ICU vs. L&D

[mkurek]

I am currently in my last semester of my Nursing degree program and I have a dilemma. I worked in Day surgery over the summer as an Undergraduate Nurse, and I had an interest in pursuing ICU after graduation. Long story short, I met with a PCM of the ICU at my hospital and was offered a job after graduation that involves 6 months of orientation. I was really excited and definetly wanted to do this, but I let them know that I still didnt know where my final practicum would be and that I wanted to wait till Sept/Oct to fully decide. Now, I found out my final practicum is in Labor and Delivery (what I wanted!!). Now, to jump back abit my overall career goal is to become a Family Nurse Practitioner, with a strong interest in Womens Health.

In terms of best career move, or advice... should I try to pursue employment in L&D after graduation given this is highly likely because I have done my final practicum in this area. Or should I continue with ICU. I have no experience in this area, nor do I know if I will even like this area, but its definetly a great orientation and would be a huge learning curve that I do enjoy.

Any advice would be greatly appreciated!!!

Melissa

[LisaRRT]

Wonderful opportunities. I had the same desicion to make. I was offered a job in a LDP and nursery at one hospital and a CVICU at another. I wanted to do the LDPN so bad, but ultimately went with the CVICU as it is in line with my career goals. The OB manager (I worked OB as a student nurse t/o nursing school) told me the door was always open if a position was available and if I ever wanted to come back. They frequently hire in nurses from other specialties.

I "think" it is easier to go from being ICU trained with lots of skills under your belt to being an OB nurse, but I think OB nurses with no other skills may have it harder when looking to try a new area. This comes from the OB nurses that wanted to try something new. Many of them could not find jobs because they had no other experience and ended up remaining in OB even though they wanted out. This could have been just in my area though and not the same for the rest of the country.

I think your decision should also be based on your time frame. If you plan to do advance practice sooner rather than later, go straight into OB, but if that is more longterm, then I would beef up on your critical care stuff now and then go to OB later. This isn't to say that OB nurses don't have critical care skills/abilities because you can get some pretty highrisk/sick OB cases too., but you see what I mean.

Good luck to you, I wish I could give better advice.

Lisa RRT/RN

[mkurek]

Thanks for the advice. It definetly makes sense to get the great experience in ICU and then go to OB afterwards. My doubts stem around my unfamiliarness with ICU nursing given that I havent had any experience within school and the 6 month orientation involves a 18 month contract that worries me if I dont like that area. Also, my pursuing FNP is on my agenda after a few years of experience, so relatively short term goal.

[New CCU RN]

I've done both - ICU being where I started as a new grad. I really think that it takes someone with a great deal of desire to be an ICU nurse to suceed whether a new grad or an experienced nurse that is new to icu. You don't sound all that into the ICU. And that is fine. The biggest thing that stands out to me is that you are drawn to the ICU b/c of the long orientation... not because you like taking care of crashing patients, enjoy the total unknown of ICU, want to know everything inside and out about your patient's condition, or think you would enjoy a constant life and death battle.

And to be honest - if that doesn't excite you - you probably won't like ICU.

However - L&D from what you say seems to be a good fit..... go for it. L&D ought to also have a good, supportive orientation. 3 months is the typical average. For the most part that works perfectly for new grads and they go on to do very well.

I say go with your gut. From what you write - you really don't seem all that into ICU. Go where you find energy, enjoy, and feel drawn towards. Only you know that answer.......

[Cosper123]

I feel you'd be best off going ICU first for a couple of reasons. You are automatically drawn to L&D as mentioned in the last post, but it's important to keep your eyes on the prize...which in your case is Nurse Practitioner.

Both areas will provide you with experience that you need, but that coming from the ICU will be more comprehensive. It will be important for you to know how things work in that setting, where some of your patients can and at some point will wind up, etc.

If the 18 month contract seems daunting to you, take a travel assignment elsewhere to where conditions are better for you. You may want to consider travelling to California as the nursing shortage there provides for ample opportunities to negotiate a contract on your terms. Your best bet is signing on with an agency that caters to travlers, and have them hash out your terms (like say, a 6 month contract, housing, etc.) You're likely to find something ideal for your situation, and find that the rate of pay in Cali is good enough to make it worth being away from home for 6 months.

The experience alone should be worth it, but in the end if I where you and considering your path...I'd make sure I hit up as many departments as possible. Don't just think L&D or ICU, consider also working in the OR, ER, etc. for awhile. Getting a feel for how the different areas function and how things work will make you a better nurse practitioner. In fact, this is advice I'd give to any nurse whose job is interdepedant/inter-related to other departments. Planning on working in the ER myself, I'm going to want to know how things function on the floor. At least then when i'm complaining about a slow transfer from my ER bed to the ICU I'll have a feel for what to expect from them :monkeydance:

Whatever you chose, good luck and enjoy yourself.