Which Nurse Extern position for pre-CRNA

[Atheris]

I am currently a Junior in nursing school (BSN) and have applied for two nurse extern positions. I've already had my interviews for both jobs and been offered a job in both positions. I do not know which position to chose that would best enhance my ability to become an ICU nurse and later a CRNA in a few years. I inquired about a third extern position at a main (level 1 trauma) hospital in their medical ICU, but they are only hiring one extern and required the extern to have at least 1 year of hospital NA experience before considering them (I don't have this experience yet). All of these extern positions are within the same health system, but at different hospitals. I'm not allowed to do meds as an extern and I cannot work with blood as an extern in this healthcare system.

First extern position: Nurse Extern on a Cardiac Telemetry Stepdown unit. Contingent position at a level 2 trauma hospital with ~400 beds and ~35 on the unit. I would be assigned roughly 5 or 6 patients at full load (after being trained and feel comfortable). I would be doing lots of hands on stuff and was told by the manager that this would be excellent experience on a busy med/surg floor and I would learn the basics I would need to allow me to be an ICU nurse later down the road. This hospital does a lot of stuff and does not like to send their patients to the level 1 trauma (main) hospital unless they absolutely have to. The nurse manager also said once a month she could get me down in their ICU as an extern as long as it's okay with the ICU manager.

Second extern position: Nurse Extern on a Medical ICU unit. Contingent position at a much smaller level 3 trauma hospital with ~200 beds and 12 beds on the unit. I would be working directly with the same nurse preceptor each day. The type of patients they receive (according to the manager) is CHF, GI bleeds, resp, CAD, kidney, post CA, etc. Nothing too crazy, otherwise the patients get sent to main. People also know this hospital is level 3 trauma, so they don't get a lot of super high acuity patients. They get a lot of people with falls and fractures and also people with things like severe influenza at their ICU. The nurse manager also said she could get me into their Neuro/Surgical ICU if I wanted which get patients with Stroke, brain hemorrhages, surgery complications, aneurysms, etc. but thought I would like the medical ICU later as I want to be a CRNA.

I know the ICU extern position would look better on paper when I'm applying for an ICU position as a nurse, but it's at a much smaller hospital. The patients they receive aren't as intense as even a level 2 trauma hospital. I don't want to be in an interview for an ICU nurse after I graduate and have them ask me what I did as an ICU extern at a level 3 trauma hospital. The list of things I could say I did or learned would not be very extensive... I have to let both managers know which job I will take within four days as that's their last day for hiring externs.

Can anyone please give me any advice on which position to accept and why?

[Here.I.Stand, BSN, RN]

Take the 2nd one -- the first ratios are INSANE! 6 pts isn't even ideal for med-surg. 3 pts is appropriate for stepdown.

Even if a smaller hospital, you would still gain experience with vents and vasoactive drips; stepdown units generally don't take them.

Unless you're wanting to work with trauma pts, the trauma designation is pretty meaningless. If you look at the criteria, it's about trauma care -- not cardiac or medical care.

[Atheris]

I think it would be more observing how the nurse operates things such as the vents and drips rather than me do anything. I am not licensed and can only do things under direct supervision of the nurse who will be with me at all times if I take the ICU position, whereas I will be more independent and hands on if I take the CT position.

[ICU-BSN]

If your goal is ICU to get to CRNA (and you have to have ICU to become a CRNA), then take the ICU spot. You will be very surprised at what you see in the smaller ICU. When I graduated from nursing school, I started in an ICU at a small community hospital, no trauma designation. There was PLENTY to learn. You still see really unstable patients, vents, drips, codes, intubation, you will get to see tons of procedures because a lot is done right at bedside and if it's not the RNs travel everywhere with the patients.

When I interviewed that small community hospital wasn't my favorite, but I took the offer because it was ICU and that's where I wanted to be. It definitely prepared me well and opened many doors for me. I have moved on and now work ICU at a level 1 facility.

[Atheris]

Is it more important as a student to develop basic skills from the med/surg type unit or to get direct experience for what I'm planning on doing in the future (ICU)? Also, does anyone think that the ICU position being at a smaller hospital could negatively affect anything? My friend works as a nurse in an ICU and said I shouldn't have a problem getting a job in an ICU after I graduate after taking either extern position.

[ICU-BSN]

Is it more important as a student to develop basic skills from the med/surg type unit or to get direct experience for what I'm planning on doing in the future (ICU)? Also, does anyone think that the ICU position being at a smaller hospital could negatively affect anything? My friend works as a nurse in an ICU and said I shouldn't have a problem getting a job in an ICU after I graduate after taking either extern position.

Personally, if my goal was ICU, that's where I would go. You will pick up a plenty of skills there as well. It being a smaller hospital will not negatively affect your future ICU chances. You will still be exposed to vents and drips in a small ICU, whereas you will not see those in a floor.

[Atheris]

Ironically, everyone I've asked in person says Cardiac Telemetry and you all say Medical ICU. I'll also add that some CRNA schools I've looked at are looking for the acuity level of the ICU you've worked in (and of course some are not, but I want to open as many doors as possible). If I were to take the extern job, after graduating I would be offered a nurse ICU job. The nurse ICU job would be such low acuity, I'm worried the CRNA school might ask me to get more ICU experience at a bigger hospital even after working for a few years in the smaller hospital's ICU. If I took the CT extern position, I would feel more apt to leave that hospital and look for an ICU nurse position anywhere (if need be) and open up more possibilities to get an ICU job at a bigger hospital. If I took the ICU extern position, I would (obviously) feel obligated to take the position offered to me at the end of my externship, but then might regret not moving up to a bigger hospital with more acute patients. Can someone also provide a reason to take each position over the other?

[ICU-BSN]

There is no guarantee you will be offered an RN position after either externship. Also, there is zero obligation to accept a position just because that's where you did an externship. Many factors could play into the decision to accept a job offer...pay, amount of support offered for a new grad, type of unit, whether or not you vibe with management and staff, commute, I could go on and on. Many ICU managers will not hire new grads, and many of those that do strongly prefer the new grad to have had an externship or other lengthy experience within an ICU environment. My opinion remains that if CRNA via ICU is your ultimate goal, you would be doing yourself a disservice to not accept the ICU externship.

I sense an amount of reluctance towards the ICU position. I'm not sure if it's simply because it's not at a big fancy level 1 ICU or if there is something more with the environments associated with either of the units. Ultimately, only you can decide which is the right fit for you.

[Atheris]

I think I only feel reluctance not to take the ICU position because there was more compassion in the way the managers at the CT extern hospital treated me. They seemed more relatable to me during the interview process and brought down their extern manager to talk to me as to why I should stay at their hospital and not take the ICU position at the other hospital (again, these are both hospitals within the same health system and I'm sure the managers from both hospitals know each other). The drive difference also comes into play (CT=20min, ICU = 35min) but the longer drive does not turn me off completely to the job by any means. I was also told by both the ICU and CT managers that a job offer would be given after the externship was done if my performance was good. Both hospital's managers said they've each only not hired one extern ever after the extern was done.

My friend who is an ICU nurse didn't even have a healthcare job before graduating and he got right into and ICU as a graduate nurse before he even took his NCLEX. I've also looked at nurse ICU position hiring requirements and recommendations for a few hospitals and they say that "One year telemetry experience preferred." and nothing is said about ICU experience. Obviously ICU experience would also be preferred, but telemetry is also preferred - just throwing that out there. I don't think it will be hard to get an ICU nurse job with either, but if the ICU extern job will really give me much more experience, will help me get an ICU job once I graduate, and will help me be a better CRNA and get into a program faster, I think I will take that job.

[Afraks]

Hi guys, this trend is a few months old but I am very interested in the ICU unit. I am currently a junior looking into externships for next summer to boost my experience and I was hoping if you could share some hospitals to look at for such opportunities