Hi Everyone, and thank you in advance for reading my novella below --
I am a new graduate who just completed an ABSN program. I had 5+ years of experience in healthcare as a tech and M.A. in areas including pharmacy tech, ED, trauma ED, IMC, Cardiology, urgent care ... I've been around the block, and nursing is a second career for me (I'm in my lower 30's).
I am a fast learner who excels in whatever specialty I land in, because I take interest and am very engaged (it was a hard choice between nursing school and med school, just because I love school). I decided nursing would allow me to bring more of myself to the table, so to say, and offered more flexibility in my life and career as I have other hobbies, and I enjoy the prospect of being able to work while pursuing advanced nursing education in the form of my masters, doctorate, MBA, etc. down the road. Over the past 2 years my interest shifted from emergency medicine to critical care and cardiology, because I enjoy getting to dive in to the patients and their patho/conditions/comorbidities on a deeper level. I did my senior capstone in a combined MICU/CTICU and loved it. I enjoyed the different flavor of fast-paced that the ICU has to offer, and the level of teamwork and collaboration is incredible.
Anywho, here I am all freshly graduated and lucky enough to have been on about 6 interviews thus far, all in areas I am interested in. I currently have 2 job offers in 2 different states (with a potential 3rd) to consider and would like some insight:
Job #1: Combined cardio-pulmonary IMC/Tele unit in a hospital located in a busy metropolis. The unit is still considered "critical care" based on the fact that it is IMC, but sounds like it has a med surg component as well based on the tele section of the unit. Amazing manager who mentors her nurses, and reputable new-grad program. Shares a clinical educator with the ICU. Potential to move into the ICU after 1-1.5 years on the IMC unit (the manager stressed that she primes nurses for the ICU i that is their goal). Mandatory 2-year contract with financial repercussions for leaving early. Keep in mind this hospital does not do CT surgery or transplants, but its sister hospitals in the same city include a heart hospital AND a level I trauma hospital. Other pros of this job would include a sign-on bonus, being in the same city/state as my significant other (who recently relocated there for a job), my mom, one of my sisters, my brother. I have lived in this city before and still have a couple of friends who I have remained close with as well.
Job #2: Cardiothoracic ICU at a level I trauma hospital in another busy metropolis in the city where I currently live/went to nursing school. This CT-ICU also takes MICU overflow and some IMC-status patients, as many do. Their new-grad RN program is brand new, but the hospital has a great reputation and is currently in the process of seeking Magnet status. This hospital does NOT require a 2-year contract, and openly offers inter-network transfers to their other units/hospitals in case an employee ends up needing a better fit. This network of hospitals also does transplants (kidney, liver, pancreas). Other pros of this job would include: starting in a CTICU! Being in a city/state where I enjoy the weather more, have the mountains, and more access to outdoor hobbies and other neighboring Western states. I've lived here for 1.5 years and have friends. Cons are obviously no sign on incentive, lack of family in the same city/state, having to continue to balance a long-ish distance relationship (14 hour drive/1.5 hour plane ride away from one another), and it's slightly more expensive to live here.
Job # 3 (If I get it): CT-ICU at the local university hospital, which also does heart transplants. 2-year contract required, it's a teaching hospital, yadda yadda yadda.
So, considering all of that ... what are your thoughts? Would it actually be BETTER to get the IMC/Tele/Med-surg-esque experience with a trajectory into an ICU, or go big for the CTICU at a hospital where the patient cases sound like they will be more complex given the various resources in trauma/surgical programs that the hospital has? I see many comments on other posts that bring up time management and prioritization, which is already a strength of mine. I took full patient loads in all of my clinical rotations with very little prompting from preceptors (including my ICU rotation) and have no trouble shifting gears due to having a firm background in healthcare. I simply want to set myself up for success by developing a wide range of knowledge that I admire in many seasoned nurses I have worked with. In my ICU rotation, I worked with new grads who had only been on the unit for 1-1.5 years and they were sharp as a tack! I also worked with the nurses who did anywhere from 3-6 years in Tele, oncology, med surg, started in the ED, etc. who were obviously excellent resources. I know being slightly older and having a background as a tech/MA will help me, as it already has. Personal feedback to me from preceptors and clinical scholars has been to go for critical care.
Thank you for taking the time to share your thoughts with me.
Can you share more about your experience with tele and how it prepped you for the CICU? Do you feel as though tele allowed you to practice your assessment skills and critical thinking?
My other fear of going directly into CTICU is that I won't get to practice the art of assessing as much and learning to "catch" things ... it sounds like the exposure to the patient population in the tele/IMC setting helps you develop these skills. One of the things I admired most about my nursing school professors is that they had these amazing assessment stories! Like, "after 9/11 at the pentagon, I caught an internal bleed/peritonitis that the doctor totally missed all the signs and symptoms of and was giving me a hard time about, and I got this guy to CT and surgery before he died of internal injuries."
Please use the quote feature so we know who are responding to.
You are correct that assessment skills are the number one skill that nurses need to learn and apply. Working on a telemetry unit exposed me to most of the problems that the seven body systems can develop.
I also was a star student. I could not nurse my way out of a wet paper bag for two years.
Caught internal bleeding , even following a "negative" CT. Caught a pneumothorax by listening to lung sounds.. two minutes after the attending rounded and charted lungs CTA. Caught necrotizing fasciitis after two specialties rounded, by using my sense of smell.
Been there,done that, ASN, RN
7,241 Posts
Please use the quote feature so we know who are responding to.
You are correct that assessment skills are the number one skill that nurses need to learn and apply. Working on a telemetry unit exposed me to most of the problems that the seven body systems can develop.
I also was a star student. I could not nurse my way out of a wet paper bag for two years.
Caught internal bleeding , even following a "negative" CT. Caught a pneumothorax by listening to lung sounds.. two minutes after the attending rounded and charted lungs CTA. Caught necrotizing fasciitis after two specialties rounded, by using my sense of smell.
There's more .. but I won't bore anybody.