Preparing to Apply to ICU

[mph53953, BSN, RN]

I am a newer nurse. I'm roughly 7 months into my first job. In January/February when I hit the big 1 year mark, I want to start applying to ICUs. I applied to ICUs straight out of school, but the only ICU job offer I got was in an area I didn't want to relocate to. Instead, I accepted a job on a progressive care unit with telemetry.

I guess one of the reasons I didn't really get any ICU job offers was because when I graduated I wasn't prepared enough for the ICU. I graduated from Bloomsburg University, which does not have a critical care clinical rotation. Instead, they have us shadow in the ICU for two days. (We still have Adult Health 2, which is basically a critical care course, but the corresponding clinical rotation focuses on assuming a full patient assignment on a med/surg floor). I also did not do an internship or externship in an ICU. So during my interviews when they were asking me about my experiences during school, I was really at a loss.

So far on my floor, I have had experience with telemetry, chest tubes, stroke patients, withdraw patients, trachs, dressing changes, drips (heparin, insulin, amiodarone), and everything else encompassed in the med/surg nine yards. I have had 6-7 patients on dayshift and 7-8 patients on nightshift. We have no step-down ICU at my hospital so I'm often caring for high-acuity patients. (Nurse-patient ratios are getting a little better now that staffing is improving.) I'm comfortable communicating with residents, attendings, case managers, and other members of the healthcare team. I'm signed up for an ACLS class in October and a PALS class in November.

I guess what I'm trying to say is what are my chances of getting into an ICU when I have a year of experience? Will they mostly just ask me about my year of med/surg, or will they dig up my lack of experience during nursing school again? Also, is there anything else I can do to try to fluff up my resume other than ACLS and PALS? Finally any advice on interview questions? "So tell me about yourself!" and "Why do you want to work here?" are by far my LEAST favorite questions to try to answer because I'm never sure what the "right" answer is.

[CCU BSN RN]

If you are itching to get off your current unit and into the ICU after a mere 6-7 months after your first nursing job, it makes you look like a prospective CRNA hopeful. In manager speak: I can hire this person with zero critical care experience, pay through the nose to orient them and in 2 years when they're finally getting good, they're going to abruptly leave to enter an academic program that will flat out refuse to let them work for 3 years while they're in school.

Also, and please don't take this the wrong way, you're coming across as pretty over confident. You may not like your current floor or level of care, but there's no way you've learned all you can at your current floor. You're still very task-oriented (which is safe and prudent at your experience level), but your entire argument is essentially that since you've changed a few DSDs and given Amio and insulin gtts, you've learned all you can out of med/surg. You've got to learn how to tell when a patient is going to crump, have to figure out why, what you think they need, and do it all before they get massively unstable and/or code.

Just my .02

[cw24pack]

Ive been in an general ICU for going on three years now. The biggest piece of advice I can give you is be honest. An ICU is not a job where you want to become over confident. You want to know your limitations. As many ICU nurses can attest, gaining entry into an ICU family is trial by fire a lot of the time because ICU nurses generally have an "alpha mentality" and the patients are so critical. Some nurse fit right into the ICU, while others cannot cut it. As far as your interview, be confident in yourself but not cocky. Talk about how eager you are in wanting to learn more and deal with higher acuity patients. Go ahead and develop the mentality of wanting to go the extra mile and have examples of you doing so.

I noticed you included about drips in your post too. Be sure you know the drugs you use inside and out because you may be asked about them. Even though amio, heparin, and insulin are drips, I think of drips more like pressure/cardiac related drugs (levophed, neo, dopamine, dobutamine, cardene, cardizem, nitro, etc.). Most of the time with an interview, the director is wanting to get a understanding of your knowledge and if your personality with mesh with the personality of the Unit. There may be a type of group interview where it is you in a room with the director and other nurses that work within that unit. You will probably get the questions that you talked about in your post, but also a very common question is "What is your biggest weakness." You want a weakness that is also a strength.

Biggest piece of advice I can give is to be yourself. Don't be someone your not to get hired onto a unit because then you may not mesh with the whole family dynamic of that unit. An ICU is a very tight net group of people and sometimes it is difficult for new nurses to be accepted. Work hard and go the extra mile. Ask questions if you don't know the answer. Do not talk bad about the floor where you came from. You want to have a hard work ethic and team approach. Best of luck during the interview.

BSN, RN, CCRN-CMC

[mph53953, BSN, RN]

Thank you so much for your feedback! I'm sorry if I came off overconfident- I was mostly trying to give examples of some of the experiences I've had as a nurse. I will honestly admit I still have A LOT to learn. And as much as it kills me to say it, deep down I know I should probably wait until the 2 year mark to start putting out ICU applications. I just feel so frustrated that even though I graduated I still have to wait YEARS until I can start doing what I actually want to be doing. Knowing what I know now (even though I still have a lot to learn), I know I would not have been ready for the ICU straight out of school. I just get so anxious watching the years tick by while everyone else seems to be light years ahead of me. I just want to be as ready as I can possibly be, and I just want to be good at this :/

[cw24pack]

I went straight out of school to an ICU. It took me a good year or so before I became comfortable with dealing with drips, vents, codes, etc. There is always going to be something you can get better at. If you feel like you have a good work ethic and you feel like it is the next step for you then do it. I love the experience and memories I have made while working in the ICU and it has opened up a lot of different doors for me. Like I said, if your heart is wanting to be in an ICU, then go for it. Be prepared for a lot of dedication and studying outside of work.