New RN-Licensed: How to enter CC nursing?

[crome]

I'm a newly licensed RN in TX (since 3 weeks ago), I've read a few articles and blogs about how hospitals who accept new grads into their ICU's are probably performing poorly and that t's a big sign that they may have poor management.

However, I've also heard from a few 1-2 yr experienced nurses, who feel like they got stuck in a Med-surge or Rehab-like field. Whose aspirations were to enter Critical Care, but now the hospital/job market will only offer positions in the area they're currently in. And, they feel it's become hopeless for them to be given a chance to transition into that specialty. They said that even within their own employer skips their applications, and primarily is because they excel at their unit and the managers may not want to let them go.

On the other hand, my cousin who graduated 2 semesters ahead of me, accepted an ICU position as his first nursing job. And, tells me that although they are always busy, their management always prioritizes critical care units as first line for staffing and scheduling. He said that it's been very few instances when he had more than 3 patients on a shift.

I looked up continuing education classes for RN endorsements, and the classes I found have a requirement of on the job experience in working critical care.

So for all you critical care nurses out there, please help me figure this out.

What are the various ways to enter the critical care field of nursing, and which of those ways is the recommended/preferred route to take.

Thanks!

[PedNephNurse]

Great question. I'm sure it depends on the state and hospital. I don't work in critical care but work with chronic and acute ESRD patients. I have asked to volunteer in the ER or PICU for experience. You could try doing that and then when the cc units see how good of a worker you are maybe they will offer you a position!

[verene, MSN]

One of my friends got into CC nursing as a new grad by applying to a new-grad residency program and putting down critical care as his first choice unit. This may not be the case everywhere but it wouldn't hurt to look around at hospitals new you to see what new-grad programs they may have and if you are qualified to apply.

[TheCommuter, BSN, RN]

Moved to the Critical Care Nursing forum for more replies.

[MYSTICOOKIEBEAR]

When I graduated nursing school I thought I was a hot shot and that I wanted to go directly into The Units. The hospital I was applying to is a Top 10 AMC and they said that they DO NOT hire into the Units and said that I could start on the Cardiac/Vascular/Thoracic Telemetry Step-down. I am forever grateful that I did this because working on the floor, even if it is just for a year, will teach you time management and prioritization in a way that the ICUs may not be able to teach you.

If I had gone straight to the CTICU or any of the other Units, I would be a lesser nurse than I am now. Mastering the floors is a different beast from mastering the Units, but if you do both, you will be better for it. I am a better nurse because I had my floor experience and was able to do well and flourish and have continued that tradition when I transferred to my CTICU where I have been for the last 5 years.

[Scroll89]

Couple different sides to it to think about....

I was directly hired into an ICU position straight out of school. It has been awesome, mainly because the staff was supportive and taught me very well. That said, and I know it only holds so much weight, but I graduated top 5% of my class and came to the table with an advanced understanding of ICU concepts as a new grad. The way I sold myself to my hiring manager was that:

A: They will have a brand new nurse that doesn't have bad habits from other units / departments and you will be able to shape me as you see fit.

B: I am a self driven learner and I am willing to undertake anything and everything to learn and grow as much as possible.

C: Med/Surg or Tele are specialties of their own and my goal and passion is critical care, therefore I feel it would be in my and everybody else's best interest if I apply my knowledge-base to learning critical care from the start.

It of course helped that I had done my senior practicum in that particular ICU, but I still beat out other applicants as a new grad.

That being said.... ICU is not for the weak of heart. I was expected (not "encouraged") to advance through my competencies extremely quickly, be able to demonstrate that I understood concepts after only seeing them a few times (pressors, chest tubes, sepsis, DKA, ect..), be able to take my own patient load after 1 month of orientation (I was still on orientation, but they needed to see that I could handle it), and be able to jump into the foray when a code or major trauma was called. I could only watch the first time, the next time I had to do the job I was assigned during codes and traumas. I would spend hours researching ICU topics and learning about the medications, the conditions, the critical thinking process, and how to navigate through any situation without losing my cool. I feel that to be successful in the ICU as a new grad, you have to continually press yourself to learn more and more and more.

If you do make it into the ICU as a new grad, listen and take advice, even if what is being said isn't the best practice or totally correct. You can always address it with your manager as a hypothetical situation and see another side without getting your preceptor or another nurse in trouble. We all have things we are lenient about, but none of them endanger a patients life. (I've been known to let a patient with an NG tube and suction have an ice cube, but no free water, when they are NPO).

ICU nurses, at least at my hospital, are the nurses that anybody in the hospital knows they can call because we can do it all. I've floated to OB, ED, SDS, Med/Surg, you name it. Its an extreme amount of pressure, but if you are a type of person who does well under pressure, then go for it. Crazy situations made me learn even faster, and although I'm nowhere near an expert, I am now confident in what I know.