred in. On the other hand, I do have a newer nurse coworker that started around the same time that I transferred who started as a new grad. She was pretty freaked out when she first started but had over 4 months orientation and she enjoys it very much.

I know that this was alot, but I hope it was helpful still. Please feel free to ask any other questions if need be :) Congrats and good luck!

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