I would second what cannew had to say. I know lots of people who started in PICU or NICU as new graduates. Some have done great and loved it. Others have struggled all along or had a particularly difficult first year. There is so much to learn in regards to assessment, technology, communication with children and families, medications, conditions, etc. I chose to start my career in a NICU step-down knowing my ultimate goal was NICU or PICU. I have never regretted this decision. I did this partly on recommendation of a friend who was a PICU nurse. She says that the nurses who started in PICU as new grads were good nurses, but she felt the nurses with prior experience, especially peds experience, had an edge even after the same total amount of experience. I feel like my first couple years of experience was directly related to my ultimate interest, but yet not the pressure of the critical care environment. When I made transition to our large NICU, I came in with strong assessment skills, recognition of normal, knowledge of neonatal conditions, communication and time management skills, and a readiness to take on the next level. Do I have some days that I am overwhelmed? Sure. But I feel like this transition has been very smooth overall, and I feel like as I am learning new things I can focus on the details and really understand rather than being overwhelmed with the many things to learn as a new nurse. I work with some nurses who started in adult med-surg. They brought with them confidence, time management, and an over professionalism, but I don't think they were able to translate as much of their knowledge. So....I would hands-down recommend getting some pediatric floor or step-down experience rather than adult med-surg experience.