Decisions for a student

[Blueorchid, ASN, RN]

For the past four months or so I've been working as a tech in the ER along with nursing school. The hospital isn't your level one trauma center- we see the rare gunshot wound and chest tubes, seizures, overdoses, strokes, and of course your basic codes, but none of the crazy traumas like long bone breaks or limb amputations. In fact the most trauma the hospital gets is hand related (we have a nationally recognized hand center).

And while I have good days and bad days, I really like working in the ER. Our department is split into two different sections, an area for low priority patients with colds and the flu and then a main side for the ones that come off the ambulance. I find myself more excited to work on the main side and I enjoy being on the move constantly and checking back with patients I help out with just to make sure everything stays alright. Not only do I get the experience of handling multiple "patients" at the same time, but I feel that by seeing patients down in the ER as a student, it really helps improve my assessment skills.

I think to myself that I'd eventually like to end up as an ER nurse. However, I would also like to graduate with a masters one of these days. And I'm thinking I'd like to get an Acute Care Nurse Practitioner degree. Granted I haven't done extensive research into an Acute Care NP (this doesn't mean I don't know anything about it), but I am aware of the requirements for my school, one of which asks for 2 years or more of critical care experience.

I'm currently in my junior year of nursing school finishing up my Med Surg rotation on an intermediate care floor. That clinical is done at a level one trauma center where we get some of the sickest patients in the state. They're transferred to my unit from critical care but I know the practice the nurses exercise on my clinical floor has many of the same components that critical care does. The patients come in with chest tubes, Foleys, plenty of ortho devices, ORIF, external fixators, nasogastric tubes, loads of drains (my care plan patient), drips, and PCA pumps. I enjoy knowing the little details about those patients, why their lab values may be elevated and keeping all their electrolytes in shape as well as catching little details that might be a precursor to something else going on.

The position I'm in as an ER tech is at an entirely different hospital. But that job comes with an offer that once I'm in my senior year of nursing school (which starts in December) I can take on an extern position that will pair me directly with a nurse and contracts me to work on the floor for a year after graduation.

Currently, that puts me to work an extern position in the ER. However I've recently been thinking that if I were to do a CCU externship, I'd have a critical care job right out of school which would put me on my way to a masters. I am aware of the taboo about burnout and how many nurses often suggest that new grads work a med-surg floor or something less intense before moving their way up to CCU or ICU. My school does not consider the ER critical care either due to the rate of patients that come in with less than "high priority" cases.

Initially, part of me was willing to jump at the chance to take a CCU position. But having worked in the ER for a little while and finding that I really do like it, I'm suddenly reluctant to change floors. I know the value of taking a position outside my comfort zone. When I'm challenged in an area I find I work to the level of my peers. But I feel like I'm learning a lot in the ER as it is. Eventually I'd like to move to a hospital that deals with more trauma-based cases but I think right now I might just be looking too far down the road.

Does anyone have any advice for a student like me? Would you recommend going through the ER for a few years before heading to a CCU or ICU? Or should I go there right off the bat?

PS. Advice or personal experiences would be great. Comments like "slow down newbie" might be understood but not as helpful.

Thanks!

[MERRYWIDOW46]

YOU DO realize you just informed everyone who reads your post where you work by the wording of the trauma seen in your ER and what it is about. I worked in your ER. It will give you GOOD basics to build on. Your critical care unit is very clicky and caddy, if you can handle that by all meas go on and do that. CVICU is a good and respected unit and you will learn alot there as is the CVStep-down unit. CVStep-down has competencies to do things that no one else in the state have been cleared by the BON to do, I worked there also.

NOW, for the 50million dollar question, should you pay your dues and work Med-surg or do an internship in CCU. Well, there are pros and cons to each alternative.....make a side by side list of all those. ONLY YOU can decide what is best for you. Consult a trusted clinical instructor about your clinical skills and if they think you are ready. Ask the CCU manager if you could spend a day or two with one of her nurses to see how the unit works.

Your current manager,(unless she's new since 2008 and I doubt that) will be supportive and have your best interest at the forfront and be understanding.

The hierarchy is Critical Care, ER, Step-down/IMCU/TELE, then Med/Surg.

Even though your school does not view ER as critical care it is a high acuity, high mortality unit and requires the skills of a critical care nurse. However, you will not consistently be dealing with Vents and Drips.

I am sure you will do what is best for you. Follow your heart, be honest with yourself and others and you will do well.

Good Luck.

[sunnycalifRN]

blueorchid,

you couldn't ask for a better response than the first one; familiar with both hospital and management.

[MERRYWIDOW46]

blueorchid,

you couldn't ask for a better response than the first one; familiar with both hospital and management.

Thank you SunnycalifRN, now I am blushing. I merely stated the facts and gave advice that I would hope was helpful. The key to true happiness is always to be true to yourself, your own values and desires. Honesty always is best. Thank you again. I didn't do anything special.