Transitioning to ICU from Step Down


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.


1 Post

Hi there!

It sounds to me like your dream has always been to get to the ICU, so I think you should keep fighting for it! It is clear that you have ambitions that will take you far.

Can I ask why you said you are miserable in the step-down? Is it because of the short staffing/something else or is it because it wasn't what you initially set out for (the ICU)? I was in a similar situation in which I really wanted to be placed in an ICU for my practicum, but instead was assigned a step-down unit (just a general one, not neuro-specific). I ended up really enjoyed my time in the practicum and felt it widened my nursing foundation and improved my time management. I recently was hired onto the Neuro ICU and while there is a learning curve, I love it. I know my experience on the step-down is proving useful as I orient to this new unit, and I definitely know that I would not be able to do it all if my coworkers weren't so wonderful!

I think you really want this ICU position and I would tell you to go for it! If you haven't already, I would suggest that you contact the manager about shadowing for a few hours or even just touring. You might get a better feel for the unit culture which can further help you with your decision.

Best of luck!


18 Posts

Thank you for your response.

I feel miserable because it wasn't what I set out for, I definitely settled and to find out the ICUs are hiring travelers, per diem and new grads, it hurts.