SICU or Cardiac stepdown- New Grad

MurseJJ · Mar 5, 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 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 ; 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.
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 . If I had gone straight to the unit, I would be more one dimensional and I would not be as versatile and rugged 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!

What are the real differences between the ICU and stepdown patients from your experience? Yes, the stepdown patients are more stable and don't require as close monitoring as ICU patients, but how does that translate to real life (i.e. interventions, nursing care, etc)? The hospital I work at as an assistant doesn't hire new grads into most of the ICUs, but we do have a CT surgery stepdown that takes new grads. Just curious what I'd be in for with that if I ended up in that type of a unit.

Thanks!

OUxPhys, BSN, RN · Mar 5, 2016

Depends. Where I work some of the pt's we get on our step-down are still pretty acute. This is because if the unit needs beds open they will send us pt's to make room (My floor usually gets pt's from two units, there are a total of 8 different cardiac ICU's at my hospital).

Honestly, starting out on a step-down is not bad. I wanted to do ICU right out of school and Im glad I started where I am at. Will I be here for my whole career? Absolutely not, but to start off and get your feet wet its a perfect setup for when you can do ICU.

It also depends on what type of person you are. Some people can handle the steep curve of the ICU right out of school, others need a year or two on a step-down before making that transition. What you don't want to be is that new grad nurse who starts in an ICU but has to be sent to a step-down because its too much for you. That does happen at my hospital.

squeetleb34 · Mar 9, 2016

OUx, I've searched all over google for this but can seem to find a straight answer. What is the uniform code for nurses there? From what I can tell, it seems to be all white, is that correct? Even shoes? I know this is pretty trivial, and not like it would sway any decision in any way, but I'm just curious. Thanks!

OUxPhys, BSN, RN · Mar 9, 2016

Scrubs are all white. Shoes dont have to be. There is a loophole where it says to try to be white but ive seen RNs wearing all types and colors of shoes.