New Graduate Job Offers: OBS, ER, or ICU

Been there,done that, ASN, RN · Nov 14, 2023

I would stay on the observation unit. Working as a nurse, is far from a tech. You will be applying nursing skills in a familiar environment. You WIll be challenged. Observation patients can go either way.

"understand everything that is going on with patients and truly learning the disease processes, how they are affecting the body". In your downtime, you could see how to do this.

Best wishes with your decision.

Brandon1981 · Nov 15, 2023

I don't think you can go wrong with any of your options. I've worked ER & ICU and both have their benefits/drawbacks (just like anything will).

I started as a new grad in ER. At first, it will be hard, feel overwhelming or even impossible (but it's not). Success will depend upon your resilience to push through those times it feels impossible, and establish yourself with solid relationships in your department-show a willingness to work hard & learn. You'll get good at a lot of things fast such as primary assessments, IV sticks, treatment protocols, etc. You'll get exposure to pretty much anything you'll ever see, but I've also seen ER start to burn out new grads relatively fast. I like ER but am hesitant to recommend it as a place for everyone to start-there is a certain type of person who can and does succeed starting there, & I've seen an EMS background be generally helpful. 20 weeks is a solid preceptorship, but beware if a sign-on bonus is very high.

ICU can have many of the same elements as ER as far as acuity goes, but in my experience, the pace is generally overall slower & may be a more comfortable learning environment for a newer nurse. That's not to say it is "easier," in fact, I would say the learning curve for ICU is more steep than in ER because you're learning to really manage complex issues more than you will in the ER-you'll see what has often come through the ER, but see how the situation also progresses through the ebb & flow of managing it. You'll learn sharp assessment skills, and a very in depth understanding of the conditions you're dealing with. I worked in CVICU and really enjoyed the in depth learning I received and how to better manage high acuity patients for longer. What I struggled with there, having come from ER, was the slower pace. If you're motivated, intelligent/enjoy continuous learning & have a strong work ethic, I don't see how you could go wrong starting in ICU.

I can't speak for working an Obs Unit, but it's great you have several options on the table.

Good luck!

Sam the New Grad · Nov 16, 2023

Brandon1981 said:

ICU can have many of the same elements as ER as far as acuity goes, but in my experience, the pace is generally overall slower & may be a more comfortable learning environment for a newer nurse.

My concern with the slower pace of the ICU is that I would not be able to handle a unit where I need to care for 4+ patients down the line. Do you think this is something I should be concerned about or no? Right now, I take care of 12 patients (but as a tech) and feel like I time manage that well and care for all of my patients with no issues. Is this a transferable skill and I should not be concerned about it, or would it lead to issues down the line of almost pigeonholing myself to the ICU?

Brandon1981 · Nov 17, 2023

I don't think you have to worry about being pigeon holed with any acute care experience, if anything, ICU will lay a foundation of opportunities down the line if you want them. A good ICU nurse will likely be preferred in procedural areas like Cath lab, IR, EP, etc over someone who has worked a med surge/telemetry type floor only. It also lays a solid foundation for advanced nursing like CRNA, acute care NP, etc, if you want that. Being able to hustle and care for higher volume patient loads is, in my opinion, more reflective of work ethic & time management skills more than where you started. Keep in mind higher volume will be lower acuity than what you're managing in ICU if you're on the floor and not in the ER.

Hoosier_RN, MSN · Nov 17, 2023

Why not wait and see what you're offered, then decide. I have seen new grads, both with healthcare experience and without, focusing on job offers that haven't occurred. Your employer may already have certain plans for you. If you do end up having these choices, I agree with BTDT, I'd stay in the familiar area, as you know routines, you know other staff very well, locations of supplies, manager expectations, etc. Less stress than going to another dept AND learning a new role. You can always transfer after you hone your nursing skills. Good luck on your nursing journey

Sam the New Grad · Nov 18, 2023

Hoosier_RN said:

Why not wait and see what you're offered, then decide.

I do currently have all three of these offers on the table. I have spoken to several nurses on my unit and they say that this is the easiest unit they've ever worked on. I'm a little concerned that if I stay there a transition to a different unit may be even harder just because it's low acuity and 1 to 4 ratio (most floors at my hospital are 1 to 6). One of my clinical instructors told me "you don't know what hard is yet. Start with the hardest and everything else will seem easy for the rest of your career.” In my case, ICU or ER would be most difficult.

Hoosier_RN, MSN · Nov 18, 2023

Sam the New Grad said:

I do currently have all three of these offers on the table. I have spoken to several nurses on my unit and they say that this is the easiest unit they've ever worked on. I'm a little concerned that if I stay there a transition to a different unit may be even harder just because it's low acuity and 1 to 4 ratio (most floors at my hospital are 1 to 6). One of my clinical instructors told me "you don't know what hard is yet. Start with the hardest and everything else will seem easy for the rest of your career.” In my case, ICU or ER would be most difficult.

Then do what interests you. Many would want the lower acuity for the breathing room while learning, I don't see it as holding you back, but only you know which specialty interests you. I have both ER and ICU experience. I preferred ICU, though with my personality, most thought that I'd like ER better. Talk to nurses that you know and trust from all of the areas and get the pros and cons. That may help you to decide

Sorry that I didn't know that you actually had offers. I talk to lots of new grads, both in person and various online forums. They say they can't decide which option, yet haven't even interviewed, much less been offered a job. In that case, it's not yet an option...

nightsrock · Nov 23, 2023

As a ten year "seasoned veteran" these are some things I counsel the nurses I precept: pay attention to the staff. Are they generally happy, supportive and engaging? Is there a lot of grumbling and bad talking? Or does the atmosphere signal the need for a morale boost? How long has the average nurse been there? There's a reason people stay for 20 years or more. Is there a high turnover rate? Is there a lot of teamwork displayed? You will learn a lot in any of the environments but your satisfaction with your career may ultimately depend on the team around you. I wish you all the best.

JBMmom, MSN, NP · Nov 24, 2023

I think the observation unit is a great option for starting out. You're comfortable with the unit and coworkers so that's a huge part of the starting process you're all set with. Then it's just concentrating on the transition from tech to RN. And that's a big transition! I assume you'll be taking patient from the ER, so you can get a better feel in report for what the ER nurse has focused on or done as far as interventions. It's a great place to improve your assessment skills and time management as a RN. Some of your patients will require admission, and your assessment will be key in determining that course of care.

You don't have to know where you want to go with your career right now. Starting the ED or ICU will not limit you in any way, but in both units the learning curve for a new nurse will be huge! I think that ICUs that have less than six months orientation for a new grad are a red flag. But that's just based on the experiences I have had. I feel like many people have either the personality for the ICU or the ED, because they're so vastly different. I know I could NEVER work ED. Their ability to juggle a large workload with patients of really unknown acuity is amazing and the environment would not fit with my stress level. I love the ICU and the challenge of helping really sick patients (hopefully) get better. For me I would not have been able to be successful as a new grad in the ICU, but if you have the right orientation structure and unit, it certainly can work.

I don't think you can go wrong with your choices, whatever you choose will be the right option for you. Good luck!