Enjoy complications...which unit would be best?

[Joe NightingMale, MSN, RN]

I'm about to start on a med-surg unit, my first job as an RN. I'm planning to stay there for about two years, and then move onto something else. What, I'm not sure.

I find that I really enjoy it when something unexpected happens. One of my most exciting and memorable clinical rotations was on a Neuro ICU floor with a patient who developed increased ICP and had to have an emergency craniotomy. I can enjoy routine stuff too, like getting all the meds passed and all the charting done in a timely fashion, but when something starts to go wrong is when I really feel alive...doing multiple assessments, paging the resident, trying to figure out what might be going on, etc.

On the other hand, I presently work as a PCT on a rehab floor, and it's pretty boring; the vast majority of the patients are stable. It's only very rarely that something unexpected happens.

So what type of unit would most likely have these sorts of complications arise? I'm pretty sure it doesn't happen that often in med-surg.

Thanks.

[Tweety, BSN, RN]

Sounds like you'd be a perfect match for a big ER, especially a level I or II trauma center.

The thing about med-surg is you can never let your guard down...just when you think it's all about charting and passing meds, you realize that your expert assessment skills are extremely important. So never let your guard down, because changes while rare do happen and it's up to the nurse to recognize it and act and rescue.....or bet yet prevent complications in the first place.

[roser13, ASN, RN]

I agree with the idea of the ER as a great fit for you, although I don't know whether a new RN can start in the ER. I would expect that they might require some ICU experience first.

As an aside, I was very struck by your description of the atmosphere that really excites and intrigues you....that very same atmosphere is exactly what fills me with trepidation and anxiety. How wonderful that nurses come in all varieties!

[WalkieTalkie, RN]

ER or pretty much any number of ICUs... I work in the CVICU, and you never know when your patient who is doing seemingly well will suddenly start bleeding out, develop an arrhythmia, or any other number of issues.

[Koperen]

Neuro-Stepdown had way too many complications for my taste; I like a nice smooth flowing shift. Sounds like it might be right down your alley. I think we must be complete opposites because I enjoyed Rehab. You really got to know the patients and we all celebrated the tiniest accomplishments as they worked their way back from their injuries.

[cjcsoon2bnp, MSN, RN, NP]

Sounds like an ER or ICU guy to me. Its a good idea to get some Med/Surg. experience in before you go on trying to tackle either one of those though. Sounds like your going in the right direction.

!Chris

[Christen, ANP]

That's pretty much how I felt when I worked as a PCT on a M/S floor, and that's why I started out in the ICUs! Extremely rewarding, always changing, and you get to deal with the occasional unstable patient. I loved it. :)

[dcglidewell RN BSN]

Intensive Care, Emergency Room, or the Operating Room. Consider Nurse Anesthesia later in your career.

[PostOpPrincess, BSN, RN]

Level 1 Trauma.

[LovingNurse, BSN, RN]

ICU or ER. Believe me, Med/Surg has plenty of "complications" but the complication eats up time you absolutely cannot afford with 6 or so patients or an admit that just hit the floor. SOmeone bleeding, sugar bottoming out, chest pain, seizure, allergic reaction, etc. always seems to be happening when a new admit is coming up, or someone else is puking, a doc is on the phone, someone's iv infiltrated, someone else can't pee and needs cathed, a sundowner pt keeps climbing out of bed - etc, etc., etc.

Sometimes a resource nurse will step in and help on a complication so the floor nurse can attend to her other patients - which is helpful and very appreciated, but doesn't give the opportunity to handle a complication you might have wanted to handle had you just had time for it. (ha!) ICU & ER have ratios that take complications into account - Med/surg does not.

When I was first on my own I would always be assigned to the unstable patients or have the person with complications. It's baptism by fire, but I prefer water myself.

Good luck. :redbeathe:nurse::redbeathe

[NeoPediRN]

I think it all depends on how good your assessment skills are. If you go looking for trouble trouble you will surely find. I work on a major surgical/sorta trauma floor and the doctors are our best friends. We get orthos, bypass grafting, carotids, amputations, gyn, bowel resections, urostomies, chest tubes, TURPS, resection of malignancies, so many things. A lot of high acuity stuff with lots of comorbidities and potential for complications. A good amount of NGTs, some g-tubes, TPN/lipids, central lines, you name it. I've been there three weeks and already sent someone to CCU who ruled in for a large MI with a troponin in the 40s, seen two rapid responses who got sent to our level I trauma hospital for brain swelling/bleeding, lots of hypotension, lots of fevers, rhythm disturbances, abnormal lab values requiring interventions, lots of "I just don't feel right." Lots of close monitoring and equipmement/technology. I love it, I love to put my hands on things and be busy and 99% of the time so far has been. Today I didn't even have time to pee for 13 straight hours! I'm hoping to eventually do ER. I get a thrill out of finding and fixing or stabilizing and shipping.

[blondy2061h, MSN, RN]

Sounds a lot like my BMT unit. I feel like someone is always crashing or something.