MR/DD or ICU???

[KayceeLeeRN, BSN, RN]

I'm having a really hard time figuring out which direction to go in...and believe me I hate THAT! I'm the kind of person that always needs to have a plan. soo...

I am leaving my job after nine months on Med/Surg (I was a new grad). Can't stand it anymore! I have two VERY different options infront of me:

1) RN for a developmental disabilites organization. I would be responsible for overseeing the medical care of the residents in three group homes, as well as supervision of the direct care workers and all the paper work. This is a M-F 9-5 plus on call (only via telephone) all week...no weekends/holidays. I love working working with this population.

2) ICU in a small community hospital. I feel like if I gain experience in ICU my life is set in some way or another....I dont know. Every nurse I have ever talked to tells me "Go to the ICU!!!" I know I can be great at it, with the right training and guidance. I just dont know if I want to. But I feel like if I dont go now I'll never have the opportunity to get right into critical care again. Saying I take option #1 and it doesnt work out, I feel like the only place I could go would be back to med/surg for more experience. I feel fortunate that they're willing to take me after 9 moths med/surg experience. I dont know if that opportunity will come along again. But then again, I dont know if I want it because I really want it or bc so many people tell me to go for it.

I feel like #1 is what I am going to love doing. #2 is going to be the best experience for m career, I may not like it at all.

Can anyone give me some insight??

[LydiaNN]

Well, if you really feel that you wouldn't have the option to try #2 again, at least not without a return stint to M/S, then it might make sense to try that out. If it doesn't work, MR/DD agencies around here always need nurses. I'd think that option #1 will still be an option for you if #2 doesn't pan out.

I don't know if $ plays a role in it for you, but I suppose you know that the pay for MR/DD is notoriously low. I have worked in this field for 7 years. Most of my hospital colleagues make at least double what I earn. Fortunately, my husband earns a good income and my job does provide outstanding benefits, but IMHO, pay is one factor that often needs to be considered in these kinds of decisions. Even as you climb the career ladder, you'll always make less than most of your nursing peers.

Good luck, whatever you decide.

[RNperdiem, RN]

Do you have any outside experience in supervision? If you were maybe a store assistant manager or supervised others at a previous job, and did a good job, consider job #1. If you feel your med-surg skills are strong, and you could delegate with confidence to CNA's you might do well. Will there be other nurses you can work with, or will you be alone there? Why are they offering this job to a new nurse?(not a criticism, but always keep your eyes open).

Job #2 sounds like a strong contender too. Do a little investigation. How long is orientation? Does the environment seem supportive? With ICU skills, a lot of nursing positions do become available.

Never let fear make you take the easy way out.

[RN1989]

Go with ICU job. I don't think that 9 months of med-surg is enough of a knowledge base for you to function safely in a supervisory role without other experienced staff support.

MR/DD pts can't tell you what is specifically wrong. You must have excellent assessment skills and knowledge of many problems in order to form appropriate nursing care plans and know when to go see the doc (and sometimes push the doc into the appropriate actions when they dismiss your concerns). I see big potential for regulatory issues as well as lawsuit issues from pt's families if you take the job with so little time as a practicing nurse.

The MR/DD jobs will always be there. Get more experience under your belt so that you can go into another job with confidence that you can spot problems a mile away, even if your pts cannot tell you there is a problem. You will be keeping both your patients and your license much safer that way.

[Quickbeam, BSN, RN]

the pay for MR/DD is notoriously low.

That has been my experience as well. I worked at a nationally recognized facility and had to leave because of the low pay (without any improvement on the horizon). Even now, 15 years later, they are still the lowest paid nurses in my area by a good 5$ an hour. I loved the work but couldn't pay my mortgage.

[vampiregirl, BSN, RN]

I guess I'm a little biased because I managed group homes for several years, but nurses who truly care about the MR/DD population are so needed. I would encourage you to thoroughly investigate the company you are interested in working for, including checking past regulatory board surveys.

Also, in regards to the on-call... please remember that most of the caretakers may not have medical training. So, some of the calls may be for non-urgent things or staff may not realize the actual severity of a situation. Training and education for the staff will be very important.

The nurses I worked with at the group home who really cared about the clients made such a huge impact in their lives. As the nurses got to know the clients, they often didn't have as hard a time assessing them. No, some of them couldn't communicate verbally, but their behavior spoke volumes.

Good luck in whatever you decide.

[KayceeLeeRN, BSN, RN]

I don't know if $ plays a role in it for you, but I suppose you know that the pay for MR/DD is notoriously low.

To tell ya the truth the pay with the MR/DD position comes out to be almost double the ICU job because the ICU position is for P/T. This is one more thing that is making me deconsider over and over. I suppose that I will have the opportunity to

pick up extra shifts or go F/T...something I will have to address when I meet with the nurse manager next week.