First Job

I always say get a really good baseline. One in which focuses on your assessment skills, the "whole" picture, learning how and why people present the way they do, the course of care.

This can be learned in a variety of ways, however, I would start with a really good foundation. THEN, you will be in the place to specialize, then continue your education as you see fit.

And I would focus on your foundation and your willingness to certify before I would throw in the part about CRNA, flight nursing, or your NP. Which are all awesome goals, but not something any number of facilities will invest in right off. "I have any number of long term goals, however, at present and going forward, I would like to be able to firm the foundation of my practice."

Best wishes!

Usually there are requirements before you can enter a specialty in Nursing. For instance, most CRNA programs require you to have so much critical care experience. To get the critical care experience you need so much of med surg etc. In Nursing there are very few short-cuts to get where you want to be. I applaud you for wanting to continue your education, that is something that you really seem to have a drive to achieve. You have to "pay your dues" in the clinical areas before you can excell. If you can get into a specialty area as a new grad that might speed up the process a little, but as the above poster stated, getting your basic foundation first will help trememdously in growing the rest of your career.

Thank you both, as I have researched and can regurgitate the requirements for all the specialties that I am interested in. My question I guess was stated vaguely, but was intended to get a response of experiences on these floors. I have been looking at ICU positions, but not many hire directly on to those floors, as you have stated, you must pay your dues. That is not always the case I have been talking to admission coordinators for a couple grad schools and they wanted me to apply as soon as I received my license. Obviously this was not for an ACNP or CRNA, but a FNP. But thank you for you input. To answer my own question I'd probably have a better chance moving in to an ICU from a PCU as its a step-down from the ICU.

I'm not going to give you the "new grads work med-surg nights for a year" line, but going from complete fresh new grad with no other med background(i.e. medic to RN) into an ICU or equivalent is reckless staffing by a facility. Get a job on a tele floor, if you're capable(which you sound like you are very determined to be) you can quickly get a solid base knowledge to move into step down units. Critical care managers love experienced nurses but not set in their own ways.

My first RN job was ICU, it's a great foundation for other opportunities (I'm in ER now). Since you don't seem certain of what you want to do down the road ICU is a great option. However, don't turn down a set job for a maybe job. PCU/Tele are great opportunities to learn and grown as a foundation for ICU or whatever direction you want to go into.

High tense and critical decision making, some may not agree with me, but ER in a trauma center fulfills that for me more than my critical care jobs did. Not only do your direct skills such as IVs have to be on par, you often need to critically think different aspects and suggest to physicians such things. My ICU patients were typically more stable as they already had most direct interventions completed and were on the medications they needed to be. My ICU patients required close assessment and lots of charting. ER is more assessment and lots of doing. So it's just a personal preference of charting versus tasks.

Sweeney, Nicki thank you both for your opinion and non-bias attitude towards my limited exp. I was on a CVICU for my preceptor and managed well, my pts and their families enjoyed my help. Not to say I didn't have a preceptor with me, but I brought up many problems in my assessments that were brought to the attention of the physicians and were followed up on successfully... I'm not saying my skills are fully developed, I know there is much more I need to learn that was not fully covered in school (how can they cover everything!?!?). I hope my ER interview goes well tomorrow its a dream job!! In a city I love, Detroit!

Well everyone, I got an offer on a CVICU and accepted it!!! I'm stoked! What a great opportunity and I am so happy! Thanks for your support and advice.