New Grad Nurse - step down or oncology?

[jlp10]

Hello!

I graduated with my ADN and BSN in May 2018 and passed the NCLEX in July 2018. I have been applying for countless of nursing jobs since July and it has been difficult. During school, my interests were in NICU, L&D, ED, ICU, peds. However, it has really been difficult to get into any of those as a new grad.This past week however, I received 5 job offers, all in which are intermediate care units and oncology. I have really been debating on which unit I should start my nursing career with - step down or oncology? I do feel that step down would be a good foundation to start and would be easier to transition to other specialties with that experience; however, during my clinical rotations, I really did not like med surg at all. On the other hand, I think oncology would be a great unit and fulfilling, from what I hear from oncology nurses; however I am worried that an oncology background would be difficult to transition to other specialties.

My short-term goals are to either go into travel nursing or join U.S. Navy nursing. Later on, I am thinking about possibly continuing my education as well.

[CalicoKitty, BSN, MSN, RN]

I'd think IMC would get you more transferable skills than Oncology. Much of oncology is med-surg, but after a while you'll be hanging chemotherapy and getting that certification. With IMC, you can probably do med-surg if needed, and those skills will make learning more critical care easier. On the other hand, there is a heavy learning curve for nursing, and starting with higher acuity patients can be a challenge for new nurses. IMC will generally have a lower nurse:patient ratio than ED/med-surg(oncology), which may make doing some things like ED challenging. It may be harder to get used to larger nurse:patient ratios.

[cleback]

In my experience, the oncology floors are medsurg floors that also can do chemo. Some patients who don't need chemo and only have a history of cancer end up on the oncology floor. So if the floors are anything like the ones I'm used to, I don't think you can go wrong.

Congrats on the offers--5 is really wonderful!

[Swellz]

You can't go wrong with either and will get a good skill set with both. You listed a variety of different specialties you'd ultimately like to end up in, and based on that I think you should pick the intermediate care unit. Showing you can handle that acuity will make you more attractive to the ED and ICUs. But I've known oncology nurses who are now in L&D, ED, ICU, NPs in other specialties, etc etc etc, so don't let that hold you back if you want that position. Oncology can be highly specialized, but depending on the type of hospital it is, it can also be a general med-surg floor with the occasional solid tumor patient. I've seen a variety of oncology units between staff and traveling and I would not choose to work oncology if it wasn't at a major teaching facility, but that's just me.

From the perspective of a current travel nurse, you are going to need a couple years experience before you can travel. In travel nursing, you make more money in certain specialties; that's not a reason to go in to a specialty, but if you were considering traveling with 2 years of intermediate care experience vs traveling in a few more years when you've already changed specialties, it is something to think on.

Congratulations for having so many options!

[jlp10]

Thank you so much for your input!! Definitely a good perspective to think about.

[Daisy4RN]

If your goals are ICU or ED I would say that step down would prepare you better than Oncology. I have worked med-surg, step down and Oncology, all at major teaching hospitals. Our Onc unit was highly specialized (not med surg at all) and very rarely had overflow patients, so trained very well in Onc, that probably would not help too much with ICU/ED. Also , most nurses don't like to stay too long in ONC r/t the demands and the fact you are around chemo/radiation. Step down or med surg would give you better experience depending on the type of hospital you work, community vs teaching etc. If I was you I would start with step down, see how u like it, and when ready to move it would be easier to go either way you want. 5 offers, congrats!! And good luck!

[Chrispy11, ASN, RN]

During school, my interests were in NICU, L&D, ED, ICU, peds.

It's kind of funny since I posted in here in the past (on a few forums here) that probably half my class was interested in the exact fields you mentioned. There is a lot of competition.

You received great offers and advice on this forum. You seldom get the dream job to start but you may find something else interesting or that you may even love. So many places to go.

Best of luck to you! Would love to hear what offer you take.