Should I travel as ICU or Step-down/tele?

[gowiththeflow_RN]

Hi all!

So, I've been a nurse for 1.5 years. I would like to travel in a about 1 to 1.5 years from now. so heres my background:

      Prior to being an RN I worked as a nursing assistant for 6 years in rehab, a step down, and in the ER. I started out as a new graduate in the ICU, completing a 6 month residency, worked several months then I left for several reasons that I feel are irrelevant to this topic (though if you feel it might be, I'm happy to elaborate). I took a position in the ICU at the hospital I came from as a tech. I've completed 3 months orientation and have been on my own for about two months now, I love it and it's going well. Unfortunately in the year and half as a nurse, 9 of those months have been spent on orientation, 9 independent. 

     Although I'm grateful for the amount of education and guidance I've received as a new RN, it doesn't truly equate to 1.5 years as an independent RN. Generally I'm pretty happy where I am now; I like the ICU environment, I feel I'm getting good experience and developing skills and confidence over time. But I feel I may have shot myself in the foot jumping into ICU, knowing I wanted to spend a year or so doing travel contracts before I want to settle down, have a family, and longterm job/career. Even though I love ICU, I'm hesitant to travel in one year to a year and a half (which would equate to 21-27 months of independent ICU RN experience). Especially given that there are much more acute ICU's than the one I currently work in. I don't want to put any patients  at risk or my license at risk. I worked damn hard to be where I am. 

   So, I've toyed with the idea of getting a per diem job on a step-down to get a better feel for that work flow as an RN. I know it is a totally different environment than ICU, but I feel if I can get time management with a larger patient load down (and brush up on my discharging LOL), then I hopefully would be comfortable traveling in that area of nursing more than ICU. Plus, I feel it could broaden my nursing skills in general. Perhaps this is naive though. I'm just not sure.. So I ask you travelers and more experienced nurses than I, what are your thoughts? Get the per diem job and let go of ICU for a bit, or just hone in my ICU skills and try to get assignments in lower acuity ICU's (how possible is that to gauge with travel assignments??)

   I can't find any topics on going from ICU to step down, its always the other way around..Thank you in advance!! I appreciate any thoughts on this.

[NedRN]

No topics, but this does get asked every so often. Way different environment so you are very smart to try it out per diem. Otherwise, you can ask your current hospital if you can be cross trained.

With 3 years of ICU experience you will be well prepared for travel. You won't be able to handle every condition, nor will you be expected to. For starters, you will be filling out a skills checklist (example). After your profile including this is sent to a hospital, the manager will call you for an interview. She can ask about any special needs, and you can share with her your specific strengths and weaknesses. Finally if you take the job and get slammed, it is your responsibility to not accept assignments outside your safe practice area.

[gowiththeflow_RN]

Thank you! That's super helpful to be able to view the skills checklist. It's a level 3 trauma center that serves a pretty large and sick population. We don't see things like open hearts, ECMO, IABP,  impella, new transplants or CRRT. We get an occasional IABP but you need to benhere a year to even be trained on it let alone be the nurse assigned to them.The hospital I came from initially I managed CRRT in tandem with a dialysis RN on call (IE they access and set up new filters we manage I&O changing dialysate and effluent bags etc and trouble shooting and can call them in if needed etc).  

    I just worry from what I read that ill either be in over my head with patients requiring skills I havent learned, or ill be floated to pcu and med surg all the time and be drowning with the work flow of 4 to 7 patients without the experience, even if I can handle all their acuity. LOL, appreciate your insight, I think ultimately I will go for the per diem!

[NedRN]

It is true that hospitals can and often do float ICU travelers (more likely at smaller hospitals). However, you can filter those assignments out for ones where it is very unlikely you will be floated. A good recruiter with experience placing travelers at a particular unit should also be able to tell you. If you have any doubt, your agency can even specify no float in your contract and a good hospital will honor it. This is also a question you can ask the interviewing manager and she will tell you the odds - and just a question about census may reassure you.

So it up to you about step down. You may find your future self will actually like the challenges of floating. I myself enjoy floating to various services in the OR and keeps me professional and on a learning curve.

I actually started in step down (couldn't land an ICU position). Very very challenging and I was not ready as a new grad (at least with the support I got with the unit). You will have to really pump up your organizational skills. I personally think it is the hardest job in the medsurg to ICU spectrum generally. Outside perhaps a 2:1 ICU patient or admitting a fresh heart (although some nurses make that look easy).