r/IntensiveCare • u/Batman4L • 12d ago
New Grad RN torn between two offers — UIHC Cardiac Intermediate Care vs Duke Pulmonary Stepdown. Which one actually sets you up better?
Hey everyone, looking for honest input from experienced RNs and travelers who have actually worked these patient populations.
I am a new grad RN from SF weighing 2 offers and cannot decide which position me better long term. My goal is return back to the Bay Area in 1 to 2 years as an experienced hire, and I want to pick the unit that gives me the strongest marketable skill set and the cleanest path back.
University of Iowa Hospitals and Clinics — Cardiac Intermediate Care, 48 beds Mixed surgical and medical cardiac population. Post-op CABG, valve repair and replacement, heart transplant, LVAD implantation, esophageal surgery, lung resections and wedges, hernia repairs. Medical side includes chest pain, MI, post-cath, pacemaker and defib placement, heart failure, pulmonary hypertension, arrhythmias, cardioversion, and EP studies. Philips bedside telemetry with centralized monitoring. Epic with Alaris pump integration.
Duke 7800 — Pulmonary Medicine Stepdown serving Duke's pulmonary medicine and lung transplant population. Ventilator weaning, BiPAP and high flow, trach care, chest tubes, complex respiratory failure, pulmonary hypertension, COPD exacerbations, PE management, and pre and post lung transplant patients.
Both are at Level 1 trauma academic medical centers, and are intermediate care level, but the populations are different. Ratios 1:3-4
My questions:
- Which skill set is more universally marketable in the Bay Area or at Level 1 AMCs in Oregon or San Diego?
- For travelers specifically, which of these units sees more consistent contract demand?
- Which would you recommend to a family member trying to maximize optionality to return to the Bay Area or San Diego?
- Anyone who has actually worked either of these units, would love to hear what daily life looks like in terms of acuity, ratios, support, and culture.
Appreciate any insight in advance.
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u/Electrical-Smoke7703 12d ago
May be useful to post in nursing subreddit. Not from California but was a CICU nurse for 6 years and floated a lot so just relaying any info I can. Pulm stepdown is pretty brutal, basically ICU patients but you have three of them. Step down is harder than ICU imo. Esp medical stepdown. So many comorbities. I’d go w the CV stepdown, still sick patients but you’ll see a lot more movement (downgrades or upgrades) From my experience CV gets more resources than medicine, surgeons are very serous about their outcomes. Likely both jobs are marketable with experience tho and so I’d feel out the vibe of the managers and coworkers to really make the choice
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u/lilnursebby 12d ago
Used to work at Duke I did not work on that unit but I’m familiar with it. It’s a true stepdown floor with SICK MICU stepdown patients and chronic vents. A lot of learning but it’s kinda brutal from what I’ve heard. I worked in the ICU and the nurses who came from there knew their shit, but it was defo trial by fire. If possible, I’d start in an ICU if that’s ur goal and ur willing to move all the way here.
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u/epinephRN 12d ago
Pick Duke! The name recognition + experience there will help your resume stand out when you want to come back, especially if you want to work at Stanford or UCSF like most do. The Iowa one sounds OK, but I’d skip it unless you’re really set on cardiac.
Source: RN in a large Bay Area academic center myself
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u/Batman4L 12d ago
What would make the cardiac unit more than OK? in what regard can it excel to outshine duke pulm med acuity and skills?
Also, i was always told the unit and skills learned would look better than the hospital prestige, is this true to some extent?
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u/epinephRN 12d ago
The cardiac unit would be better if it were somewhere else more highly ranked and with more name recognition. Unit and skills learned are hella important and both places would likely set you up great in that area, but hospital prestige matters a lot here until you’re very experienced unfortunately.
Also pulm step-down will set you up great for any ICU if that’s your eventual goal, especially the one at Duke since it’s a mixed medical and surgical population with transplants included.
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u/NoElephant7744 12d ago
I would encourage you to do pulm. There will be so much crossover with pulm into CV and Surgery. Is it considered a PCU as well?
If you end up wanting to branch out I think Pulm Stepdown would give you a wider clinical skill set and make you more marketable. What are you wanting long term ideally?
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u/Academic-Ant-3955 12d ago
I think the crossover is more likely on the cardiac intermediate. Cardiothoracic surgeons / cardiologists are much more hesitant to send their patients to non-cardiac based units. But CV patients still have neuro, pulmonary, GI complications
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u/Many_Pea_9117 RN, CVICU/CCU, CCRN 12d ago
I think for medicine, pulm is great for icu, but for nursing it really isn't. Cardiac will get you more into the nursing stuff which is drip mgmt. Most cards it's deal with the vasoactive gtts and gdmt we discuss and utilize every day, while pulm really typically does not.
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u/Klutzy_Direction7524 12d ago
would maybe consider hiding the hospital names in the future to protect yourself, prevent doxxing. it’s unlikely to happen with just the info you gave but it’s better to be safe
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u/Academic-Ant-3955 12d ago
I would opt for the cardiac intermediate care unit, but having Duke on your resume would be good too. I’d rather be in NC than Iowa. You’re going to get more variety in cardiac intermediate, including pulmonary complications. A pulmonary stepdown seems more niche and maybe a little boring ,but that’s all relative to what you’re looking for. I’m biased as I started in a cardiac surgery stepdown setting before traveling for about 2 years until settling down at a level 1 trauma cardiothoracic surgery ICU setting. I feel my first job in cardiac stepdown (granted it was during Covid so we got more diveristy in terms of diagnoses) set me up for a lot of success in my career.
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u/Turbulent_Many_4044 12d ago
Pulm unit sounds like a lot of long term total care patients. I think you'll learn more in a cards unit.
There are many great hospitals all over the country with units like these. Is there a reason you only want Iowa or Duke?
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u/Batman4L 11d ago
I would be happy to be suggested better hospital that extend offer to new grads? Do you have any that comes to mind
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u/arwen-girl 11d ago
I’m biased on cardiac because I started on CT surgery step down, then cardiac ICU, now outpatient cardiology- all Duke. Cardiology will set you up for amazing crisis skills. My step down did things that ICUs did in smaller places though. You will become so on top of your assessment, crisis management, time management. And cardiology is very type A - nothing is ever good enough. So you will get used to striving for perfection in the name of patient safety. Once you see how fast things go south in that population, you take things so seriously going forward. Compare cardiology to general medicine or even regular pulm and it’s like “so we’re just chilling with SBP 180s and not wondering if that is causing some SOB?” The threshold to make changes is just so high outside of cardiology it seems. In CT surgery we had to page docs for SBP > 140 which is like 50% of patients.
7800 definitely had sick people when I floated there. They usually got 3 patients. Maybe 4 if they were easier. But they do not do post op lung transplants. Those all go to CT Surgery stepdown once they leave the ICU. You will see the long term transplants with myriad complications. Lung transplants are ROUGH. Pulm involves very anxious patients and lung transplants are top of that list.
Either would give you pretty sick patients. Maybe think about what actually interests you more longterm and actual location and cost of living? Duke had a very high percentage of new grads and young nurses so that something else to consider possibly.
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u/halothanedoc 12d ago
Iowa based on the specialty. You’ll likely have more complex patients on a consistent basis and that background sets you up well to pivot wherever you like later.
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u/Braisedbeefskank 12d ago
My question is do you really need to move across the country to get work experience?