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Insights from an ICU Nurse

Thinking about entering the medical field, but not sure where to begin? Emilie Maxie, Travel Nurse and Scribe Alumna, shares insights from her own healthcare career path to help prepare you for your own journey ahead.

After graduating nursing school in Colorado, I was hired as a new grad in the Medical ICU at Johns Hopkins in Baltimore, Maryland. After a year, with a desire to expand my knowledge and competency, I took on per-diem positions at various local hospitals. I started travel nursing last summer in California and soon will be working at the Mayo Clinic as their staff ICU Traveler, where I will float between their Florida, Arizona and Minnesota campuses.

Through three years of experience as a nurse, I learned a few things that will hopefully help you as you begin your journey in healthcare.

Don’t worry if you are still undecided on a specialty. 

My first exposure to healthcare was working as a scribe in the Emergency Department. After a few years, it was a natural choice that I wanted to be an ED Nurse. Despite requesting to be placed in the ED for my nursing externship and senior practicum, I always ended up in the ICU instead. That was when I had a change of heart and fell in love with the ICU.

Nursing students have shared with me their concerns about where to start as a nurse. Residents during their ICU rotations have also voiced similar thoughts. There are so many possibilities and specializations, and for nurses, bedside is not the only option. Clinical rotations will help you realize your calling, along with an open mind and heart. You may end up liking a specialty that you never thought you would. 

There is more than one way of doing things.

In the beginning when we have limited experience, we get used to the way things are done, particularly if we have only been exposed to one hospital. When changing facilities, avoid stating “at my other hospital, we did it this way.” This was my mindset in the beginning of my career. The local hospitals in Maryland shared similarities in practice; however, it wasn’t until my travel assignments in California that I saw major differences. 

Evidence-based practices can also differ between institutions depending on which evidence they follow. The diversity of practices are influenced by a provider’s preferences, specialties, organization’s policies, protocols, and budgetary constraints, and state legislations. Be willing to understand different perspectives while remaining proactive and unafraid to voice concerns over unsafe practices.

Community vs. University vs. Trauma Centers vs. Critical Access Hospitals

Hospitals can have many classifications based on specific criteria. My goal was to be an ICU nurse, so I prioritized gaining a solid foundation in critical care medicine. My advice is to research existing types of facilities and decide how they fit with your goals.

There are pros and cons in working at small community hospitals vs. large university hospitals. Large university hospitals are well-resourced, focused on research and evidence-based practices. I enjoyed learning alongside the residents and the fact that residents and providers are very receptive to nurses. In smaller community hospitals, ICU nurses have much more autonomy dealing directly with the providers. This is where I learned to trust my judgments the most.

It is okay to start in the ICU as a new nurse.

There is a controversy in the nursing community over whether new graduate nurses should start in the ICU. Some people believe that new nurses should start in the medical-surgical unit to gain basic nursing and time management skills prior to specialization. Others believe that if your end goal is to be in the ICU, there is nothing wrong with starting there right away. 

However, be aware that it is very competitive to get a new graduate nursing position in the ICU. In order to increase your chance, I would advise the following:

  • Be willing to relocate to expand your options.
  • Start thinking ahead, even before nursing school. Browse the different residency programs for the ICU and check their common requirements. 
  • Work towards making your application stand out, such as highlighting extensive volunteering experience.  

Be respectful of different areas of expertise and professions.

Different specialties or patient loads do not always mean a more difficult or easy job. Med-surg nurses have 5-6 patients and their days are task heavy. Although ICU nurses may have a lighter load (1-3 patients), one patient can be so critically ill that they require the undivided attention of the nurse. 

Whether having 5 patients on the floor or 2 in the ICU, nursing is a hard job. I purposely picked up shifts on med-surg units to learn time management and multitasking skills. My days in the ICU are as busy and difficult as my days in the med-surg unit. Each area of expertise requires knowledge and abilities that are acquired over time and a well-rounded background.

Looking for more notes from the field? Download our Ultimate Scribe Guide and learn how scribing can shape your future in healthcare.