HELP! Can't decide! ED or Cardiac

Nurses New Nurse

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Help, I am graduating with my RN in a week and I STILL do not know where I want to work!!! Unlike many in my class, I did not enter nursing school knowing where I wanted to work. The reason for my delay in applying is because I wanted to complete my senior externship in the ED. I loved the ED, I am a very social adrenaline junky and I love the fast pace. My externship was at a level 1 trauma center at a large teaching hospital in VA (They are currently renovating & expanding the ED). I would love to work there, and they do offer an internship program for new grads.

Here's the problem though, I know it would be wise to have a year of floor experience. In addition to emergency/trauma nursing, I have an interest in critical care & cardiac. So my considerations at the moment are the ED, HICU, cardiac stepdown, & burn/truama stepdown.

I recently had a shadow day on the HICU & on a cardiac stepdown unit at the same hospital ( It is ranked in USA Today's top50 for cardiac). I was initially leaning towared the HICU, b/c it would be wonderful experience to work in an involved cardiac unit as a new grad, in addition to the new heart hospital. The new addition will be state of the art, and I would be going in learning the new unit with everyone else (Also, not a bad thing to have on your resume as a new grad ;) ) The HICU was nice, I am sure it gets quite busy and you have greater social relationships with the patients. I am worried that I become bored though. A CCU nurse I recently spoke with said that if I like the ED, I would get bored in HICU, even as a new grad. Also, I question my ability to handle the greater psychosocial issue.

My other shadow was on a cardiac stepdown. It is a tele floor with CHF, CAD and post cath patients. They appeared to have a great support system on all levels of care, many new hires were in their 20's and 30's (I'm 24) in addition to many experienced nurses. This unit will also be moving to the new heart hospital. However, it appeared very quiet with a slower pace.

My last consideration besides the ED is a burn/trauma stepdown unit. This unit would be great experience for the ED; lots of neuro pt's, GSW's, back injuries, burns, etc. I have had clinicals on this unit twice,I really enjoyed the diversity of patients seen and the excitement. They have a good management team. The staff does not seem as cohesive as the other units, and the support from CNA's and other nurses can be either wonderful or terrible. Typical patient load is 5 to 6 patients per pod, with 3 to 4 in the stepdown pods. I recently completed 4 patient management on this unit, on my 2nd day the CNA was late, and not very helpful ( I had to do much of the her work myself)I know those tasks are ultimatley my responsiblity, but I am so frightened. How can I handle caring for 6 patients if I am doing everything ( meds, wound care, VS, Labs, BS checks, hygiene, etc)!????

My instructors are very supportive of me, one says I have been her best student (although I don't believe it, there is much room for improvement)

As you all can tell, I just don't know which to choose. I guess I am going to apply to each. Perhaps my choices will be narrowed depending on who will interview and hire me. They are all at the same hospital, so there won't be much to compare in terms of the 'better offer'.

I know I can always change jobs at some point, but I want to make the right decision (I may also move to another city or state in the future, and would like to have the option to work in the ED or perhaps even critical care).

Does anyone have any advice or recommendations?

Thanks,

Cassie

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Specializes in ICUs, Tele, etc..

Hi i think anywhere you'd like to go would be good as long as it's an environment that fosters learning early on. Heart ICU can be a little bit monotonous if you are admitting post op open hearts every day. The first 2 hours is usually the busiest part. And everything else just goes fine. After four hours, that's when happiness sets in because you see your patients extubated and talking. BUT when your open hearts go south, they really go south. This is when all of your skills would have to come into place. Titrating drips, rapid assesment and intervention, and essentially good relationship with your cardiac fellow/cv surgeon/and most specially the heart nurses. Though within the first year or so even if you are getting trained with stable hearts, it would not be monotonous for you. It's when you do it day after day, admit heart after heart where you'd feel comfortable and think it's a little monotonous. Since you have experience with ED in a level I before, then I suggest finding a SICU with Trauma ICU and Heart ICU combined. If you do that, you'd have your mix of recovering open hearts and taking care of trauma patients in the critical care setting.

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Specializes in OB, lactation.
I loved the ED, I am a very social adrenaline junky and I love the fast pace. My externship was at a level 1 trauma center at a large teaching hospital in VA ... I would love to work there, and they do offer an internship program for new grads.

Sounds to me like you answered your own question.

I am a chicken though and I like to stay with a good thing. I always hear how hard the first year or so is, I would stay where I know I am happy! At least until I felt more competent as a new nurse. That's me though, everyone is different.

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Cassie,

What ED are you talking about in Va. Just wondering because my ED in Va. is also a level 1, and we are renovating/expanding!

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Burns hands down.

While there is a shortage going on , it has often been recommended a year of critical care prior to coming to the ED. Of course you don't need it, but you will be better prepared.

you will be much more confident if you have had at least a year of managing drips (pressors etc) in a unit before you try to set one up in the ED. I'm all for new grads, but they often have trouble with the more difficult 1:1 patients we have. (vents drips etc)

As you have identified, Burns gives one of the best preps for the ED, its where I would go if I had to do it all over again.

Cardiac is not a bad choice either, as you will be able to nail the rhythms better than most of the ED nurses when you finish a year there!

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Cassie,

What ED are you talking about in Va. Just wondering because my ED in Va. is also a level 1, and we are renovating/expanding!

I'm interested in Sentara Norfolk General Hospital's ED. Do you work there? if so, I may have met you. I did my senior externship there. I finally narrowed my choices and applied to the ED internship, the ICU internship and burn/trauma stepdown. I've graduated :balloons: and just waiting to hear from everyone now. If you work at SNGH's ED, do you have any tips on the application process?

-Cassie:nurse:

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Hi Cassie,

I am a new poster, but I live in PA and will graduate in December. A girl in our class actually has already been accepted to the ICU internship at Norfolk General. Since she is out of state, she completed the process in August. Good Luck to you!!

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The most important part of making the decision, is also knowing all about the preceptorship that you will get. How long is the training? Will you be with the same nurse all of the time or change nurses all of the time. Most prefer the same nurse for the initial training, so you do not have so many different styles being thrown at you.

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