Am I thinking this through properly? New grad ICU/ED

[TammyTho]

Hello all, I need to make sure my heads on straight and I'm not missing any aspects of this so I came here :).

Little background, 42 mom, grandmother, have owned businesses, managed companies and now that my kids are out doing their thing, I have finally gone back to school and graduated with my nursing degree. I have been working as a tech on a med/surg floor throughout nursing school and while my manager has offered me a position, I know that is not where I want to be as a nurse, it's just not me. I have also been a float tech and worked in the ICU where I am amazed at the acuity and knowledge base there is to soak in and an ED tech and love the hustle and bustle and unknown of the ED.

I have been offered two different positions in the last two weeks, both full time midnights, different hospitals - one in a level 2 ED where I haven't worked but have heard amazing things about the manager and staff, they have offered extensive ED internship/training and one in a step down/ICU overflow floor with a manager I know and respect (and who loves my work) who has also offered extensive ECCO training as well as additional orientation time in the ICU so I can eventually pick up shifts there.

This is where my brain waffles and I need your assistance. Part of me wants to take the ED opportunity, to soak in the crazy and either thoroughly enjoy it and know I've found my place or at least get it out of my system. I enjoy being busy, the unknown, the traumas that come in and the team work of the ED. The other part of me wants to take the stepdown/ICU overflow position to be part of the long term care, take excellent care of those who need it most (and their families), soak in the details of the different disease processes and continue to expand my knowledge base. I enjoy researching the details of what is happening with my patients, the whys, the hows, the what ifs. I honestly love the idea of both of these decisions and don't know how to decide. Right now (at this moment as my mind changes moment to moment) I am leaning hard toward the ICU as I believe that if it ends up to not be my place it would be an extremely marketable skill to have in the search for where I belong while the ED may not give me the same marketability if I find that isn't my place.

Thoughts? (other than start med/surg first because I'm not doing that :))

A million thanks in advance!

[OldDude]

I know several people who have transferred from the ED to the ICU but I can't recall any that have done the reverse; I'm sure there are some out there. It's my opinion that working in the ED, especially as a new nurse, develops independent critical thinking skills and the confidence to enhance your nursing track regardless of which road you take.

[amzyRN]

In both the EDs I've worked in the people with prior ICU experience got rotated more to the critcal care rooms (resus/trauma). The new grads who started in the ED and the people who worked on floors not familiar with vaso active drips, how to take a CVP or familiar with hemodynamic monitoring had to work up to get that experience in which it might take a full year to be put into a challenging assignment. Sure you can help with codes and such, but to get to be the primary nurse assigned to one of the critical care rooms, your skills needed to be solid (ie, you can start a line quickly and accurately, are fimilar with vaso active meds, know your ACLS and PALS where you could run a code if you needed to, and know how to manage the patient after you restart their heart. The IV skills and time management are things that might be more tough for an ICU nurse I think, but those can be gained relatively quickly. This is just what I've observed, but I've only worked in 2 EDs and my combined experience is less than 2 years so I am by no means an expert. If I had it to do again, I may choose to go to ICU first then the ED because then I would have the ICU knowledge I can apply to critial patients in the ED. I think you've got 2 great opportunities and you probably won't go wrong with either one. I think having experience in both ED and ICU will make any nurse much more marketable.

[JKL33]

More and more I'm beginning to think the best place for new grads is wherever someone will actually care about their overall development and will offer a substantial and organized orientation. Culture is something that is unit-specific.

So in that regard, I'm not sure you can go wrong here. I guess I would review both of them for any culture-related red flags and then go for it.

Good luck; let us know what you decide!

[Lunah, MSN, RN]

Congrats on having options, I am sure your work ethic spoke for itself! Good luck!!

[Guest219794]

While both promise good training, and sound well intentioned, you should look past that. Look at the actual track record of each. If both have a significant record of new grads doing well, ask to job shadow a day in each.

[vegechik_RN]

First of all, congratulations on having such a great choice to make!

My two cents: I started as a new grad in an ED two years ago, and switched ED's about 6 months ago when my husband's job relocated him. I have had the benefit of being a newbie in two different environments, and seeing two ways to train new grads. I think there are two important considerations to make: First, how does each department train its new grads? How long is the training program for each one? (I would recommend 12-16 weeks for a new grad critical care nurse). Is the training department specific, or are you lumped in with other new grads from med-surg and other units for your classwork? In my experience, a lot of the general one-size-fits-all training is not geared toward ED/ICU nurses and it may not benefit you as much as your counterparts who are working the floors. Second, what is the atmosphere/environment/culture in each unit? (This might actually be number one.) Is it a team environment? Are coworkers eager to help teach and encourage new grads? Does it foster your ability to learn, encourage questions, and does it do this in a safe manner where you are not putting your license or your patients at danger?

I would talk to anyone you can find who is currently employed in these units, or better yet, nurses who have gone through the training in each unit. This might give you the best idea of what to expect, and what the strengths and weaknesses of each program are.

As far as ED vs ICU first, I know lots of ED nurses who are transplants from ICU. There is a definite "type" - these nurses are super smart, very knowledgeable, and always thinking about the hows and whys with their patients. The ones who successfully make the transition to the ED pace are amazing resources to have. I love to pick their brains about pathophysiology and specialized equipment/procedures.

You will ultimately decide which environment is best for you. If you enjoy the fast pace, the variety, the push to get patients through quickly, and the opportunity to be a bit of a detective, the ED is a great choice. Remember, you will still have critical care patients in the ED, along with peds, geriatrics, psych, trauma, med-surg and all the rest. If you enjoy spending more time getting to know patients, having the chance to analyze what is wrong with them, and watch them recover, ICU might be more your thing. That's another factor to consider: does the ICU you are considering have a variety of patients? Some focus more on cardiac, some have trauma, others have a variety of patients.

Ultimately, either job will make you very marketable, so it comes down to what you love and which is the best environment for you to learn and grow as a new nurse. Good luck with whichever one you choose! It sounds like you will be successful.

[TammyTho]

Thank you so much for this response, it is extremely helpful as the thing that I love about the ED is the trauma, the intense situations and it makes complete sense that as a new nurse I would not be in on those for a very long time. Gaining those skills in the ICU where I must have that knowledge just to function on a daily basis seems would push me in the direction I would want to be if I decided later that the ED was a better fit. Thank you for taking the time!

[thoughtful21, BSN, RN]

Job shadowing might be helpful. I've done it, and it went really well. It gives you an inside view of the department. You can learn about the work they do, connect with the nurses who work there, get a sense of the culture, and ask a lot of great questions.