Insight & advice on Critical care(ICU) VS. general Med-Surg floor?

Nurses General Nursing

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New here and just seeking some advice... I'm a third-year nursing student who's in the process of getting an externship at a hospital. Currently I have a choice between either University of Pennsylvania Hospital or their sister hospital, Presbyterian Medical Center. UPENN hosp currently has no critical care externship positions, but PMC does.

My question is if anyone has any insight to shed on critical care and med-surg(specifically, surgical telemetry for example) particularly when it comes to an externship. I'm currently in my med-surg clinical rotation, and really haven't found it to be anything great/appealing. As for my future I think I'd eventually like to do OR or ER, but one goal I've considered pursuing would be to eventually become a CRNA.

ANY advice anyone could spare would be appreciated. Thanks!

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I went straight into the ER from school, even though my instructors all advised against going straight into a specialty. A lot of nurses here will tell you to follow your heart. My feelings: I love the ER and I can't imagine doing anything else, but I don't have the base knowledge that people with medsurg experience do. I don't know what chronic illnesses look like when not exacerbated. I have no idea what happens to my pts when they go to the floor. I don't think I would have liked medsurg either but I wish I'd gone through it just to get the knowledge base. I recommend this especially if you're thinking about the OR, because your pts would not be in exacerbation when in the suite.

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I have one year experience and I work in a small hospital. I work the ER, and the med surg floor its all on one level ER on one end and the med surg on the other end and the nurses station is in the middle. ER is my passion, but I am glad that I get to work med surg too. When my patients are admitted from the ER I admit them to med surg and take care of them there too. The experienc that you will get in the med surg unit will great. You probably will not enjoy it like you would in a specialty unit, but you will def. be able to use your experiece you gain in your specialty and glad that you did.

Hope this helps!

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Still wondering why people think med-surg isn't a specialty...? When we get floats from other units, they are never given our total hip or total knee replacements, or anything too critical (nowadays, stuff lands on our floor that used to be in ICU not long ago, but that's another story).

Anyway, OP....med-surg is an outstanding opportunity to learn critical assessment skills. You will learn when to spot when a post-op is starting to go bad, or when your new admit with abdominal pain is something to monitor more closely. You will learn to pick up the slight changes in someone's condition from lung sounds. You will see treatments and procedures only available to you on that unit. I have learned so much about so many types of equipment I can't begin to tell you.

I, too, had no real interest in med-surg per se. And by some stroke of fate I chose a position IN med-surg and I feel I am getting SO MUCH education this way! I now recognize conditions and anticipate patients' needs so much more quickly now.

Just food for thought :)

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I'm an intensive care nurse, and I have to say that its an entirely different mindset in there. The more experience you have on a med surge floor or in the ER would help greatly before advancing up to the ICU.

My advice would be too get as much experience as possible before jumping into something such as the ICU. The ICU takes a certain personality and certain level of skills. The more experience the better you'll do when you get there!

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Specializes in Nurse Anesthesia, ICU, ED.

While I agree with antidote that more med/surg experince that you bring to a critical care setting, the better, I think the OP would be better served by following the externship that puts him, or her in the ICU.

I find that the OP describes an identical situation to myself. I am a student nurse tech at a VA hospital in NC. The experience that I have gained is invaluable. Even if I did not stay in critical care, which I plan to and hope to jump right in after graduation, the skills and confidence that I have now can transfer to another setting. The OP really needs to follow his passion, instead of "doing his/her time"

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The OP really needs to follow his passion, instead of "doing his/her time"

I agree with you on that statement too.

If you want to go ahead and jump right into ICU nursing, go ahead! As I've told many people and myself over and over again: don't let anyone or anything stop you from perusing you're dreams and passions.

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Specializes in Telemetry, Oncology, Progressive Care.

I would have to recommend doing a med-surg externship depending on why you are choosing to do the externship. Why are you doing an externship? In my case I chose to do an externship to help me out with my last year of school. I felt the more exposure I had to nursing type situations the better I would be. I think it was the best thing I did. In nursing school you don't typically have ICU type patients (unless you have a patient that is starting to go bad or has gone bad). The drips and medications a patient has in ICU are different than what you're going to see in med-surg. I do agree with following your heart but think about why you're doing the externship.

Kelly

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Thanks for all of the replies!

So it seems the consensus is that it's most advisable to start off in med-surg just to get that fundamental experience/knowledge. To that I want to ask, does the externship matter so much when considering this? Since externships are generally only 8-10 week programs, I'm just wondering peoples' opinions on if it really matters what you do since it seems like it'll mainly be just a "taste" of things to come. And I could always choose to start my "career" in med-surg after graduating in '08. So any opinions on this?

I would have to recommend doing a med-surg externship depending on why you are choosing to do the externship. Why are you doing an externship? In my case I chose to do an externship to help me out with my last year of school. I felt the more exposure I had to nursing type situations the better I would be. I think it was the best thing I did. In nursing school you don't typically have ICU type patients (unless you have a patient that is starting to go bad or has gone bad). The drips and medications a patient has in ICU are different than what you're going to see in med-surg. I do agree with following your heart but think about why you're doing the externship.

Kelly

I'm thinking of choosing it because...

--For the longest time I was pretty set on pursuing the CRNA path, which of course requires CC experience. So my initial desire for a CC externship was due to advice given by CRNAs who advised me to choose such.

--Lately I've realized I should keep my options a little more open and not be so set on my pathway, but at the same time CC seems very interesting.

--I'm in my medsurg rotation right now, and to be honest I really don't like it. It's not really what I expected, but it could also be due to the unit among many other factors(I'm on a respiratory care unit.) Honestly I can't picture myself being a floor nurse for an extended period of time; I definitely feel like I'd grow bored of it rather quickly. To some extent from what I've seen, it almost reminds me of being a waiter, but providing a totally different service, lol.

--The biggest reason I'm taking an externship is for the experience, since honestly we don't get nearly as much of it as I expected in clinicals. And I know that working full-time for 8 weeks will be just perfect for getting experience. Not to mention I can't think of a better-paying/more rewarding summer job! Heh.

I guess the main thing I'm curious about at this point is on the choices for an externship in general(since I can do or transfer to whatever I want after graduating.) Do you guys think it's a big deal to choose one path over the other just for the sake of an 8-week externship? Again, thanks to all that have already replied.

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Oh and excuse my ignorance, but what does the "OP" stand for that everyone keeps referring to? :uhoh21:

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Still wondering why people think med-surg isn't a specialty...?

My apologies. I am an older nurse and in my younger days "specialty" meant critical care. You're right, medsurg is a specialty.

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Specializes in ICU.

The choice is entirely yours, of course, but I would recommend a year on a med/surg floor before going to ICU. However I would STRONGLY recommend picking a ward that is highly acute and extremly busy, not a pedestrian sub-acute ward. For this you will have to do your research.

I consider myself to be a specialist in medicine. I do NOT do surgery, except for the occasional post-op BKA or unexpected E1. I work on a ward that is extremely intense, to the point of having an average of one code per day on this 30 bed unit. It is said that if you can survive here, you can survive anywhere. Our nurses are heavily recruited into ER and ICU due to their experience and comfort with unpredictablity.

Here you cannot get into ICU without 1 years experience and another 8 month fulltime course. I agree with this as no brand-spanking newbie nurse is going to be ready for the full on assault that is our tertiary care ICU wards. It would simply be unsafe. In ER, a new grad nurse would spend a year in Observation and minor treatment, before more intensive classroom work and eventual progression to stretcher bay. Rescusc is only manned by nurses with years of experience.

However, on our ward, with all the codes and instability, you get to experience "rescusc" and ICU like conditions hands on. After a year of this, you'd be more than ready for ICU, but not before.

Anyway, I can only speak from personal experience, but there is no shortage of excitement and complexity on this medicine ward. Medical residents cry when they find out they are assigned here.

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