Unrealistic goal to get job as new grad in ICU?

pebbles, BSN, RN · May 19, 2005

Yes, you are being unrealistic, imo. One of the realities of being new at the job is that you have a lot to learn, and one of the commonalities of new grads is taking time to learn how to integrate all the knowledge they have learned into a solidified practice. Don't turn your nose up at med/surg and stepdown. You think those patients aren't challenging enough for you - ??? Believe me, they are challenging and they are very complex. When you learn to master those kinds of patients, you will be more ready for the ICU than you are now.

Oh, don't get me wrong. With a good internship program and a great preceptor, you could learn to be an ICU nurse. But you will be missing a lot of perspective gained by taking care of the patients both before and after a trip to the ICU....

Also, if there truly are a lot of med/surg or ED nurses applying for the spots in ICU, you might not have a choice. You may want to evaluate what it is you think you'd hate about the med/surg and stepdown areas and see if another hospital could provide a better environment for you.

I work on a trauma/surgery unit in a large teaching hospital. Our "new grads" are kept working on the main unit for at least a year before they are even trained for the Step-Down unit.... and believe me, they need it!

Just some thoughts...

Tweety, BSN, RN · May 19, 2005

I think you should apply for what you are interested in. If you don't get it, be willing to work med-surg there, so when positions come open you have the advantages those internal nurses have by being one of them.

Lukestar · May 19, 2005

Help! Am I being unrealistic trying to get into the ICU as a new grad?
Ever since I started nursing school I have had a desire to work in critical care. Actually it was the encouraging words I heard from critical care and ED nurses two years ago that helped me to decide to get my nursing degree first instead of the paramedic degree I was headed towards. My long-term goal is to be a flight nurse because pre-hospital is where I truly love to be and I knew that I would probably have to work >5 years in a Level 1 Trauma ED and ICU before I had a chance to get in the air. The thought of getting stuck on med-surg has always been, well, awful to me.
Now I am about to graduate from nursing school and have found during my senior preceptorship in a Level 1 Trauma/Neuro ICU, that many of the nurses on that unit think that a new grad will never make it in ICU and should start out in the neuro stepdown med/surg unit. However, other nurses who were new grads in the ICU and ED (at the same hospital) encourage me to not settle for anything less than what I truly want, and to go for it. "There's no sense in making yourself miserable in med/surg," I've been told.
Now that I've had a taste of taking care of patients in the ICU for the past two months, I really, REALLY don't want to start on med/surg. The thought of being stuck there for at least one year just isn't pleasant. I love it in the ICU. (Also, the particular neuro stepdown unit is poorly staffed and I just see myself getting burnt out with nursing if I have to work there for a year.) However, I don't want to be so bullheaded about starting in the ICU that I miss the opportunity to get my foot in the door by starting on a stepdown unit to eventually get into the ICU, if that's the only way to do it.
The hospital I am doing my senior practicum in is projecting that they will have a critical care internship this October (but they do not have any openings right now). It is the place where I would really like to be. I've been told by someone in the employment office that I don't have a chance because of all the internal applicants that want to move from med/surg. I did apply at the other large hospital in the area for their critical care internship this summer, but am unlikely to get in because I did not do my senior practicum there (although I did do more than a year of clinical time on their med/surg units.) I do have additional patient care experience as an EMT for three years on a rural transporting 911 ambulance, a CNA for a year in med/surg, and a unit secretary in med/surg and telemetry for more than two years.
My other consideration is that I do have a guaranteed med/surg position at the hospital I currently work at as a US/CNA, if I want it. I do really love working there, but it is a small hospital with mostly routine stuff and I don't know that I would get the experience I need to get into the specialty area I want (Level 1 Trauma). I also know that if I started there I would likely be moving on in a year, if I could, to a bigger hospital, and would feel bad for leaving after they spent all that money on me for orientation. They've been so good to me over the years that it just doesn't seem right to take the job and leave after a year.
So that is my dilemma...turn down the med/surg position and take my chances on getting into the critical care internship later this fall, or do the time in med/surg and try again in a year to get to where I really want to be. Help!

I would hire you in the ICU I supervise in a minute. I hire new grads every semester, especially with your internship expierence. We have a 12 week orientation period and then mentor. Most new grads do fine in our ICU's.

pricklypear · May 19, 2005

Why does it have to be ICU or Med/surg? Does the hospital you prefer have a telemetry unit? What about a cardiac interventional unit - like a cardiac step-down? If your ulitmate goal is ICU, I would encourage you to start in one of those areas. I started in Tele, and learned a great deal. By the time I did go to ICU, I had a sound foundation of rhytms, cardiac procedures, etc. Our floor had a good sprinkling of med-surg overflow, too.

BTW, I think it could go either way as a new grad in ICU. You'll either sink or fly, depending on the orientation/training you get and the staff.

Ali_Oop07 · May 19, 2005

My class just graduated 18 students and 13 are going into an ICU including three in a trauma and two in NICU.

Their NMs feel that no Med/Surg equals no bad habits and they can train them the way they want them.

That said, I am thinking about working tele! I like my patients hooked up to monitors and a second set of eyes looking at their monitors!

~Ali

pricklypear · May 19, 2005

That said, I am thinking about working tele! I like my patients hooked up to monitors and a second set of eyes looking at their monitors!
~Ali

I hear ya!! I'm always nervous when float somewhere where the patients are not on tele. Freaks me out!!

piper_for_hire · May 19, 2005

Make sure you are listening to the right people. In other words, why take advice from people that have not actually done what you're intending to do? They may really be trying to help you, but they can't possibly know because they didn't experience it themselves. There are plenty of new grads out there that went directly into an ICU setting. Ask them.

-S

megs07 · May 20, 2005

Not that I know a whole lot, I just graduated myself. But I got hired in a NICU in which I have never had clinicals. I never really had a specific pediatric clinical rotation. But I think with desire, dedication, and determination (the 3 D's) you can excel in any area. I look at it this way, there are BSN candidates that could have taken the job, but I feel they had to have some reason to choose me. Practice for interviews, I took five pages of notes and go figure, they only asked me one question the whole interview. Work experience is great, I have been a PCT for a year and a half and some of that time in the ED, so I have a varied work experience. I really would say NOT TO SETTLE FOR WHAT YOU DON'T WANT TO DO!!! Have you ever worked with a nurse that hates their job? It makes for a less that pleasant working environment. I didn't want to do med-surg because I floated on med-surg floors for a year and it wasn't my fave in the least. I didn't want to be someone that ended up disliking the profession because of a less than satisfactory job. Another piece of advice, take it upon yourself to study new things. I just ordered 400 dollars worth of NICU books. I know they will teach me, but I don't want to have to learn it all from them. best of luck to you and I know several people that have been hired directly into specialty care units! don't get frustrated!

megs07 · May 20, 2005

I forgot to mention to look at a hospital that is not super huge. By starting in a hospital that is not small, but smaller in nature, you will get the patients that are critical, but not so critical that they would have to be sent to a regional leading hospital. (Look at trauma levels)! At the same time that that may help, some smaller hospitals are not like the large teaching hospitals so you just have to investigate the hospital and what the dept. manager prefers.

AuntMeggie · May 20, 2005

I graduate tomorrow and a majority of my class are starting in ICUs. PICU, NICU, CSICU, MRICU, STICU, NVICU....

I think hospitals prefer new grads sometimes because they get to mold you.

Lukestar · May 20, 2005

I graduate tomorrow and a majority of my class are starting in ICUs. PICU, NICU, CSICU, MRICU, STICU, NVICU....
I think hospitals prefer new grads sometimes because they get to mold you.

You nailed that one on the head. Sometimes experience can be a problem.