I want critical care, I just don't know what kind!!

[nightingale1969]

I'm an ADN student heading toward graduation in May (woo hoo!!), and have been trying to carve out a path toward a career in critical care nursing. I have worked in nursing assistant jobs in the PICU and pediatric/adult med-surg. Like my classmates, I'm trying to make sure that I have my foot in the door in a place that will get me on the road to what I want to do. I am pretty sure that I want critical care nursing, and I had a very promising interview yesterday for a nursing assistant position in a combination adult CCU/SICU/step-down unit at a hospital that is very close to my house (important b/c I have a young daughter), and which is known for its critical care. Also, it is per diem and the shifts are flexible...8's (though I can do 12's if they're available) with the option to pick up a few 4's here and there. We've been learning all sorts of great stuff about critical care in class (shock, arrhythmias, chest surgeries/chest tubes, etc.) and it will be great to see some of this coming together in this nursing assistant job. I would say it's perfect...for right now, given my school and home schedule. Here's the problem: I *think* my eventual goal is NICU, not adult critical care (though I might change my mind). The hospital where I interviewed only treats adults, so if I wanted to switch to NICU, I'd have to pick up and go somewhere else.

I will be shadowing someone at a local community hospital in the NICU in the next few weeks, but there are no nursing assistant positions open in the NICU or in their LDRP unit at the moment (so I would know what caring for healthy babies is like). All other NICUs in this area are pretty far from my home, and I figure I've spent enough time away from my daughter while I've been studying furiously over the past few years...I'd like to stay local if I can.

On the one hand, adult nursing is more familiar to me...we've had very little experience with infants and none with preemies. I don't want all this knowledge of adult nursing to go to waste if I specialize too early in NICU. I figure that getting adult critical care skills will still help pave the way toward a career in NICU (although I am aware that the meds, physiology, etc. are VERY different). Who knows, I might like adult ICU. But I just want to make sure that after all this work, that I'm on the path to the type of nursing that I *want* to do...and if I take this job and end up wanting NICU, then I have to go somewhere else and start all over again.

So do I take this job (if it's offered to me) and stay in adult ICU, then try to switch to NICU at another hospital if the opportunity arises and my schedule allows? Will this be a difficult switch? Or do I wait and try for a L&D/PP/NICU position when it comes up? Like I said, I want critical care nursing, and I think I have a good shot at getting my foot in the door in this CCU/ICU/step-down...I just want to make sure that it's a reasonable way to get where I want to go. Maybe if I'm not really certain about NICU, I should just go for the adult ICU for now because the opportunity is there...I'm sooooo confused

Sorry for the long-winded post, and thanks in advance. :)

[ecnav]

have you considered ob nursing to start? what better experience to attain some perspective of the initial conditions these fragile lives were delivered from. maybe a year of ob followed by a year acute care pediatric? if you're a fast learner then shorten your rotations. nicu is a very special unit in any hospital staffed by extraordinary nurses. some new grads will always want to 'go direct' to critical care but, i think it's important to hone your acute care skills first. learn to skate before learning the game, so to speak. very best to you!

[climberrn]

I've worked both PICU and NICU and depending on what level nursery the NICU is, it might not be that critical. Once the babies are about 27-28 weeks, they are critical for a very short time. After that brief window your job is to get them to their "birthday" so they can go home. Obviously this is a generalization and you have to know your stuff so you can get them there but it's not that exciting. If you are truly wanting critical care you'd definitely want a level III nursery that can take micro-premies and that does hearts.

So it just depends on what you want. If you want the excitement of critical care, with lots of pumps, drips, patients "circling the drain" you'll probably want adult CC (lots of co-morbidities means sick, sick patients). If you want those things but with maybe a better chance of survival, PICU is your gig (kiddos bounce back like crazy). If you want some CC with time to really know your patient over weeks and months with some "exciting" stuff but lots of TLC, NICU could be your goal.

Good luck!

[seanpdent, ADN, BSN, MSN, APRN, NP]

Souns like you have a lot of options in front of you.

I don't have any experience with peds... and NICU, but do have experience with the 'type' of critical care you can or cannot choose.

I've seen of the past year and a half that having a sound cardiac knowledge base is imperitive in the critical care setting. It doesn't matter where you may end up and 'which' ICU setting (MICU, SICU, TRAUMA, NEURO, etc). If you can't interpret and extrapolate your pt's cardiac issues, let alone surf your way through a swan-ganz and pacemakers, etc. You'll have your work cut out for you.

I started in a small CCU/ICU where I got some great cardiac experience. I carried over later for me in Trauma. My past experience and comfort level with cardiac has always been a blessing for me on the clinical floor.

Good luck with your decision and your awesome career ahead of you. Its one hell of a ride!!!