Old nurse looking to get into the ICU, any tips?

steelcityrn, RN · Sep 28, 2009

I would think you could get a job in icu, but you would probably need to be fulltime, as there is quite a costly investment today in training. You will probably need to have telemetry and or critical care classes, along af course with acls. As far as the problems with gossip and personalities that are not enjoyable to work around, you will have that in any and all departments across the board, its just that common.

Ruby Vee, BSN · Sep 28, 2009

i've worked ltc most of my career. i feel stagnant and want a new challenge. i have a bsn but no experience in an acute care setting. i'm not a spring chicken anymore, but i hope i've still got enough life in me to try something new.
any advice on how to break into the icu? i see where a local college offers a graduate certificate in critical care, do you think this would be beneficial at helping me get my foot in the door?
also, how long do you think it would take before a nurse could work her way to a day shift position?
do they have any 8 hour shifts in hospitals?
is there cameraderie or hostility in the icu among the nurses? i just wonder if the gossip and cattiness is as bad there as in the nursing home?

most hospitals will give you icu training if they hire you to work in the icu. eight hour shifts are rare, however. as far as how long it will take to work your way onto the day shift -- it varies. a friend of mine got days within 2 months; it took me five years to get into days in the same icu. it just so happened that when she arrived, no one senior to her wanted to move to days; after she got it suddenly it was a very popular thing to do.

cameraderie or hostility? depends on the unit, the staff and how you fit into the mix. also hostility and cameraderie are, to some extent, in the eye of the beholder.

geekgolightly, BSN, RN · Sep 28, 2009

Any advice on how to break into the ICU? I see where a local college offers a graduate certificate in critical care, do you think this would be beneficial at helping me get my foot in the door?

Depending on the course, I think that it would be very beneficial to take the class. There is alot to learn in ICU and the more you have a handle on before you hit the unit, the better off you would be. Also, it would show a commitment to the change you are about to make.

Also, how long do you think it would take before a nurse could work her way to a day shift position?

I walked into a day shift. It all depends upon what the needs are on the unit. Of course my "day" shift is day/evening. Sometimes I work 7-3, or 3-11 or 7-7 or 11-11.

Do they have any 8 hour shifts in hospitals?

I don't knwo where you live, but it seems that in the northeast there are more hospital 8 hour shifts than in other parts of the country. My hospital allows you to sign up for 4, 8, or 12 hour shifts. The sign up only means a request. They will still stick you where they need you if the schedule is tough.

Is there cameraderie or hostility in the ICU among the nurses? I just wonder if the gossip and cattiness is as bad there as in the nursing home?

Honestly, I think, for the most part, there is hostility. I work in a great unit where hospitality is at a minimum, but it could have easily gone the other way. Our unit is known for being particular, and fussy, but not hostile. The nurses are great teachers are I am lucky. I know this.

Gossip and cattiness are par for the course when working with a bunch of women, but on the whole, I think in ICU the cattiness is about work issues rather than personal issues. "oh, she never dates her suction tubing!" rather than "oh her husband is a loser."

Dinith88 · Sep 28, 2009

Gossip and cattiness are par for the course when working with a bunch of women,

:yeah:

WindwardOahuRN, RN · Sep 29, 2009

I've worked LTC most of my career. I feel stagnant and want a new challenge. I have a BSN but no experience in an acute care setting. I'm not a spring chicken anymore, but I hope I've still got enough life in me to try something new.
Any advice on how to break into the ICU? I see where a local college offers a graduate certificate in critical care, do you think this would be beneficial at helping me get my foot in the door?
Also, how long do you think it would take before a nurse could work her way to a day shift position?
Do they have any 8 hour shifts in hospitals?
Is there cameraderie or hostility in the ICU among the nurses? I just wonder if the gossip and cattiness is as bad there as in the nursing home?

To be blunt? It's very unlikely that you would be considered for a position in any acute care area, even med-surg, with no recent acute-care experience. With today's tight market and the glut of both experienced nurses and new grads looking for jobs a nurse with only LTC experience has virtually no chance of being hired in an acute care setting.

An acute-care refresher course might be a good place to start and after that you can start the hunt for an acute-care position. ACLS, a telemetry course, IV skills class.

That "graduate certificate in critical care"? AFAIK that's a program for nurses working towards their Masters' degrees or for nurses who already have advanced degrees? It would warrant more investigation before it could be considered an option.

Curious---what is attracting you to the ICU?

TootsieRN · Sep 29, 2009

Well, I've always wanted to work in a big hospital, but I spent my 20's and early 30's having and raising children. I'm 36 now, and I figure if I'm going to ever make a change I'd better grab it now, as time is running out fast.

I got a hospital job offer last year (renal transplant floor) but I couldn't take it because of family obligations. I'm getting old, I can't compete with these young 23 yr. old whippersnappers. Recruiters won't want me when they can have a spritely young thing who isn't saddled with a bunch of other responsibilities.

Indiana State has a critical care course and they advertise it as "a course to prepare a nurse to work in intensive care." I don't know if there would be any use in me taking it, though.

I've got a cushy job in management at a nursing home, but I don't really feel like it's taking me anywhere. I'm starting to feel trapped and owned by this job, and I can't stand that (though I do a lot of blood draws and port-a-cath flushes and I'm the one people go to when there is a problem with putting in a catheter or dealing with a PEG tube.) Still, I'm in such a tame position. My big project right now is revising and updating the policy and procedure manual, which I enjoy, but it isn't what I want to be doing 5 yrs. from now.

I would be doing a lot of hands on in an ICU, with a lot of excitement and I'm impressed with the level of knowledge it takes to work in critical care. Hospitals (I'm talking big city hospitals) are such exciting places buzzing with activity and full of smart (for the most part) people. I'd love to be a part of that activity. And, of course, I fantasize about applying for CRNA school in a few years (I was pretty good at math and science) but I realize that is more than likely a fantasy that will never come to fruition, but I've learned you have to have 3 things in life to keep going: hope, dreams and a future.

Anyhow, rambling aside, I would just like a change from my boring life. I have always wanted to work in a hospital, but due to family constraints I worked where it was most suitable for my family.

WindwardOahuRN, RN · Sep 29, 2009

Well, I've always wanted to work in a big hospital, but I spent my 20's and early 30's having and raising children. I'm 36 now, and I figure if I'm going to ever make a change I'd better grab it now, as time is running out fast.
I got a hospital job offer last year (renal transplant floor) but I couldn't take it because of family obligations. I'm getting old, I can't compete with these young 23 yr. old whippersnappers. Recruiters won't want me when they can have a spritely young thing who isn't saddled with a bunch of other responsibilities.
Indiana State has a critical care course and they advertise it as "a course to prepare a nurse to work in intensive care." I don't know if there would be any use in me taking it, though.
I've got a cushy job in management at a nursing home, but I don't really feel like it's taking me anywhere. I'm starting to feel trapped and owned by this job, and I can't stand that (though I do a lot of blood draws and port-a-cath flushes and I'm the one people go to when there is a problem with putting in a catheter or dealing with a PEG tube.) Still, I'm in such a tame position. My big project right now is revising and updating the policy and procedure manual, which I enjoy, but it isn't what I want to be doing 5 yrs. from now.
I would be doing a lot of hands on in an ICU, with a lot of excitement and I'm impressed with the level of knowledge it takes to work in critical care. Hospitals (I'm talking big city hospitals) are such exciting places buzzing with activity and full of smart (for the most part) people. I'd love to be a part of that activity. And, of course, I fantasize about applying for CRNA school in a few years (I was pretty good at math and science) but I realize that is more than likely a fantasy that will never come to fruition, but I've learned you have to have 3 things in life to keep going: hope, dreams and a future.
Anyhow, rambling aside, I would just like a change from my boring life. I have always wanted to work in a hospital, but due to family constraints I worked where it was most suitable for my family.

If you think of yourself as "getting old" at 36 and unable to compete with the "young whippersnappers" you'd better think twice before setting the ICU as your goal. I'm waaaaay older than you (grandmother of seven, thanks for asking) and I'm still able to handle twelve hour shifts with a patient on a rotoprone bed, ten gtts, on CRRT, AND on respiratory isolation (that means an n-95 mask, the granddaddy of discomfort). And at my advanced age I can still run rings around some of the "young whippersnappers" I work with. (Just musing to myself and thanking my lucky stars for my peasant stock ancestry, LOL.) I just did four twelves in a row, very busy ones, and I'm getting ready to go out and re-pot my plumerias after I finish my morning coffee.

I think you may be romanticizing ICU just a wee bit. Okay, more than a wee bit.

It is tough tough TOUGH work. They don't call it "intensive" care for nothing. If you work in a real heavy duty ICU, where you don't ship your tough ones out but the tough ones are shipped to your facility, it can be surreally tough sometimes. Totally non-stop for the whole shift and beyond. You are on your feet for many hours at a time, pushing beds (and loaded IV poles and vents) to CT scan and MRI, moving bariatric patients with (often) not quite enough help, lifting and turning patients. There are often few or no nurses aides in ICU---due to the presence of sensitive equipment and patient instability it is up to the nurse to bathe and turn patients. Lots of drainage, dressings, and the presence of some pretty darn aggressive bio-organisms adds up to a less romantic and exciting picture than one might imagine.

Besides the physical stress there is tons of mental stress. Rapid-fire orders during crisis situations, patients suddenly going bad and the need to know what to do NOW or someone could die who may not have died if only the right thing had been done. The ability to assimilate facts and apply them to the situation and react appropriately NOW. Assessment and diagnostic skills (oh yeah, sure, nurses are not supposed to "diagnose"---LOL, we do it all the time). Putting your foot down when a first-year resident orders something that could kill someone and insists that those orders be carried out, showing you his "official" reference on his Palm Pilot (memories of a hyponatremic patient and a totally off order that a new grad nurse was going to implement----OMG!!!). Dealing with families who are dealing with tragedy, families who sometimes are not dealing with that tragedy well and are transferring their anger and frustration on to the nearest object---YOU, all while you're trying to save their loved one.

The transition from "cushy management job" in LTC to full-blown staff nurse in ICU is going to be tough, IMHO. Maybe, as a test of endurance, you might want to try working the floor as a staff nurse in your own facility. If that's not possible, start applying again for acute care positions. IMHO I think you need to build up your CV to make yourself a more attractive candidate for a critical care internship or trainee position.

BTW, if you are basing your idea of critical care on the ridiculous portrayals of ICU's on TV shows you can toss those ideas right now, LOL. Those shows and the sappy Johnson & Johnson commercials are light years away from portraying acute care and ICU nursing as it really is. :cool:

Manurse715 · Sep 29, 2009

Fact. Truth. Strongly confirmed through extensive evidenced based practice. lol. I personally have met with some strong bias when it comes to gender differences as it relates to my perceived competency and skill.

To the original post: I hope I'm not old when I'm 36. If you change your attitude I'll bet you can get a position. I work with a lady now who has just finished her orientation in our 33 bed EverythingbutNeuro ICU. She was in the corporate front office of QT (very popular gas station in Ok) for 20 years before deciding to "try something new." So it can be done.

Also, as a 24 year old dude sometimes it's challenging to work with nurses who are 10-20 years my senior. I have been raised to respect my elders, even if they have less ICU experience. The challenge comes from communicating across the Generational Chasm. If and when you start to work ICU NEVER EVER be intimidated or scared to ask questions about EVERYTHING, even if its from a young whippersnaper like me . At the end of the day we're all on the same team.

Good LUCK and don't take No for an answer.

WindwardOahuRN, RN · Sep 29, 2009

Fact. Truth. Strongly confirmed through extensive evidenced based practice. lol. I personally have met with some strong bias when it comes to gender differences as it relates to my perceived competency and skill.
To the original post: I hope I'm not old when I'm 36. If you change your attitude I'll bet you can get a position. I work with a lady now who has just finished her orientation in our 33 bed EverythingbutNeuro ICU. She was in the corporate front office of QT (very popular gas station in Ok) for 20 years before deciding to "try something new." So it can be done.
Also, as a 24 year old dude sometimes it's challenging to work with nurses who are 10-20 years my senior. I have been raised to respect my elders, even if they have less ICU experience. The challenge comes from communicating across the Generational Chasm. If and when you start to work ICU NEVER EVER be intimidated or scared to ask questions about EVERYTHING, even if its from a young whippersnaper like me . At the end of the day we're all on the same team.
Good LUCK and don't take No for an answer.

Personally I don't give a flying crap whether the nurse I'm working with is male or female. What I have seen, though, is chips on the shoulders of some male nurses who feel they are discriminated against because of gender when, in actuality, there are other reasons why they are not particularly favored by other staff members, cockiness (no pun intended) being among the top factors. The person crying about "gender discrimination" is often using that as a smokescreen, IME. Hard to admit that the reason we really don't like working with you is because (eeeek) we REALLY DON'T LIKE WORKING WITH YOU. For whatever reason. And that reason is very unlikely to be related to your gender, based on (many more) years of evidence-based practice observations.

Some guys are just used to being the boss. It was the way they were raised, I guess---Mom deferred to Dad, sons took precedence over daughters. So when they enter what is still essentially a female-dominated profession (full of really STRONG females) they get knocked off kilter a bit it and pull the gender card to as rationalization when things don't go their way. It's easier than trying to figure out what's really going wrong.

Yep, we're all on the same team. But as with any other team, some are better players than others and it has nothing to do with the "equipment," LOL.

BTW, just my opinion here, but your applause for the derogatory statement made in a previous post regarding females is kinda lame.

That remark is in the same category as any generalization made about any group---females, males, older nurses, younger nurses, ethnic groups, races. In my book it falls under the heading of "STUPID." :down:

Just my opinion, of course. YMMV.

Manurse715 · Sep 29, 2009

Personally I don't give a flying crap whether the nurse I'm working with is male or female. What I have seen, though, is chips on the shoulders of some male nurses who feel they are discriminated against because of gender when, in actuality, there are other reasons why they are not particularly favored by other staff members, cockiness (no pun intended) being among the top factors. The person crying about "gender discrimination" is often using that as a smokescreen, IME. Hard to admit that the reason we really don't like working with you is because (eeeek) we REALLY DON'T LIKE WORKING WITH YOU. For whatever reason. And that reason is very unlikely to be related to your gender, based on (many more) years of evidence-based practice observations.
Some guys are just used to being the boss. It was the way they were raised, I guess---Mom deferred to Dad, sons took precedence over daughters. So when they enter what is still essentially a female-dominated profession (full of really STRONG females) they get knocked off kilter a bit it and pull the gender card to as rationalization when things don't go their way. It's easier than trying to figure out what's really going wrong.
Yep, we're all on the same team. But as with any other team, some are better players than others and it has nothing to do with the "equipment," LOL.
BTW, just my opinion here, but your applause for the derogatory statement made in a previous post regarding females is kinda lame.
That remark is in the same category as any generalization made about any group---females, males, older nurses, younger nurses, ethnic groups, races. In my book it falls under the heading of "STUPID."
Just my opinion, of course. YMMV.

Thanks for your opinion.

My statements come not from my victim cries but from multiple mouths of multiple women who objectively speak to my circumstances. I never have played the gender card when raising issues to my superiors.

Generalizations are usually full of inaccuracies. Personal experience, well that's a bit more authentic. Some of both men and women are able to be objective about gender rolls and ICU capacities. Some aren't. I've encountered more of the latter.

The opposition I've encountered has motivated me to engage in independent studies and subsequent acquisition of my CCRN. So I try to use the "nay-sayers" to improve my capacities and tools of my personal practice which leads to safer and improved quality of care for ICU patients. That's what we all really want....right?

Ruby Vee, BSN · Sep 30, 2009

i've been a nurse since the op was in pre-school. 36 isn't old by any stretch of the imagination, and the idea that you wouldn't be able to keep up with "the young whippersnappers" is ridiculous! if you want to work in the icu -- even if it is because you've romanticized the idea from watching too many hospital shows -- go for it.

you certainly have the basics down pat with your ltc experience. you already know how to do an assessment -- you'll learn more assessment skills of course, including lots of technology. but you know the basics. you know how to talk to patients and families, how to call a doctor and perhaps when to. i suspect you already have a better feel for when a patient "looks bad" than some of those young whippersnappers who went straight into icu and don't know how to make an assessment without the cool technological toys.

after working in ltc, you've developed a work ethic that many of the brand new rns haven't yet managed to figure out. partying all night before your college classes is one thing; partying all night before a twelve hour shift in the icu is quite another. skipping classes because you're hung over is one thing, but call in sick to work and you're letting down not just your boss but your colleagues as well. (i'm not talking about the legitimately ill, but about those whose partying make them attendance nightmares at work.)

yes, the icu is hard work. you may run for 12 hours straight, lifting bariatric patients, pushing beds, holding folks over on their sides while you change a dressing on a wound big enough to stick your whole head into. it's difficult emotionally as you watch families keep a "loved one" alive, torturing them for months in an effort to keep the social security checks coming, or as you watch a young father with everything to live for dying. it's difficult intellectually as you try to figure out what's wrong with a patient who seemed fine an hour ago and is now tanking. it's difficult to be assertive when you're new and a physician is in your face screaming about how he wants this or that and you know it isn't possible to give him what he wants.

but if you want to try it, go for it. you've got a solid background in the basics, you can easily build on that background.