ICU, PACU or MedSurg for new 56 yr old nurse?

[Nurse Beth, MSN]

Dear Nurse Beth,

What is the best career path for late starter?

I am 56 years, in my 3 semester for RN. I started 3 years ago with the intention of becoming a LPN. On the recommendation of my teachers, I continued my education. I have been going to school and work full time nights for almost three years in a SNF.

Also I thought SNF is what I want to do, I feel a need more experience "nursing". Working nights mostly memory care does give me many skills. So should I do my first years, ICU, PACU or Med Surg? In the fourth semester we have a preceptorship and can be a possibility for landing a job.

Dear Best First Job for 56 yr Old,

Congrats on being almost finished with your RN program! Wow- you are really motivated to work full time while attending nursing school. Amazing and motivated!

You already know nursing takes stamina and a high energy level. Everybody is different in their physical "age" and you are definitely used to working hard.

But your question is, which is better, ICU, PACU, or MedSurg? The question is, where are you more likely to get hired? In the interest of landing a job, I would do a preceptorship in the area that is currently hiring or has a history of hiring new grads.

Here's an excerpt from my book on how to land your first nursing job...and your next!:

Clinical rotations are a job seeker's dream! In what other jobs do you get a chance to see and be seen time and time again before you apply for a job? Meet and impress the nurse managers and/or charge nurse during clinical rotations. How to do that?! Look for opportunities- they will present themselves.

Write a note to the nurse manager after your clinical rotation. By write, I mean use a pen, and by note, I mean paper and envelope. Here's an example.

"I learned so much during my clinical rotation on your unit. The staff were all so supportive and helpful, especially Beth Hawkes. This is exactly the kind of nursing team I'd like to be a part of someday. Thank you for the experience."

Or semblance thereof.Sign your name legibly and prominently. Stop by a week later to see if he/she got your note. Wait! there it is! Pinned on the wall above the nurse manager's desk! Because everyone appreciates a personalized, handwritten note!

You have set yourself apart.

Tip: Make sure our name is legible. You want them to remember your name.

Wherever you choose to do your preceptorship, be sure to make contacts and network. You will have insider advantage when you apply for a job because they will know you and your work ethic.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[Syane, MSN, RN]

Definitely PACU! I cannot imagine being in my 50s and working MedSurg! So hard on your body!

[Nmbeck]

I'm sorry, what is PACU?

[Nurse Beth, MSN]

I'm sorry, what is PACU?

PACU is post anesthesia care unit. :) Also called Recovery.

[Mavrick, BSN, RN]

PACU is not the place for a new grad especially in an acute care setting. You need experience and the confidence that comes from that experience to work so independently. Med-Surg experience is good, ICU is better.

PACU can be very fast paced and not the place to be developing basic nursing assessment skills. A lot of what you do is prevent problems that you have had experience in dealing with in the ICU. It is easier on the body but very taxing on the mind.

[Salsacat]

Your age is irrelevant. There are 25 year olds in terrible shape with no stamina and my 70 yo mother-in-law just finished a bike trip - across Eastern Europe. What matters is as Nurse Beth says - what is your geographical location and where can new grads get hired? I'd go for med surg because I live in California-- and that is a tough market and unless you already work as a CNA on an ICU floor - it's not very likely. PACU almost never hires new grads that I know of. I'd start networking with med surg new grad programs.

[Here.I.Stand, BSN, RN]

PACU is not the place for a new grad especially in an acute care setting. You need experience and the confidence that comes from that experience to work so independently.............

PACU can be very fast paced and not the place to be developing basic nursing assessment skills.

This is my personal observation, but many of the nurses working in PACU are former (read: experienced) ICU RNs.

[Irish_Mist, BSN, RN]

PACU is not the place for a new grad especially in an acute care setting. You need experience and the confidence that comes from that experience to work so independently. Med-Surg experience is good, ICU is better.

PACU can be very fast paced and not the place to be developing basic nursing assessment skills. A lot of what you do is prevent problems that you have had experience in dealing with in the ICU. It is easier on the body but very taxing on the mind.

Once again, I agree with Mavrick. The PACU is no place for a new grad. Most PACUS won't even consider an applicant without solid ICU experience.

[Ruby Vee, BSN]

I'll have to second (third? fifth?) the notion that PACU is no place for a new grad. I've been working in ICU for the better part of my decades-long nursing career. I've precepted young new grads and older new grads. I've had particular problems with career-changing new grads (forties and on) just not fitting in to the team and either quitting or being asked to resign. I make a point of having lunch with them sometime after they've left our unit, and several have told me the same thing (or variations of): second career or older new grads just do not see the urgency in critical care. I'm not sure why that would be -- surely an older new grad has the intellectual capacity to see asystole, for example, as an urgent issue. Nevertheless, a couple of these former colleagues have even told me it's been discussed in their nursing classes in school. (Of course, the possibility exists that it's not really a thing except with one particular professor in the nearest nursing school).

Most of the older new grads hired by our unit end up going to less acute patient care areas. My advice is to start in Med/Surg, oncology or some other non-critical care area.

[qaqueen]

I was an older new nurse. Now, I am an older not so new nurse. Honestly, if you want to be well rounded, Med-Surg would be my suggestion. You see a lot of different conditions. Often these patients are not so sick that they are unable to turn (or at least assist with a turn) in bed (a little easier on the back). You get experience in several areas, and learn time management. PACU nurses need to be able to identify a deteriorating patient and act quickly. ICU nurses must be familiar with medications, and procedures beyond the scope of the Med-Surg nurse. Although a two patient assignment sounds like an easy shift, if they are both deteriorating, the stress levels can be incredible.

As for me, I was 48 when I graduated with my ADN. I completed my BSN at 50. I started out in Med-Surg for three years, then telemetry(PCU) for three years and now ICU for two and one-half years.

It can be done. You must take care of yourself. Follow your dreams and if you want to start in ICU, give it a shot. All they can say is "no", and "no" never killed anybody.

Best of luck!