Travel ICU assignment with stepdown experience only

NedRN · Feb 18, 2020

Did you have a manager interview and make clear your lack of specific ICU experience? What did the manager say? Did the skills checklist you filled out also clearly show honestly your specific skills levels and experience? if not, I'd suggest bailing now.

If so, it is OK to stress about it, but don't overdo it. If you must study, it should be related to the dominant patient population that the manager described to you. The good news here is that a large hospital will have a large variety of ICU patients, some of whom will be suitable for your skill levels. Hopefully the charge nurse making assignments will be on this page. Your license does depend on your judgement and turning down pt assignments that stretch your skills too far.

There is a decent possibility that the hospital is really hiring for medsurg and is just trying to get the best for their otherwise low bill rate. This is a common situation in the past where hospitals are trying to gain better depth of skills and experience and ICU travelers reported online as having never once worked in their purported hiring unit. Hiring travelers like this not only gains extra strength in supposedly easier units (that actually have higher acuity) but allows for staffing flexibility should they need to staff a real ICU.

Just FYI that this could happen. Kind of sucks. Your agency could be in on the scam, or be an ignorant first time agency to this hospital. Your compensation package, agency name, and geographical area can be hints to such a practice. I can just about 100% guess the offered travel assignment is in the South (including TX).

As far as anesthesia school goes, a bad ICU staff position should be enough. And a single travel assignment will not be sufficient. If you want a "good" staff ICU position to ensure your career path, expand your search nationwide. An extended one year "travel" assignment. You may have to do two years to satisfy your contract with such a teaching hospital, but I can promise you that extra year of ICU will serve you well as an entry to school and to practice as a CRNA.

anesthesiajourney · Feb 18, 2020

Thanks for the advice, Ned.

I told the manager during the phone interview that there were skills which I was familiar with, but would need guidance to execute, and she said that a run-down of those skills would be possible during orientation. I really didn't expect to be offered the assignment after the interview. I had a 2 hour in-person interview for a CVICU position in my area, which seemed to go well, and was ultimately not offered the position, but was able to get into a large ICU as a traveler after a 5 minute phone interview. Go figure. It seems hospitals in my area don't really train external candidates for ICU. This travel position seemed like it would be an entry into intensive care, and I will only take ICU assignments from here on out. I realize it will take more than just one 3-month assignment to qualify for a CRNA program, but it is a start. I will take your advice and expand my search net, but I'm not really willing to go too far out.

There is a requirement with this assignment to float to stepdown as needed, but staff ICU nurses also float to stepdown as needed (I know as they float to the unit I am on now). As a traveler, it is likely I will be the first to float, as that is a common policy, and I am fine with that, as long as I can obtain some ICU experience. The bill rate was nice IMO, as I am on a step-down unit now where cost of living is quite high, and the cost of living where the ICU is is significantly lower, yet the gross is a bit higher. Again, we will see what happens.

NedRN · Feb 18, 2020

OK, hope it works out and you actually get ICU experience and can leverage that. It is a bold plan! Good luck.

A thought about health insurance though. If you COBRA your staff insurance I think you will find a net decrease in pay which may change your calculus. Skipping it is probably low risk at your presumed age, but if something happens your plans will be severely disrupted.

What's the issue with going too far out?

Rnlaceyw · Apr 23, 2020

Hi anesthesiajourney,

I have had the similar experience. My desire is to be in the ICU, but those positions are hard to come by. However, I’ve been a PCU nurse and have completed a recent travel assignment. My recruiter reached out regarding an ICU assignment and during my interview with the manager I did share my experience and they were OK with my skill set and was told I would go through orientation so I would be fine for this assignment. How was your experience. I have received an offer however unsure if I should accept.

anesthesiajourney · Apr 24, 2020

Hello RNlaceyw,

My experience has been that I started in ICU, and was doing fine, but then one shift erred on something I wasn’t familiar regarding use of a piece of equipment, with which resulted in ‘concern’ (patient was fortunately fine). I was told I would get some additional training about that equipment, but that didn’t happen. I’m still on the same ICU assignment, I’ve just been floated to stepdown since then, which I’m assuming is correlated.

The good news is that I was able to get an ICU position in my home state, and so will be starting that soon. I think the reason that I was hired for the permanent position was because I am on an ICU travel assignment now. I was honest that it was my first time in an ICU and some things were new to me, and the manager stated that they were willing to get me up to speed, but with a much shorter orientation than that of a floor nurse, as they need someone who can be independent soon due to the pandemic.

The reason it’s hard to find ICU positons in certain areas, I think, is that it typically takes months to train a floor nurse, which starts to affect the bottom line. There’s also a lot of union hospitals in my area and internals generally get ICU positions before externals. But, I think that if you can show that you can work ICU by taking an ICU travel assignment, the door will open for you. Good luck with whatever you choose to do!