What is the best duty station for a new grad nurse who wants to transition into ICU as soon as possible?

[gee_mcgee]

Hello everyone! I am about to graduate nursing school and will be commissioning into the Army Nurse Corps through ROTC. My ultimate goal is to do CRNA school, so my sights are set on getting into the ICU as soon as possible. I have heard that as a new grad nurse I will be required to begin in a medical-surgical unit and will have to wait a bit of time before being able to take the ICU course. 
My question is: what duty stations are best for a new grad nurse who wants to get into the ICU as soon as possible? My top three choices right now are Fort Sam Houston, TX;  Tripler AMC, HI; and Landstuhl, Germany. However, I am willing to change these if any of these don’t provide good opportunities to transition into the ICU or if other stations that I haven’t listed here are better. I would love input from nurses who have been stationed at these medical centers, or any other medical centers, who can give me some good, relevant information! Thanks so much! 

[offlabel]

BAMC or Tripler...Military hospitals historically have treated young healthy patients that don't offer a great learning experience for someone wanting to get into more advanced roles. That's starting to change now that the military services hospitals are opening care to all DoD eligible and family. That said, the bigger the better. Landstuhl is a comparatively small hospital relative to the other two and will not have the acuity you want. Hawaii would be a second choice to BAMC, IMO.

[jfratian, DNP, RN, CRNA]

Everything the prior poster said is true.  Military acuity sucks in general.  San Antonio is as good as it gets for higher acuity.  The military CRNA schools are both highly respected and of high quality.

Having said all that...

You should think long and hard about attending the military CRNA schools; about 1 in 3 fail out (vs about 1 in 12 in the average program).  If you fail out even after just one semester, they still own you as a nurse for at least 3 more years (and as many as 5 years depending on how far you get in the program).  Since most people take about 4-5 years to get into school, (putting you close to 10 years in), it almost forces you to do the full 20 year career.  

Many articles have discussed why the attrition is so high at the military schools, including the one below from the AANA journal.  You'll find all sorts of discussions on AllNurses painting this as a positive thing.  I'll note that all the other schools in the "top 20" have attrition rates under 10%.

My hot take: They're jerks and it's a culture thing.  The military in general thinks that "high washout" equals "more challenging" equals "better education".  They could fix it (higher admission standards, etc) but they choose not to.  Plus, locking-in ICU nurses for 3-5 years (and perhaps a 20-year career) only benefits the military.  

https://www.aana.com/docs/default-source/aana-journal-web-documents-1/addressing-attrition-1015-pp351-356.pdf?sfvrsn=cfd848b1_6

[gee_mcgee]

Thank you for your replies @offlabel and @jfratian. I appreciate it, I will definitely keep BAMC at the top of my list. I am not planning on going through the army’s CRNA program. The plan as of now is to serve out my first active duty contract of 4 years, then return back to civilian life and use the Post 9/11 GI Bill to cover the cost of a CRNA school of my choice. If you have any opinions on that decision, I would appreciate feedback. My biggest concern is just getting accepted into a CRNA program, which is very competitive, and in order to gain acceptance I need good ICU experience. I’m concerned at the possibility of the army not giving me good ICU experience and having to get a civilian ICU job once I’m out of the army to gain the experience that I need, because that will push my timeline back even more and I’m trying to make this process as smooth as possible. 

[jfratian, DNP, RN, CRNA]

I don't think lack of acuity is going to sink you on its own.  I had 3 years of ICU in small military community hospitals while active duty and got into multiple CRNA schools after I separated.

Get the CCRN and try to get a masters with tuition assistance in either nursing education or nursing leadership/management or informatics.  Mine was only 32 credits and all online.

[offlabel]

1 hour ago, gee_mcgee said:

Thank you for your replies @offlabel and @jfratian. I appreciate it, I will definitely keep BAMC at the top of my list. I am not planning on going through the army’s CRNA program. The plan as of now is to serve out my first active duty contract of 4 years, then return back to civilian life and use the Post 9/11 GI Bill to cover the cost of a CRNA school of my choice. If you have any opinions on that decision, I would appreciate feedback. My biggest concern is just getting accepted into a CRNA program, which is very competitive, and in order to gain acceptance I need good ICU experience. I’m concerned at the possibility of the army not giving me good ICU experience and having to get a civilian ICU job once I’m out of the army to gain the experience that I need, because that will push my timeline back even more and I’m trying to make this process as smooth as possible. 

What you may lack in facility acuity, you'll well make up for with your military service. That means something and you'll bring that discipline and, for lack of a better word, altruism and world view to the table that civilians just won't have. But it's a wise choice to get what you can from your military service and leverage that to civilian schools. You'll do fine. 

[St.BaptistRN, BSN]

I’m currently at BAMC, spent a long time in a few of their ICUs. PM me if you want my personal take on it.

[gee_mcgee]

11 hours ago, St.BaptistRN said:

I’m currently at BAMC, spent a long time in a few of their ICUs. PM me if you want my personal take on it.

Hello @St.BaptistRN, I would love the chance to get your personal take on the ICUs at BAMC. Unfortunately, I am unable to send private messages because apparently I need at least 15 posts in order to have that functionality and I am fairly new to this website and therefore have not posted that many times yet. If there is any other way to communicate with you please let me know, because I really would love to chat. Thank you! 

[St.BaptistRN, BSN]

41 minutes ago, gee_mcgee said:

Hello @St.BaptistRN, I would love the chance to get your personal take on the ICUs at BAMC. Unfortunately, I am unable to send private messages because apparently I need at least 15 posts in order to have that functionality and I am fairly new to this website and therefore have not posted that many times yet. If there is any other way to communicate with you please let me know, because I really would love to chat. Thank you! 

Reach back out to me after you make more posts. My experience has been…interesting. I’m AF, not Army, so I have a different, perhaps skewed perspective.

[St.BaptistRN, BSN]

Either way, going back to your original, I’d start with a fun assignment like Germany or Hawaii if you can. Let’s say you can get into ICU with as few hoops as possible. You’ll still start out as a 66H (med surg) and have to do your time there. By the time you’ll be ready to get into ICU course and work there, it’ll be time to PCS. So, you’d start at the highest acuity ICU in the entire military, then leave before you get to enjoy it

[jfratian, DNP, RN, CRNA]

I'm not entirely sure if the Army works it the same way as the Air Force.  The Air Force always does a permanent change of station (move to a different base) following the ICU course, which you can apply to after 2 years.  The Army may treat it as a simple TDY with a return to the same base; you'd have to look into that as well.  

I'd recommend against Hawaii and Alaska in your case.  Both carry mandatory 3 year tours with a set DEROS date (date eligible to return from overseas).  That's a DOD policy and doesn't change based on branch.  You'd need to apply for a waiver to apply to school at 2 years, and few commanders are going to agree to it.  All other overseas assignments have 2 year DEROS dates....so Germany is fine.

Also keep in mind that the ICU courses often come with payback time.  In the Air Force, you have to agree to 2 years after graduation from the course.  I'm sure the Army has something similar.  

[jfratian, DNP, RN, CRNA]

Also note that ROTC grads are NOT eligible for the post 9-11 GI bill.  You have to serve an additional 3 years active duty following the time you owe for ROTC in order to get it.