Would 2 years in small ICU provide enough experience to get into Trauma/Neuro ICU?

[AKav8trix]

It's not official yet, but it looks like I'll be starting out my nursing career in a small community hospital's 8-bed ICU. It sounds like I will get a thorough orientation and the staff has many years of critical care experience for me to benefit from.

However, my goal is to get into a Level 1 Trauma/Neuro ICU eventually and I'm wondering if starting in the small ICU would give me enough experience to move right into the Trauma/Neuro ICU after 2 years. I know that I will get a wide variety of experience in the small ICU, but unfortunately their ER doesn't like trauma and most neuro patients will bypass this hospital and go to the nearest stroke center that is just 10 minutes farther down the highway. The hospital also does not have a cath lab, so most of the acute heart patients get transferred out.

Although I would be lacking trauma, neuro, and cardiac experience in the small ICU, I will also be finishing my EMT-Paramedic degree next year and gain a total of hundreds of hours of clinical experience in a Level 1 ER, trauma ICU, and out in the field on MVA's, Code 99's, and assorted other calls. (I already have 3 years on the 911 ambulance as an EMT.) Would that be enough to fill in the experience gap?

What it boils down to, is that I will probably have a choice between the internship in the small community ICU for the next 2 years, or spend a year on a mid-sized med/surg/tele floor (mostly routine abdominal, thoracic, and vascular surgeries) and try for an ICU internship later. If you were a Trauma/Neuro hiring manager, which place would provide the level of experience you would want an applicant to have prior to starting in your ICU?

Thanks,

Brand New RN

[pricklypear]

Do they do a lot of surgery at the small hospital? Handle a lot of vents? I'm not sure what experience you would get that would help you at a larger medsurg floor that you wouldn't get in a small ICU. It just depends on what kinds of patients the smaller one does handle. Some of the "smaller" ICUs in towns around here don't do much of anything except deal with patients for a few hours until they get transferred elsewhere.

I take it the place you want to go have a new grad internship for ICU? What about a MICU in the same hospital?

[AKav8trix]

Do they do a lot of surgery at the small hospital? Handle a lot of vents? I'm not sure what experience you would get that would help you at a larger medsurg floor that you wouldn't get in a small ICU. It just depends on what kinds of patients the smaller one does handle. Some of the "smaller" ICUs in towns around here don't do much of anything except deal with patients for a few hours until they get transferred elsewhere.

I take it the place you want to go have a new grad internship for ICU? What about a MICU in the same hospital?

Yes, they do a lot of routine surgeries and it sounds like occasionally a sicker abd or thoracic surgery patient will wind up in their ICU for a few days. It seems to be more of a medical ICU in that the usual things they handle are overdoses, DKA, hypertensive crisis, CHF exacerabations, kidney failure, etc. I'm pretty sure most of the really sick patients get transferred to the university hospital or one of the other bigger ones in town. I'm not sure how often vented patients are cared for in their ICU, but on the med/surg floor I mentioned, they never have vents or new traches.

I really would like to start out in the ICU, but starting out on the med/surg floor wouldn't be too bad. I really like the staff there in the hospital with the med/surg opening and am familiar with how they do things because I've worked as a unit secretary and CNA for a few years there. :)

[pricklypear]

Sounds like maybe you're leaning toward the med-surg floor? If you're already comfortable there, it sounds like a good idea! Good luck, I know making these decisions is hard! I started in tele as a new grad. We had lots of different patients on that floor - and I got lots of experience. I wasn't comfortable starting out in ICU, but I work with some new grads in ICU now who have done great.

[AKav8trix]

Sounds like maybe you're leaning toward the med-surg floor? If you're already comfortable there, it sounds like a good idea! Good luck, I know making these decisions is hard! I started in tele as a new grad. We had lots of different patients on that floor - and I got lots of experience. I wasn't comfortable starting out in ICU, but I work with some new grads in ICU now who have done great.

The ICU is actually my first choice. Yesterday I got the official job offer for the ICU internship, so now I really have to figure out if that is where I want to be for the next two years. I would get at least 4 months for the internship, more if I feel I need it, and the charge nurses I interviewed with seem like they would be very nice to work with. I told them I'd give them the decision next week. They don't get many complex ICU patients, but I think I would at least get a good foundation in the ICU basics of hemodynamic monitoring, drips, and vents. Hopefully that would be enough to get into a more specialized ICU later.

Thank you very much for your input and encouragement. :) Have a great holiday weekend. :balloons:

[pricklypear]

Thank you - I hope you have a safe and fun weekend, too. I'm sure your time will not be wasted in the ICU. 8 beds is big enough to have some pretty critical patients. I bet you will handle a lot of respiratory failure patients - many of whom become hemodynamically unstable and require gtts and such. It will be a good way for you to become comfortable and familiar with the ICU setting and pace. Then you will have a good base, and be less overwhelmed in the bigger ICU.Good luck to you!! I think you'll do great whatever choice you make!

[esrun3]

I think your ICU experience will be a definite plus but it all depends on your state and what hiring practices are like. Many of our hospitals, if not all, will hire new grads for trauma/neuro icu as well as the other icu's. They usually have great oreintation and training programs so not knowing something or not having the exact experience isn't really a hinderance. Good luck in whatever you decide to do. :) You'll learn something new every day!

[hollyster]

Take as many ICU/CCU, hemodynamics CEU or seminars that you can.

Sometimes it is easier to learn in a smaller unit so that when you make the move. You skills will not be too different so the move will not be so scary the place may be will be different buts not so scary.

[AKav8trix]

Take as many ICU/CCU, hemodynamics CEU or seminars that you can.

Sometimes it is easier to learn in a smaller unit so that when you make the move. You skills will not be too different so the move will not be so scary the place may be will be different buts not so scary.

Thanks for the feedback everyone. :) I just accepted the job at the small ICU and start the last week of July. Although, I really do love the trauma/neuro ICU, this probably will be a better place for me to start, especially with the added stress of paramedic school that will begin in January. I'm excited, but a little scared, too. It seemed I would never get this far during the long journey of school, but now that I have made it, I can't believe sometimes that I am actually an RN now. I will be so glad once my first year is over and I won't feel so brand new and inexperienced.

Brand New, RN

[barefootlady, ADN, RN]

You will be trained and learn plenty in the next months. I wish you the best of luck in your new nursing career. We need excited, caring nurses everywhere, glad to see you onboard.