Career options for MSN?

[prenursing359]

I am a new grad and started out my nursing career in a very intense, high acuity cardiac ICU. I attended a 2 year nursing program that was a master's entry to nursing practice program, so I came out of nursing school with an MSN. Orientation for my hospital is 12 weeks long and the expectations were very high. At the end of week 9, the management and I decided that maybe it would be best for me to start my career on the cardiac step-down unit so I am in the process of transitioning there. It was very difficult learning how to be a nurse and how to be a good cardiac ICU nurse at the same time. They feel that the step-down will be a better start for me. The funny thing is I moved here from out of state due to this ICU position. However, in just those 9 weeks, I realized that I enjoy stability in my work environment and I get overwhelmed by all the curveballs thrown my way during a typical work day in this busy ICU. My initial plan was to work in the ICU and become a great ICU nurse first and then apply to CRNA schools. However, now I'm thinking that maybe ICU in general or CRNA is not the best career choice for me. I love learning about critical care but the uncertainty and lack of stability scares me. For example, I get very nervous when my patient suddenly goes into A.fib or they start to desat and I almost feel like I don't know what to do. I am considering maybe going a different route instead after getting some experience on the floor like perhaps management or health administration? Maybe even nurse research? I know little about these career opportunities and was wondering if anyone could provide me with some advice and/or insight into these options? Thanks!

[Rose_Queen, BSN, MSN, RN]

First, being overwhelmed is completely normal as a new nurse. The first year is the most difficult. Each time you change jobs, especially into a new specialty, it's going to feel like starting over.

Those management and administration jobs are best based on a good solid foundation of being a floor nurse. Not just a year or two, but several years. It's difficult to manage something if you don't have a very thorough understanding of what it is you're managing.

Under the career section, there is a forum for first year after licensure. I'm sure you can find some support, tips, and tricks in the posts there.

[WestCoastSunRN, MSN, CNS]

I second Rose Queen's thoughts/advice. I like to think of this in terms of Benner's Novice to Expert framework -- it takes a lot of time/hours/years to move through those stages and you cannot hasten that progress (well higher acuity helps you move forward in critical care environments quicker than lower acuity, so that caveat).

If you are at a high acuity institution, your step-down is going to give you LOTS of great learning experiences and chances to learn how to practice confidently when things go south quickly with your patient. I have been doing this for many years and I am never nonchalant/relaxed when my patient starts decompensating or looking sick -- and certainly not when I am actively keeping them alive the whole shift, as is often the case in the ICU). Critical care is not everyone's cup of tea, and truthfully, I know there will be a time when I no longer want to have that particular kind of stress. But I know transitioning to something else will put me back in that Novice category again, and that is going to be a whole other kind of stressful.

So it takes time, no matter what you're doing. I think if new nurses can get this through their heads and make allowance for that, and support themselves/take care of themselves as well as they can during these transition times, a lot of nurses will experience breakthrough (and even joy!) once they realize they are a bonafide competent or proficient "ICU/OR/WOUND-OSTOMY/PEDIATRIC/STEP-DOWN/MED-SURG/FILL-IN-THE-BLANK" nurse.

My advice to you is to spend some real time in that step-down and really go deep into growing your practice there. What is going to come next for you after that is going to be much more clear to you after you've given yourself time to actually be a nurse and grow in competency. The world is not going to pass you by as you do that, I promise.