Quick advice on multiple unit offers!

OrganizedChaos, LVN · Jun 14, 2016

Wow lucky you! I know you are just starting your GN residency but where do you see yourself in the future?

parasalyne · Jun 14, 2016

Hello! Ultimately, I want to be an ER nurse. I was really blown away by my experience in the ER. But like I said, I still have studies to think about, so I really do not want too much to overwhelm me while I'm still beginning.

Thank you!

NightNerd, MSN, RN · Jun 14, 2016

Dang, that is awesome! Congrats on all the offers! I would give the most consideration to MICU, Onc, and Med-Surg. I think those are the places that tend to best solidify general skills and critical thinking, both of which you'll need in the ER. I feel like an observation unit is not going to be great experience for what you want to eventually do. I don't know anything about the gen surg bariatric; that sounds very specific to me, though. What would you do there?

An experienced nurse friend of mine has told me that with ICU on your resume, you can do pretty much anything. I recently had a couple interviews but ultimately went with the more general Med-Surg. MICU sounded awesome, but like you, I hope to go back to school in the spring and want to succeed at both pursuits. Just my two pence, as someone with similar goals.

nutella, MSN, RN · Jun 14, 2016

I went to ICU as a new graduate nurse and loved it. It was a steep learning curve but it definitely a great environment. I liked that I was able to focus on only 1 or 2 patient ("real" ICU - not a tray ICU where most patients eat...). Most patient were intubated and sedated and as soon as awake and stable enough transferred out. Families were usually grateful and only very occasional giving me a hard time, physicians were usually grateful as well.

But some people do not like ICU /critical care ...

Bariatrics - I floated once to a bariatric floor and most patients were walky talky and motivated - though I found it hard to figure out the diet and such (because I was a float...) I do not know if I would want to put in foleys daily on such a floor.

Onco is also good with great options to further your career.

blondy2061h, MSN, RN · Jun 14, 2016

I started in onc and feel like it was a great place to start. I got loads of experience giving blood products, antibiotics, dealing with multiple IV lines, TPN, trachs, tube feeds, chest tubes. I really got experienced at seeing abnormal labs- and understanding their significance. In oncology you see a lot of oncology specific emergencies- malignant hypercalcemia, sepsis related to neutropenia, cord compression. My oncology unit was a critical care unit when I started, and later was transformed into a step down unit.

parasalyne · Jun 14, 2016

Thank you for your response! A friend told me that bariatric surgery would be more like post-op pts; pain meds, ambulating, diet etc. I do think it's also very specific. I had clinical rotations in MICU and it was laid back (at least the 3 days that I was there) but I reckon that's not always for the whole unit; there was also enough diversity in that 10-room unit.

Thank you again and good luck in your future endeavours!

Cricket183, BSN, RN · Jun 14, 2016

I started out in oncology and loved it! So much so that I spent my entire career there. It is a great place to learn a vast amount of skills, everything from hanging blood products, IV ABX, TPN, chemo, lots of IV pain meds, chest tubes, NGTs, ostomies, CBI, wound care, port/PICC, gtubes, trachs, chest tubes, etc. You are exposed to a lot of abnormal lab values. You also do a tremendous amount of patient teaching and psychosocial support. You get to know many of your patients & their families over time as they are often admitted repeatedly. It is a very rewarding area in which to work. In my experience, cancer patients are usually much more appreciative and less likely to whine & complain about little unimportant things. Thay are some of the most inspirational people you will ever meet.

Lev, MSN, RN, NP · Jun 14, 2016

I would go with the unit you are familiar with that seems like a nice environment - MICU - but make sure you do more research before accepting a specific unit. I would want to know how many weeks of orientation you will be getting for each unit and also ask to shadow on the other units - CV intermediate can also be a good idea.

I would avoid a unit that only takes bariatrics because it is very very specialized (I worked on a general surgery unit that took bariatric patients) and your friends mom is not correct about the NGTs - you will not be placing them - if they come out of surgery with them - which is rare you will be managing them. Bariatric patients can usually only get NGTs placed by an MD, preferably their surgeon - and that goes for life. They also don't come out of surgery needing a foley. They are usually very motivated to get up and moving.

Obs has a very fast turnover - usually walky talky "easy" patients that will be discharged within 24-48 hours. If you looking to learn something for the ER I would not go there.

blondy2061h, MSN, RN · Jun 14, 2016

The nice thing about the obs unit is some hospitals' obs units are connected to their ER- physically, staffing wise, and management wise. If you want an in for ER, look into that.

calivianya, BSN, RN · Jun 14, 2016

I started in MICU and I am still there - albeit a different MICU. My personal opinion is that it is the be all end all of learning a little bit of everything, but I am very biased. You obviously learn ICU care - but your average patient is 60 to 80 years old with every comorbidity in the book, so there is no disease process that is off limits to learn about.

Just to give a brief idea...

We take pregnant and postpartum eclampsia patients as there is not an OB ICU at my facility. We occasionally have the violent pregnant withdrawing patient as the OB unit does not like to handle DTs. I have had a placental abruption patient who was bleeding out. I have hung chemo when no chemo certified nurse was available to come help us. When neuro ICU was full, I assisted with putting in a ventriculostomy once. We take stroke patients post tPA, cancer patients, bariatric patients, pain management patients (and actually my unit takes people from hundreds of miles away for a specialized pain medicine treatment), and of course hypertensive patients, heart failure patients... anything you can imagine. We take peds occasionally - as long as they are 15 and up. They usually come to us for DKA. I had a suspected CJD case once - never found out if the guy was positive. I've had several "mystery" patients who were sick and near death but nobody had quite figured out what was wrong with them yet, which is always fascinating.

If you want to learn to assist with procedures, there are a ton of line insertions, chest tube placements, bronchoscopies, EGDs, etc. at bedside. GI lab usually brings their own staff (and anesthesia) so they don't really need you around, but they'll let you watch. RT does the main assists with the bronchs, but RT does not push sedation - so you are still an active part of that procedure.

I just think it's a really great place to start out because you could branch to anywhere after MICU.

bebbercorn · Jun 15, 2016

I started on a floor that did a lot of post op bariatric pts... they were, by far, my favorite patients to take care of. 1) They weren't there because they were "sick." 2) They were embarking on a new, positive journey and were almost always excited about getting started. 3). Not too many orders... especially with the surgeon that did them... no IV pain meds, never had an NGT, it was scheduled, ambulate, medicate, give PO at a certain hr... etc. However, 18 months in, I felt like there was not much more to learn (I feel like this will be where I go to work when I am close to retirement). MICU, on the other hand, will blow your mind! If you ultimately want to do ED, MICU, Med/Surg or even Obs is a good place to start (high turnover, will help you determine lower acuity pts). Congrats on aceing your interview, and good luck!!!