ICU ARNP vs Neurosurgical ARNP

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    its been a while since my last post but i have a choice to make and hoped the input of other advanced practice nurses might help.

    I find myself having to choose between to jobs. the first is a critical care nurse practitioner in a pulmonary intensivist group. i would have my own assignment of about 5 patients daily. there are morning rounds, then we present patients to the attending, then early afternoon we do consults and procedures (lines, spinal taps and intubations mostly) and have family rounds after that. I would have a decent amount of autonomy. The group is very pro NP. there is a lot of opportunity for education as the group does a lot of research and seminars

    The second position is a neurosurgical position. i would round mostly on patients in the icu, some clinic and would see new consults. i would also get some OR time which would be new to me. I wouldn't have as many procedures but I would be trained for ventriculostomy placement (also new to me)

    Ive been an ICU NP for a couple years now and really like it, but the thought adding OR time and ventriculostomy placement to my skill set is really appealing, not to mention its a very focused specialty. Any thoughts?
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    I can only tell you my stance as the sole Orthopaedic NP in town. I absolutely LOVE being in the OR. I met some opposition originally since it's such a PA heavy field, but I'm now accepted freely. Neurosurgery is such a specialized field that if you can break into it I don't think you'd regret it.
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    I am a neurosurgery NP, and absolutely love it. I round in the hospital including the ICU, consults, clinic, and first assist in the OR. The OR is my favorite part of the job. With your valuable ICU NP experience, you will be able to pick up first assist skills very quickly. I think receiving another specialty experience will only make you an even stronger NP, as well as more marketable. You might even be able to work out with the neurosurgery job, a way to keep up your ICU procedure skills. I have seen that happen before where they let a surgical NP in the ICU do intubations, LP, chest tubes, every so often to keep up their skills.
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    So I am a Neuro ICU NP. Our team admits our own patients to the Neuro unit (seizures, Myasthenia, MS, Stroke, etc) but then we are also the critical care consult for all of Neurosurgeries patients and co-manage them while they are in the ICU. I love my job because I am only in the ICU. I'm an ICU from before my NP days and can't imagine being anywhere but in an ICU. I had NO desire to do clinic time, but admit that sometimes I wish I got some OR time. I get to do bedside procedures up in the unit (LPs, Central line, arterial line, etc) but I don't actually get to go to the OR and even our bedside EVDs are placed by neurosurgery. My advice would be pick the job that sounds better for you. Are you okay with doing some clinic time and being out of the ICU to go see Neurosurgery consults? If you are then If you want to add OR skill and EVDs to your skill set then go for it! I know I would enjoy the OR time and EVDs but I would not enjoy seeing the neurosurgical population once they are out of the ICU (but I wouldn't enjoy seeing anyone outside of an ICU) So, weigh the pros and cons of each decide which one has more of the things you want in a job


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