NEURO ICU or NICU?

[donutcrumbs]

I got accepted as a new grad in both of these residencies. I have 10+ years as a multi hospital float in a level 1 trauma system as a PCT taking care of adult/ped burns, neuro ICU, Cardiothoracic ICU and NICU patients. My heart is in NICU but I hear that it's hard to transfer out of this specialty because it is not applicable to other specialties the way Neuro ICU is. My only thing with neuro is the unit I got the offer on, the ANM is a bully and have known/worked with her for years. She is not in charge of hiring so she had no say but when she caught wind of my offer she scoffed and make some mean comments. what would you do??

 

[EmergentAnesthetics]

I wouldn't take that Neuro ICU position solely based on the fact the ANM is a bully. Imagine spending 36 hours around this individual...it's sounds like a living nightmare.

[adventure_rn, MSN, NP]

I don't think NICU will be as hard to move out of as you expect if you change your mind down the road. Yes, there will be a very steep learning curve going from NICU to adults (the same way there is going from adults to NICU), but if it's a question of actually getting hired into another unit I think you'd be fine, especially if you were to apply for a lateral transfer to another unit in your current hospital down the road.

NICUs can be hard to break into because the staff often have greater longevity than a lot of specialties, so there's generally less turnover. On occasion, unpopular management decisions can definitely cause a mass exodus in some NICUs and make it extremely easy to get hired (though often into a crappy situation), but that's true of any unit. By contrast, it seems like adult ICUs have a pretty consistently high turnover between people getting burned out and those just putting in a couple of years to get into CRNA/NP school, so they're probably always hiring. Again, it can be a rough transition since you have to 'unlearn' all of the weird niche NICU habits that only exist in NICU, but if you approach it with an open mind and are willing to put in the work, it's definitely doable.

If your heart is in NICU and the ANM in neuro ICU is a jerk, I'd definitely lean toward NICU. I'd see if you can shadow on each unit to get a sense for the overall culture - adult ICU and NICU tend to self-select for different personality types.

You probably have a good sense for what types of patients and medical management style you'd like based on your float background. I will say that in NICU vs. adults, the outcomes are generally happier, the families are generally kinder/more appreciative/less difficult, and the messes are always smaller.