Med-surg or NICU first?

Christel2Rn · Jul 1, 2002

I have also just graduated. I will be taking my NCLEX next friday and starting in a level III NICU in August. I was also debating whether I should do med surg prior to NICU. I am planning on being a Neonatal nurse practitioner as well. I think that if you have the opportunity to go straight to the NICU that you do so. I figured it would be best to work there before commiting myself to the practitioner program. Good Luck. If nursing is who you are then you will be successful either way. Christel

Neonatal WannaB · Jul 6, 2002

Thank you Christel2RN for your advice. Please let me know how it turns out for you on the NICU. Also good luck on the NClex. I know you will do well.

HollyWA · Jul 24, 2002

I graduated from school in 1989 and back then----I couldn't get into a "speciality" without at least 1 year experience in med/sur first. So I moved out of state to Kansas. I got a job in adult ICU (my BIL was the director) until an opening in nursery/NICU. (high level 2). I waited 7 mo and a job opened up. I've never looked back!! If I ever thought that I was going to HAVE to work med/surg first---I would have never become a RN.

nursecheryl · Jul 24, 2002

You'll learn all the organizational skill you want right in the NICU. A lot of new grads started right in the NICU. Try to get a job in a large metropolitan teaching hospital and you'll get the best experience. As for starting off on a med surg floor (that is probably the hardest floor of all to start). It is, in my oppinion, not for a beginner. I have worked in nicu, picu, psych, home health, hospice and don't feel quite ready yet for a typical meds surg floor. :chair:

nurseiam · Jul 26, 2002

I think that old habits are very hard to unlearn. I been in the NICU for 3 years and I see people from other areas having a harder time adjusting. New grads are a clean slate. We just had a residency that was all experienced people from L&D, ICU, Ortho.... the longer they were there the more they have had to relearn.

I went to the NICU as a new grad and I cannot imagine starting any other place!

NICU_Nurse, BSN, RN · Jul 26, 2002

As a seven-month nurse (heehee, still can't believe it!) who started directly in the NICU, here's my two cents. I debated this question endlessly with various instructors, students, and nurses that I knew right around graduation in December. I had heard the whole M/S thing first already but just wasn't sure if that was as effective as people said it was. Now don't get me wrong; I know that just about any type of nursing is effective at least a LITTLE by teaching you organizational skills, etc. However, the differences between babies and adults is just astounding, and after working this time on the NICU, I'm seriously glad that I didn't go into adult care first. Even peds and neonatal nursing are totally different- we get floated to Peds and PICU, and I never fail to be slightly overwhelmed at what they seem to think are slight differences. Yes, I understand ventilators, but what about all of the OTHER things wrong with this two-year old??? I am now a firm, staunch believer in newborn nursery first, then NICU. I applied for a job in the newborn nursery, but none was available so I accepted a job floating between a Level II and a Level III. Now, I have learned so much, and have so much MORE to learn. Literally years and years of studying and personal experience is what will make me more competent. I come home EVERY DAY from work and study for about an hour, looking things up, reviewing drugs, etc. I am on the go all the time at work, learning to perfect procedures, asking questions- you thought you worked hard in school? I did. Until I came to work here! I love my unit, love the work I'm doing (the hospital is questionable, but that's a completely seperate issue). However, I now have the retrospect ability to recognize how much help working NB nursery would have been had I gone there first as I originally planned. NB nursery is kind of like M/S for babies. Now, the babies in that nursery aren't usually sick, and most of them don't require medication (or if they do, it isn't extensive). Despite that, you will learn PLENTY of organization there. The nurses in that nursery have six, seven, eight or more babies a piece at the busiest times. They have charting, just like we do. You will learn from the beginning- this is a healthy baby, this is what it looks like, this is how we know this baby is not healthy, etc. Just like in nursing school, when you start off with basics. This is a cell, this is anatomy, this is a healthy person...THEN you move on to 'This is a diseased or sick person and this is how you treat them.' You will learn all about basic antibiotics, how to admit and assess babies (and this may seem simple now, but babies are complicated and can go down the tubes in a matter of seconds...I got thrown to the wolves, and would not recommend this to another person), how to do procedures properly (like heelsticks, PKU's, start IV's- you want to learn this on healthy babies. IV starts on preemies are the hardest things I've ever had to learn to do, and I'm still learning that), how to educate the parents about newborn care and breastfeeding, circumcision issues, etc. You'll have your hands full with this and so much more, and it's a great place to start. I recommend it WHOLEHEARTEDLY. In the NICU, you have ALL of these things and MOREMOREMORE. If you are really serious about neonatal nursing, I urge you to do one of two things: Either start in the newborn nursery (I say six months to a year- it's not that long in the long run and it will provide you with a solid foundation to further your knowledge, not to mention a beautiful reference that will get your foot in the door) or MAKE ABSOLUTE sure that your NICU HAS AN EXCELLENT ORIENTATION PROGRAM. I am dead serious on this last one- they need a REAL orientation, lasting at LEAST 8-12 weeks, including some classroom time interspersed with your clinical time on the unit. My hospital has a horrible orientation program- I got eight weeks of orientation (a week of classroom time in which multiple visitors and administrators from other units repeated the same info over and over again- big waste of time, but I couldn't have known that ahead of time; and seven weeks on the unit in which I was given my own assignments and my preceptor did nothing but 'oversee' what I was doing). I have had to self educate, and have enough CEU's now to coast through the rest of my nursing career, not to mention a LIBRARY of textbooks and handbooks so I could learn various things, not to MENTION harassing the nice nurses to death with questions about sometimes the most basic things. Be wise about this, because your experiences will color your outlook on nursing and the NICU for as long as you are alive. I love my babies with my whole heart and soul, and know that after a couple years of experience I will be a completely competent and excellent nurse, but boy, I'll tell you, they call it 'Hindsight' for a reason. I've been kicking myself in the 'hind ever since. ;>P Good luck to you!!!

Neonatal WannaB · Jul 29, 2002

Thank you for all of your comments. I will consider each and every comment. You guys are definitely giving me different perspectives.

Anaclaire · Aug 7, 2002

I also had to make the same decision as you are doing now...

I worked on an adult telemetry unit as a student nurse. I loved the heart patients but the overflow med/surg patients we received often broke my heart or kinda grossed me out. I asked my favorite nursing instructor, the one who taught OB, if it was really and truly necessary for me to do one to two years of Med/Surg before entering the baby arena. She told me that many years ago a solid Med/Surg foundation was very important because when a nurse went to work she was never sure if she'd be pulled to work on orthopedics one day and labor and delivery the next and the emergency room the next. She said that today nearly every area is specialized in such a way that nurses aren't as easily able to go from one unit to the next seamlessly. (This is not so true in the tiny hospitals though because I know nurses who must be able to work in every area there.) Anyway, she said the following words to me that I'll never forget:

"Anaclaire, I'd rather see you go straight to the nursery and be happy rather than try to force yourself to doing Med/Surg first. The last thing we need is for you to begin to hate nursing and leave the profession while trying to force down the Med/Surg experience. If you search your heart and know for sure that babies are what you want, then go to the babies and don't look back."

I searched my heart and then had to decide between the NICU and the Well Baby Nursery. I chose the Well Baby Nursery because I figured if I could learn to recognize a well baby that it would help me identify a sick one. I also felt intimidated when I took a tour through the NICU for the first time! (I try to remember how I felt that day when I'm welcoming parents and visitors into a NICU for the first time too.) I'm glad I chose the Well Baby Nursery first because I don't have children of my own... I had no personal experience with babies.

As it turned out, our Well Baby Nursery combined 6 months later with our Post-Partum Unit to become a Mother-Baby Unit. I found myself working there for another 6 years. We also took care of antepartum Moms who were to unstable for discharge but not critical enough for a L&D bed. I must say, I received a very firm foundation on that unit! I had my babies, learned to start IVs on them and draw labs, etc., as well as identify sick newborns requiring transfer to the NICU. I learned how to deal with the pediatricians and their routines. I learned how to teach post-partum care to Moms, as well as helping them with breastfeeding and general baby care. I learned the emotional rollercoaster the antipartum Moms and families ride while trying to keep a baby in the womb for "just one more day". We had lots of Moms who had Med/Surg type problems too... asthma, sickle-cell disease, auto accidents, strokes, pneumothorax after receiving a central line, respiratory distress requiring transfer to intensive care, morbid obesity, drug addiction, gallstones, kidney stones, etc... you name it, they had it. I received plenty of adult experience there with procedures they require. It was a terrific learning experience, to say the least. By the way, catheterizing a woman with a swollen bottom full of stitches is a real job! If you can find her "special place" you'll have no trouble catheterizing a neonate! LOL!

At the end of 6 years I'd had enough though. I no longer felt challenged. I had made friends with many of the NICU nurses as our Mother-Baby staff ended up taking over the Transition Nursery (newborns went there during their first 3-4 hours of life) from the NICU staff. They often told me that I should be working with them in the NICU. Finally, I was convinced and after speaking with the Manager I gladly accepted the next available position. I've never been happier!

I loved the NICU from the first day! I do know that my Mother-Baby experience was incredibly helpful because I was able to understand the routines of the floor where the Mom was staying (and this helped with my rapport with her); I could understand on a deeper level all a Mom and her family had been going through while on bedrest before the baby was born; and I was excellent at assisting these Moms and their preemies with breastfeeding. I also was already able to start neonatal IVs, give them injections, draw labs, and understand many of the routine orders. I received a 6 week orientation and felt it was plenty. Within 2 years I was on the Transport Team, I was a Mentor, and a Preceptor too. I received my RNC from NCC and have continued to keep that current.

This is my 2 cents worth. I hadn't seen anyone else mention the Mother-Baby option and thought I'd throw it in the mix.

Whatever you decide, remember to make the best of it. Find out the difference of the orientation you would receive as a new grad versus a staff RN with some experience as that could help sway your decision. In our unit we tended to coddle the new grads more... give them a bit longer to learn... If you have a good preceptor, you should be fine. Just keep your chin up and try not to let yourself become overwhelmed. Search your heart and you'll have your answer.

Warmly,

Anaclaire

ladnred31 · May 17, 2011

I think you should do at least 1 year of med-surg. you gain all the skills you need. that is where you learn how to do iv's, careplans, central lines, picc, and anything else you can think of. you learn a lot in that year. then move into the area of your choice. i think you will appreciate it in the long run.

Bortaz, MSN, RN · May 19, 2011

. As soon as possible, go to NICU.
think that year of M/S is a bunch of c**p.

Agree with this. I started in the NICU right out of school and am very glad that I did.

BabyLady, BSN, RN · May 19, 2011

Hello all, this is my first time being on allnurses.com. This site is excellent. One of my classmates told me to check it out and I am glad I did.
I have a couple of questions for the "seasoned" nurses. First off, I'm a GN and I work in a sub-acute facility where patients come from the hospital for rehab or they aren't sick enough to stay in the hospital. I am going to continue to work here until I get my license. Question #1. Should I start off on a general med-surg floor for a year like everyone has been telling me since I entered the nursing program? or #2. Should I go right to the NICU? My ultimate goal is to be a Neonatal Nurse Practitioner. I just want to get the best experience so that my career can flourish in the way that it should.
I welcome any incite from anyone who can help me. :confused: :confused:

Go straight into the NICU..trust me, Med-Surg will not help you!

jewls67 · Sep 7, 2011

Hello everyone, I really need some advice. I recently passed my RN boards and had an interview with the nicu position here in town. I also will have an interview with another hospital for the newborn nursery level II.

I have never worked in a hospital and have no nursing experience. I don't know if I should take the nicu position, which is more than likely going to be offered to me ( I have a second interview with them), or should I start out small and start in the newborn nursery at another hospital?I really want the nicu job, but when I think about it, I get anxiety. Is this normal? But then when I think about the newborn nursery I am thinking do I really need to start out there before nicu?? Oh decisions, decisions, lol!!

Please any thoughts or comments appreciated :)! Thanks!