Transitioning to ICU from Step Down

[NeuroNurse101]

Hello everyone,

I have almost a year of experience working on a Neuroscience step down unit, I'll make a year in three weeks! I tried to speak with my manager on multiple occasions regarding ICU but I did not think she would transition me due to lack of staffing on my unit already. Some staff members who wanted to go to ICU for about two years quit as a result. I decided to pursue other options, I went to many job fairs, met with ICU directors and have been rejected. I only had about 5 to 6 months at the time.

Fast forward, I attended a job fair and put that I was interested in ICU on the sign in sheet; however, the recruiters/ HR personnel sent me to interview with step down management. I was offered a position by the end of the interview. It is a medical surgical step down, more advanced than mine because they administer drips, such as Cardizem, Heparin, Amiodarone, etc. I accepted because the managers mentioned all of the opportunities available (committees, climbing the clinical ladder) and how they promote growth.

I started on the step down unit and I feel miserable, especially since the facility is hiring a bunch of travelers and per diem staff for the ICUs... I feel as though I settled by not pushing harder for an interview with an ICU director/ manager.

After all of the rejections, I re-evaluated myself and resume and have been working on a lot to increase my chances of entering an ICU, such as joining the American Critical Care Nurses Association and American Association of Neuroscience Nurses. I am preparing for the SCRN and PCCN, I have to wait until next month to register (requires one year of experience). I am BLS/ ACLS/ NIH certified. I have my ADN but I am currently enrolled in a Bachelors of Nursing program and I'll be a BSN-prepared nurse in the fall of this year.

Personally, I have purchased a lot of Critical Care material: The ICU Book by Paul Marino, CCRN Review by Laura Gasparis (also using to prepare for PCCN), The Ventilator Book, Fast Facts for Critical Care, etc. But it is quite difficult to understand most of the content because I am unable to apply it.

I was considering finding out who the director/ manager of the Neurosurgical ICU is and trying to see if I can get a few minutes of their time and speak to them.

I would appreciate honest advice and opinions, do you think that it would be a good idea? Also, what should I do to increase my chances and/or prepare myself for ICU? Should I go to ED, stay on the med surg step down, keep applying to ICUs, wait after taking the board exams to continue applying, etc?

Sorry for the lengthy post, all advice is greatly appreciated. Thank you in advance.

[Ruby Vee, BSN]

If I understand you correctly, you're currently on your second step down position and still have less than one year of experience. In that one year of experience, are you including the time you spent on orientation?

Now that you've accepted and started a second job in the step down unit, you really owe your new employer a year after you finish orientation. Your dream might be ICU, but you accepted this position, knowing it wasn't ICU. So you owe them some time. In the meantime, you may have an opportunity to make some connections in the ICU as step down units usually work fairly closely with their ICU. Patients will transfer back and forth, and there may be training opportunities that both units share. If you have the opportunity to take ACLS with ICU nurses, take it. Teaching ACLS is even better. Are there Skills Days that include the staffs of both units? Seminars given by the medical staff where both units attend? The more connections you make in the ICU, the more likely you'll be hired there after you've given the step down a year.

I would urge you to stop looking for jobs now, until you're close to the end of a year at your new job. As we've frequently advised another member, when you start blanketing the city with resumes, HR tends be overloaded when they see yet another one. And besides, you don't want to look like a job hopper.

If you had asked before you jumped to a new stepdown unit, I would have advised you to hang tight, work on developing connections with your ICU and all of the other things recommended above.

[NeuroNurse101]

Thank you for your response.

No, I'm not including my orientation. Get re-certified in ACLS? The hands-on portion is done one to one with the clinical educator, so everyone does it solo. There are upcoming seminars, I'll be in attendance. I'm still employed at my first nursing job as well, I didn't quit. Just to be clear, you're suggesting obtaining another year of step down experience then apply to ICUs? Another year seems like overkill.

I'm going to join some of the committees and become more involved, I'll try to give it six months then try to transfer to ICU. I'm already off of orientation, I had 3 days. I spoke with management and discussed that I didn't need any more than that.

[Ruby Vee, BSN]

Thank you for your response.

No, I'm not including my orientation. Get re-certified in ACLS? The hands-on portion is done one to one with the clinical educator, so everyone does it solo. There are upcoming seminars, I'll be in attendance. I'm still employed at my first nursing job as well, I didn't quit. Just to be clear, you're suggesting obtaining another year of step down experience then apply to ICUs? Another year seems like overkill.

I'm going to join some of the committees and become more involved, I'll try to give it six months then try to transfer to ICU. I'm already off of orientation, I had 3 days. I spoke with management and discussed that I didn't need any more than that.

I misunderstood -- I thought you had quit your first job and were employed in a second stepdown unit. Less than a year in a job is a red flag for HR unless there are extenuating circumstances. (My husband was transferred out of state or something of the sort.) But two years in stepdown isn't really overkill. It takes approximately two years to become competent as a nurse, and there's a lot to be said for being competent before transferring to another unit.

Yes, joining committees is a great way to make contacts in other units. That's great! The more people you know in ICU (in both hospitals, and in every ICU in those hospitals), the better.