Do I go with my heart or my mind?

[jenj1928]

I'm in the last year of my BSN degree and I'm applying for preceptorships and future GN opportunities and I'm trying to decide which way to go. My two favorite career path choices are in totally different directions, one is ICU and the other is towards midwifery. (I will be doing my masters degree either way) but with the ICU it stimulates my mind, I really get to think about the science behind the patient and I do truely enjoy that, I'm one who will always be looking for the challange and I have to be challenging myself, that's the basis for the masters as well, I set my limits high and always achieve my goals. My clinical instructors have said numerous times I'm very determined and will get where I want which may even include CRNA if I stick with the ICU path.

But then part of me really wants to look into labor and delivery and go for the certified nurse midwife degree, I had a clinical in L&D and told my instructor that I never wanted to go back, I was frustrated by the medical interventions to such a natural process. If the're not going fast enough give them pitocin, throw them in bed, monitor constantly (I know it's necessary with pitocin but they even did it for non pit deliveries!) encourange epidurals, give 'em all a foley, after delivery the moms never held the babies for over half an hour! and if the blood sugar was a touch low shove a bottle in them even after mom says she wants to breastfeed. No one walked, used a tub to relax, music, etc, heck the rn only went on the room to up the pit and then walked back to the monitor station to watch her patient only to wait another fifteen and up the pit again! get em to 20 so they go faster! ARGH!!! the rn's were even joking about who was going to get their patient to deliver first, it was a race and very frsutrating. So as you can tell this is something I feel very strongly about but I don't think it will ever change and even more reason for me not to go into that line of practice and frustrate myself further. Or do I go it trying to change the world ( not very realistic but...) with the ICU I don't want to say that there's no emotional attachment because that sounds wrong but it's not like I'm against ventilators of vaso drips or anything like that!LOL! It's teh right place for all the medical interventions and it does fascinate me how fast pt's can react to vaso drip changes etc... It would just be the science of nursing and of course there would be the personal touches and dealing with families and all just not the passion and personal emotional attachment I'd have to midwifery.

so I'm really torn and don't know what to do. and please don't say do med surg for a year or two I honestly don't believe that is necessary, I went for my BSN to get the advanced chem courses, advanced assessment and critical thinking pathways. They have encouraged us that "finding your specialty" interest and going for it is okay, it is a different world of nursing now. I'm working in ICU as it is so either I stay or jump ship and do the extreme.

So for those of you who are RN's what did you go with, head or heart? Did you regret your path? find it hard to change later on? What would you tell to a new RN (but not a young RN without life expereince here, I've spent my time doing other careers enough to have 1/2 a clue anyway and three kids to fuel the passion of the one choice!)

Thanks for you insight

[RN1989]

That is really hard to say. Write out the pros and cons of each position and see which looks better. As a CNM you will have a little more autonomy - but if you go the other route and eventually do CRNA/CNS/ARNP you can have some autonomy also. Not sure what to tell you because I don't know you so I can't say what I think you would be happier in.

I will tell you that your views on OB really struck me. I knew an OB nurse who was so fabulous. She believed in the hands-on stuff and did all that stuff as much as she could within the hospital system. She taught me some great stuff. I watched her do massages and helped prevent most all of her patients from tearing or needing episiotomies. She taught those new moms tons of stuff, instead of sitting at the desk all the time. I felt like she really made a difference in her natural, human touch approach.

Having worked the units as well as OB, I can say that they are vastly different. But my critical care skills helped me when taking care of seriously ill PIH pts and OB skills helped me care for pregnant women in the ICU.

Write things on paper so you can see something tangible. Say some prayers and see where you are led. Good luck!

[Pistachio]

I can't tell you what to do only you know what's going to be best for you. I do however want to encourage you that you could make a difference in midwifery, if you get an advanced practice degree in some states you could practice independently. Thereby making better care avalible to women who want it.

[llg, PhD, RN]

I think you are missing a MAJOR point in your deliberations. The intellectual challenge and science of L&D and midwifery should be just as stimulating as an ICU career. To practice maternity nursing otherwise is to do a great disservice to your patients.

Don't confuse "science" with the use of high technology and/or a highly interventionist approach to maternity care. The way you establish guidelines and standards that support the types of maternity nursing you wish to practice is by doing the research necessary to show that such practices are safe and effective. That is every bit as much of an intellectual challenge as anything ICU has to offer.

Both ICU and Maternity can provide wonderful career opportunities and ways to use your intellectual skills to help patients. There is no need to choose career paths on that basis.

So ... once you see the intellectual and challenging aspects of maternity nursing -- and see that it can be as stimulating as ICU -- does that make a difference in your deliberations.

[deeDawntee, RN]

I have always been a heart person. I love your vision for midwifery. You could really make a profound difference.

You could always supplement your career later with some per diem ICU work when you get the itch to learn some more stuff. I have been an ICU nurse for about 18 months now and to be honest with you, it is a pretty specific set of skills, and it doesn't take that long to become competent. (mastery is another matter, like any other area in nursing, can take a lifetime!)

I am looking at doing some cross training now myself, interviewing for a position in a trauma ED. Nursing is great that way. You can fashion a career almost anyway that you want.

I say heart, heart, heart!!! :heartbeat:heartbeat:heartbeat ;)

[jjjoy, LPN]

I doubt it has to be one or the other... you probably can't do them both at the same time, especially straight off, but maybe you'll have the opportunity to do both ICU and midwifery!

My thoughts are this... I can see where you'd feel there's plenty of room for improvement in L&D. As a newbie, though, you couldn't come in and change everything right off. Given how frustrated you were with your student introduction to L&D, how would you feel about working with that 40 hours/week, month after month? And if you could find a unit that treated it's patients in a way that you felt good about, do you think that you'd like to work there full-time? Or is the motivation to want to see it done better than what you saw?

My bias is that there are many areas about which I feel passionate and would like to make a difference. But when it comes to full-time work... the day-to-day drudgery and stress that they pay you to put up with... well, we all have different tolerances. For example, I love teaching, but much to my own consternation, I've realized that full-time teaching wears me out. And then I can't be the teacher I want to be. Can your passion for midwifery withstand the reality? Maybe it can!

Another bias of mine is that I'm very science-minded and thus tend to find the immediacy of and distinct focus on the physiological balances and imbalances of critical illness to be very stimulating. And for me, I think maternity would be really neat to learn about and be a part of for a short time or on a part-time basis, but I don't think it would hold the same interest for me if it were my full-time job... clocking in for the 1000th time, checking my day's assignment (what do you know? another couple of laboring mothers, just like yesterday, like last month, like last year)... But that's just me! Others think it's a pretty darn neat job to go to each day! There are things that I enjoy that others find monotonous or whatnot. Do you have any sense about that?

Anyway, that is my take on what you wrote. The reality of where you are and what you want may be totally different. You don't have to decide this today or tomorrow and you can always change your mind or change your job in the future. It may take a bit longer if you don't go straight for this or that goal, but it takes time to figure out what direction to head and there's nothing wrong with taking a winding path. And who knows, the local job market may also influence your initial job direction.

Good luck with your future career! I'm sure you will do great no matter where you end up!!