NICU or MICU

  1. Hi All,

    I am a new grad, just finished my last test today! I have been offered two jobs and don't know which to take. One is in the NICU at a hospital I did my peds clinical rotation at. I fell in love with it while I was there. They said they would also train me to the PICU if I want. The other is in the MICU being cross trained to the CCU at a hospital affiliated with a university. Both are amazing hospitals. Both are teaching facilities. The adult care is a trauma center and the children's is a level III. The pay is about the same because one I would have to pay union dues and high parking fee. I just don't know what to do. I am drawn to them for completely different reasons. My left brain loves the university setting, MICU/CCU, broad knowledge, fast pace. My right brain loves the children's setting calmer, dim lights, babies, nice people. I am a type A personality, straight A's, love to learn, assertive, confident. I am so attracted to the amount I can learn in the MICU/CCU. The knowledge is so broad and I love how the ICU nurses know their stuff. In many cases they seem to run the show with their patients. I just mean it is amazing how they are so smart about so much and can handle all sorts of patient situations. I am also attracted to the hospital and university reputation. They are rated 5th in the nation and #1 on the west coast. I know I will see things there that I will not see other places. I know that after working there for a period of years I will have so much knowledge and that totally excites me. I also read all the info here that says that ICU nurses are burnt out, which scares me. Unfortunately, my school did not give us an opportunity to spend a great deal of time in the ICU and I did not get to go to this LA facility at all because my school is in OC, CA. I did get to spend several weeks at the peds hospital in the NICU though. I can't explain how I felt. I did not want to leave. All of the other students were bored and I was so facinated by all I was seeing. I forgot to take my lunches because I was so into what was going on. I love how the nurses get to teach the parents how to take care of their babies (illiostomy etc..) I love the high acuity level, but the calm. I felt like I had known the nurses for years, they were all so nice. This hospital also has an amazing rep in OC for peds, the best I think. It is only a peds hospital though and the LA facility has adults and peds. I am worried about limiting myself if I go right into NICU. A lot of nurses say go ICU, that way you can get a job anywhere later. I mean MICU. I think from my research, the $ is about the same and they are both looked at as a highly skilled nursing specialty, I just don't know if one is better than the other to start with. I loved amost everything I did in nursing school so I was not "called" to one over the other. I love them both. Some say that the feeling I get when I am at the NICU sets me way ahead of the game and some say do the MICU while your young for the experience. I have to make a decision as I need to let the hospitals know. I have researched it endlessly, taken online personality test to match career (I'm forsure a type A), talked to nurses, my instructors and even called the critical care nurses association today to speak with an RN with experience to find out if one would have more of a shortage in the future versus the other. All of this and I can't make up my mind! CHOC or UCLA Westwood?

    Any advice would be greatly appreciated......thanks for listening!

    frustrated new grad :spin:

    PS-already tried the follow your heart thing. Heart says NICU, head says MICU!
    Last edit by randybayrn on Dec 6, '06
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  2. 10 Comments

  3. by   AJACKSON1048
    Run straight to the medsurg floor... I am an RN ICU nurse. I know it seems cool and great to have the places say they will train you. but the doctors expect you to allready know everything and trust me.. its a big responsibility. Those jobs will be there in six months and you need to learn priority and whats really important to the average patient before you take on a multisystem crashing patient that is depending on you to save their life. Your going to get to the ICU if thats what you want. Set yourself up for success not failure.. or being so crazy you cant learn what you need.
    good luck
  4. by   Jolie
    I am a NICU nurse, so I can't speak to the realities of MICU/CCU nursing, but I wanted to post to offer a different perspective to the reply above.

    I have the greatest admiration for nurses who excel in a med-surg setting. Why? Because it is something I know I could and would never do. It is fast-paced, backbreaking, and highly-pressured work. It is a wonderful specialty for those who are interested, but I also believe it is a fast-track to burn-out for those who aren't "called" to it. I do not support the notion that med-surg serves as a training ground for other specialties, ESPECIALLY NICU and peds.

    As a former NICU manager, I can assure you that most successful NICU nurses start out as new grads. Nurses with other experience, especially in adult health, often have a difficult time acclimating to the NICU, and "un-learning" things that are done differently with adults. Seek a hospital with a lengthy (at least 12 weeks) orientation that includes both classroom and clinical orientation 1:1 with a consistent preceptor. Find a job on a unit and shift that has at least 50% experienced nurses working at any given time. (By experienced, I mean at least 2 years NICU experience.)

    PICU is a unit which also draws the interest of many young nurses. In my opinion, it is a much more comprehensive unit, and orientation there may seem overwhelming to an inexperienced nurse. Having seen both units, I personally would suggest starting out in NICU, and possibly transferring to PICU after a few years if you still have an interest.

    I can't comment on the above poster's comment that med-surg is needed prior to MICU/CCU, but I would strongly encourage you to choose a unit as a new grad that is vitally interesting to you. Working as a new grad is difficult enough that I can't imagine overcoming the challenges of everyday worklife on a unit with a patient population that does not fascinate you.

    As far as the possibility of working on different units in different hospitals as a new grad: I would discourage this. I think it is incredibly important for a new grad to find a "home" where s/he has some sense of security, familiarity with the staff and physicians, a comfort level with unit policies and procedures, and knowledge of unit politics. Once you have a few years of experience and have developed a strong knowledge base, skill set, confidence, and sense of professionalism, then it is much easier to work on multiple units.

    Good luck in your decision making, and in your new career!
  5. by   cardiacRN2006
    Quote from AJACKSON1048
    Run straight to the medsurg floor... .
    Nonsense. You never need to see the light of day in med-surg, no matter what anybody says.



    Now, what a choice you must make! For me, I loved NICU too, but the thought of what one little mistake would do really turned me away from it. Those sweet babies are so fragile...

    MSICU is really, really fun. I've had some really intresting Dxs-mysathenia gravis, long QT, lots of dead bowel, suicide attempts, lots of rhabdo (desert crossers).....and all the other regular stuff. It's so interesting, never boring. If you get properly trained, and you have a little experience, then you should do fine. If not already, study up on rhythms, hemodynamics (swans, cvps, etc) and get yourself a good reference book specific to whichever field you are interested in.

    I say go with MICU. It's so fun and interesting! I really dig it!
  6. by   randybayrn
    I forgot to add that CHOC NICU has a 6 month classroom/one on one preceptor orientation period. UCLA MICU is 3 months of classroom/one on one preceptor. Both will extend the preceptorship if needed and both offer an RN mentor for a period of a year to continue helping you adjust. Both are teaching facilities and seem more than willing to help the new grad adjust. I just can't seem to pick between the two. The hospitals are both amazing as far as I know and the units both completely facsinate me. HELP!!
  7. by   Jolie
    Quote from randybayrn
    I forgot to add that CHOC NICU has a 6 month classroom/one on one preceptor orientation period. UCLA MICU is 3 months of classroom/one on one preceptor. Both will extend the preceptorship if needed and both offer an RN mentor for a period of a year to continue helping you adjust. Both are teaching facilities and seem more than willing to help the new grad adjust. I just can't seem to pick between the two. The hospitals are both amazing as far as I know and the units both completely facsinate me. HELP!!

    Obviously, I cast my (very biased) vote for the NICU. If it helps, one of my former co-workers started at CHOC as a new grad. Her skills and experience were awesome. She was most definitely one of the most well-rounded nurses in the unit where we worked together.
  8. by   GregRN
    Randy,

    I've seem time and again numerous people go straight from school to the ICU and do well. You'll hear too many people who say you need med/surg first and I agree that it's nonsense. You'll hear just as many people say that after a couple years of med/surg they are now in the ICU and feel like a new grad again. So, how well does med/surg really prepare you? You'll be fine going straight into the ICU.

    Now, that said, which ICU to choose is your dilemma. Let me give you this angle to think about: do you have kids? Are you planning on having kids any time soon? I work with a number of people in the ICU who started out in the NICU or PICU. All of them made the change to adult ICU because being around those kids so much made being around their own kids harder. They felt after a long day at work being around kids/neo-nates all the time made them less emotionally available to their own kids. It was truly difficult to "leave their work at work." This all changed when they made the switch to adult ICU. Just something to think about and consider...
  9. by   randybayrn
    I think I have decided to go to Children's Hospital of Orange County California because after reading many of the posts on this site, I think it might be an easier transition. I have been told that the trasition from new grad to nurse can be a difficult one without having to worry about other nurses being mean to you because you are a new grad in the ICU without med/surg. CHOC has a 6 month internship with one on one precepting. UCLA is only 12 weeks. I thought if I spend a year in the NICU and then train in the PICU that it will broaden my knowledge and prepare me a little better for the adult ICU. I also figured I may get a little more respect as a NICU/PICU nurse coming in over being a new grad. I will also hopefully feel comfortable functioning in a nursing role so I will be a little tougher. UCLA does offer 2/3 off tuition. I was thinking that I would get my BSN at CHOC through the on site Cal State Fullerton program. Then in about 4-5 years, I can transfer to UCLA into the adult MICU with some ICU experience, not as a new grad and with my BSN. After working there for a while I can take advantage of the 2/3 off UCLA tuition and get my masters. At this point after being exposed to quite a lot I will know what I want to get my masters in. I am really having a hard time giving up the UCLA thing though. I am a type A and UCLA just seems so exciting. I know I will be excited at CHOC too, it will just hopefully be a little less stress while I make this giant transition into the RN work force. Hopefully I won't have any problems getting into the adult ICU with only NICU/PICU experience. HHHHMMMMMMMMM decisions decisions! STILL ANY ADVICE WOULD STILL BE APPRECIATED.
  10. by   Jolie
    It sounds as if you have been incredibly fortunate to receive 2 good offers. That reflects on your preparation and interview skills. Be proud of yourself.

    Now, make a decision, make your phone calls, and then treat yourself to something nice: a massage, a new outfit, a night out. And don't second guess yourself. If you post again questioning your decision, I will personally track you down!

    Congratulations!
  11. by   KatrinaPM
    I PMed you about my experience but, reading your post, I think that NICU sounds awesome. (I wish I was in THAT nicu!) And 6 months is a great preceptorship, you're going to feel totally comfortable after you're done, and remember, you can always ask your fellow nurses about certain policies and about their opinions regarding care after your orientation as well. And if you still want MICU later, then go to MICU
  12. by   kate1114
    Quote from KatrinaPM
    I PMed you about my experience but, reading your post, I think that NICU sounds awesome. (I wish I was in THAT nicu!) And 6 months is a great preceptorship, you're going to feel totally comfortable after you're done, and remember, you can always ask your fellow nurses about certain policies and about their opinions regarding care after your orientation as well. And if you still want MICU later, then go to MICU
    I think I'm a little late to the table, since it sounds like you've made your decision. Congrats, BTW, on getting two great job offers! I think you had a lot of very intelligent thoughts going in to your decision.

    I've worked NICU, PICU, and now I'm working in a medical/neurosurgical ICU (adult). I worked in NICU exclusively for 6 years, then had a fairly smooth transition to PICU (while going through the new grad classroom orientation). After 10 years experience (mostly NICU), I started in September in the adult ICU. I want to emphasize that it is definitely possible to move from one to another, just make sure that you get a good orientation. With your background and attitude I think you'll have a great future Good luck!

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