New Grad Needs Help Choosing Job

[Nurse Beth, MSN]

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Dear Nurse Beth,

I am a new grad who went to ICU for my first position about a couple weeks after NCLEX (about two months after graduation). I oriented on telemetry for three weeks (no solo patient care) and then down to ICU where it seems like I had at least one “bad” night a week.

It got to the point I was throwing up before work and having chest pain for hours before the first shift on rotation, plus nightmares between shifts. I worked my first shift of my 5th week and said enough is enough. I approached my supervisor that morning after shift change (I work nights) and said I can’t do this.

She said I was doing fine, it was just a self confidence issue, please work through it. I finished my rotation and thought okay not too bad maybe I can. All the same problems came back in prepping for the first shift of my 6th and final week of orientation. So I finished the shift and approached her again and said okay I really can’t do this.

She offered me the option to transfer up to the psychiatric unit at the hospital (what used to be my dream job!!). I “observed” a shift there and will interview with the director soon.

I also have interviews set up soon with directors of multiple Med Surge units at a different hospital.

Now I’m torn. I have to wanted to work Psych since starting nursing school (including getting my PMHNP degree) but no one seems to think it’s a good idea. I kind of agree, it’s very limited in this area (only three hospitals have units within 100 miles, that I know of), and transitioning back to “real nursing” is likely going to be very hard afterwards. Added to that, I am currently making a 1.5 hour drive to work. My other hospital is a 1 hour drive. The only jobs available close by are home health, long term care, and emergency/urgent care (primarily) that all require experience.

I just feel like there’s too many pros and cons no matter what I do! I’m torn between following my passion and making what seems to be logical career choices that will provide me with a safety net job wise.

What do you recommend to help me make this decision? Do I follow my head or my heart? Any tips for dealing with the stress that will come with either decision (or new nursing in general.

Dear Torn,

If you are offered a residency position or supportive (longer) orientation for new grads on a MedSurg unit, consider taking it. Once you no longer have new grad status, you will no longer be eligible for a residency.

Specializing in Behavioral Health nursing right after graduation comes with consequences. If you decide to change specialties down the road, you will face an extra challenge.

I recommend following the "broad to narrow" track. It is easier to transfer from a broad foundation (MedSurg) to a narrow specialty (Behavioral Health) than the other way around.

You will always be able to land a job in Behavioral Health. You will not always be able to easily land a job in acute care.

Best wishes in making your decision.

Nurse Beth

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