SICU or Cardiac stepdown- New Grad

Here.I.Stand, BSN, RN · Feb 24, 2016

Congrats on the offer and the pending interview! Of course you'll need to see if you get a 2nd offer.

I love SICU personally. You see some sad stuff, but you also see people get better. I feel (just based on my observation) that there's more acute-on-chronic stuff in medical vs surgical, but again I don't have official statistics.

I find stepdown to be a lot of work. The pts are sick enough to need close watching, but are well enough to be needy. In some cases, very needy. The cardiac/medical stepdown unit at my hospital gets a fair amount of DKA pts too, and that is very high acuity -- q 1 hr BGs, q 4 hr Ks which in my exp results in almost continuous q 1 hr replacement, q 4 hr BMPs, management of the insulin gtt plus D10 plus NS per the protocol...not to mention all the pt teaching and making sure lab is running your blood in a timely fashion. Just one example.

On the other hand SICU being critical vs intermediate is going to be a steeper learning curve.

Here.I.Stand, BSN, RN · Feb 24, 2016

Oh I wanted to clarify, I'm not trying to deter you from stepdown. In today's market I would take that opportunity and run with it, if you don't get an offer from the SICU. If it ends up being too much, you can always ask for time in med surg or extra orientation (the worst they can say is no.) Some new grads look for months and have to take any job because they need to get paid! I was simply comparing SD to ICU in my other post.

RN_Man · Feb 24, 2016

First off congratulations on finishing your nursing program and getting an offer at Cleveland Clinic - AMAZING! I don't personally have experience on either units but here are few things to consider:

1. If you plan on applying to any graduate program that requires critical care experience - CRNA, ect - most programs do not consider any step-down unit to be ICU.

2. Do you have a strong interest in cardiac patients? Where you one of those nursing students that loved the cardiopulmonary section of Patho and A&P?

squeetleb34 · Feb 24, 2016

Thank you very much for the insight. I hope I didn't seem presumptuous about being offered the second position. I'm so grateful to have one offer let alone the possibility of 2. I just want to be prepared in the event I do get a second offer and they need a quick decision.

I really appreciate those scenario examples of what I might expect on the step down unit. Do you have any examples of types of patients that are typically being cared for in the SICU?

Both of these positions will be in a nurse residency program so I do feel a little more comfortable knowing that I will (hopefully) be looked at as a true new grad who needs the teaching as opposed to someone having ICU experience.

RNMan- I hadn't thought about the fact that the step down unit would not be considered ICU experience if I decide to go that graduate route. I definitely want to do a graduate program just not decided on what yet. And I absolutely love the CP system. I fell in love with it during Patho and again for every semester that we discussed it in different capacities.

Thank you very much for all the insight!

purplegal · Feb 25, 2016

My first nursing job was on a cardiac stepdown unit, and for me, as a new grad, it wasn't a good job. I never made it through orientation.

If you are very good at time management, are quick at your skills, have extensive cardiac knowledge, and able to handle rhythm issues/codes well, it may be a good fit. However, I would not recommend it if you are not very proficient at nursing skills, not able to learn new skills quickly, get stressed out/overwhelemed easily or have any, any hesitations that it's not the right job. Personally, I would not recommend any ICU job for a new nurse, but that's just me.

However, other new grads are able to do well on a cardiac step unit. I observed it first hand, as someone who started only two weeks before me did very well.

I cannot speak for the SICU, as I have no experience there.

nutella, MSN, RN · Feb 25, 2016

I have worked ICU as a new grad and did not find it to be a problem. In fact, it is probably better as opposed to step down. Step down is much more work and less support. In SICU you would have more support and you have 1 or 2 patients, some of them hopefully intubated and sedated. There is also a difference between the so called "tray ICU" where most patients are extubated and get regular meal trays - indicating low acuity - community hospital or small hospital and major teaching hospital ICU where you transfer your patient out when they become demanding and "better" ...

I had good shifts as a new grad in ICU at a major teaching hospital - most pat were intubated and sedated and in code situations people were working together and great support.

TheCommuter, BSN, RN · Feb 25, 2016

Thread has been moved to our Critical Care forum.

MYSTICOOKIEBEAR · Feb 25, 2016

First things first, CONGRATS! Getting a job offer before you are even finished with nursing school is a very big deal and at Cleveland Clinic no less! Directly out of nursing school I started on a Cardiac/Vascular/Thoracic step down in a top 10 hospital, stayed there for a year, and then transferred down to the Cardiac/Transplant ICU and have been there ever since. When I graduated I was a young hotshot and I initially wanted to go straight into the CTICU but they said no new grads are hired into THAT unit, and urged me to go to the CVT stepdown, and for that I am forever grateful.....

We do not have a residency program and when I first started, I quickly found out that I learned nothing from nursing school :banghead: haha (not literally, but it sure felt that way as I felt completely unprepared). It was a very sink or swim culture and mentality that was rather risky but made some pretty tough, young nurses. I will be honest I thought about quitting a lot during my first 2 months. As time went by I learned a great deal of information in a very short amount of time (has more to do with the nurse IMHO). Throughout my first year I rose through the ranks very quickly and became one of the best nurses on the floor and by the end of the first year I felt that I learned everything that I could from my floor and knew that I was ready to get onto The Unit.

When I transferred to the CTICU I was excited, nervous, and very eager. A lot of the ICU nurses already knew who I was and of my reputation so I felt like I had to live up to the hype and make a very big impression. I will be honest I wanted to quit everyday for the first few months :drowning: ; it just felt like it was too much, and things were so intense and critical I didn't think that I had the chops for it, but I decided to stick it through.........fast forward 3-4 years I am now one of the best ICU nurses in any of our 5 ICUs, have built quite the reputation, and have earned a great deal of respect from many of the nurses through all of the units (I am especially proud of the praise from the 20+ year veterans who hold me as their equals and a few who have admitted that I have surpassed them ).

If you take two new grads and put one in the unit and the other in the CVT stepdown, by 12 months, the unit nurse will be more experienced than the CVT stepdown nurse. Now if you take the CVT stepdown nurse and transfer them into the unit with the other nurse, by 18 months the unit only nurse will still be a little bit more experienced, by 24 months they will be just about even, by 30 months or mid way through the second year the CVT stepdown nurse will surpass the unit only nurse because of the floor experience. That originally CVT step down nurse will be just as good, if not better, and will be much more versatile and bring far more to the table than the unit only nurse. :yes:

I would not be as good of a nurse today if I didn't have my CVT step down experience. Because of my time there I was able to see the big picture and follow our patient populations from being admitted with a problem, to going to the OR, needing ICU care, going to step down, and then being discharged. I am able to pick up OT on any floor because I have survived and achieved excellence on the most intense floor in my hospital, I am able to pick up on any unit, PACU, etc because I have once again achieved excellence on the most intense unit in my hospital :specs: . If I had gone straight to the unit, I would be more one dimensional and I would not be as versatile :ninja: and rugged :borg: as I am today.

Each person is different, each person has their own journey, but I would advise you to take the step down position, gain the experience on the floor, learn as much as you can, be the best you can be at it, and then transfer onto the units. The experience that you gain on the step down will be invaluable and will make you a much better unit nurse when you make the switch. I have worked with a lot of ICU nurses in my time, and I feel like the ones with CVT experience are some of the best ones that I have ever worked with. Good luck and let us know what you decide!

squeetleb34 · Feb 28, 2016

Thank you, everyone, for your advice and input! It is all very helpful, and I'm thoroughly considering the pros and cons of each unit.

OUxPhys, BSN, RN · Mar 2, 2016

I work on a stepdown at the clinic, straight nights. We get CHF, Afib RVR, nitro drips, post cath, post pacer/ICD. It can get busy even at nights and like the one poster said we dont have the support sometimes. That being said I have seen and learned a lot since starting in August. I thought I wanted cardiac ICU (maybe I will at some point). I do know other areas of the clinic, like cath and EP labs, considers our floor to be ICU experience (when it comes to job req in those units).

It really depends on what you want to do. If you want CRNA or ACNP then go to the unit right off the bat. But if you have to do a year on a stepdown it isnt the end of the world either.

squeetleb34 · Mar 4, 2016

Thank you so much to everyone for the thoughts and guidance. As of yesterday, I officially accepted the position in the CV surg stepdown unit! I'm so excited, and I know that I'll gain so much experience especially with it being such a well-known and forward thinking cardiac hospital. I am thrilled to have this opportunity as a new grad (well technically even before I'm a new grad!)