New grad trying to choose between mother-baby and ICU

babeinboots, MSN, NP, CNM · Mar 12, 2019

That’s a tough choice. My advice would be to ask to shadow on both units and go from there. Good luck and congrats!

Nurse87EM · Mar 22, 2019

As a Mother-Baby nurse, I would say that in many ways Mother-Baby and ICU are on opposite ends of the nursing spectrum, so your decision will come down to the kind of acuity, pace, and variety you want, and how much stress you think you can tolerate. I know many ICU nurses and we talk about our jobs a lot, so I'll do my best to give you some insight.

1. Patient ratios: in MB, you will typically have 3-4 couplets, which comes to 6-8 patients. (Depending on the hospital, you have have 5 couplets, which is really too many. Never, ever accept more than 5). Mother-Baby patients are essentially "well," but that doesn't mean they don't need a LOT of help. Breastfeeding is a complex business and if you like learning about that, you can make a huge difference in the next few months for a new mother. Meanwhile, in the ICU, you will typically have 1-2 patients who are very sick. So here, you're choosing between dividing your attention among a larger number of low-acuity patients or focusing on 1 or 2 who need your attention constantly. IMPORTANT: do not choose the ICU primarily because you'll have the lowest number of patients there. That alone is not a good reason to go.

2. Availability of doctors, pharmacists, and specialists. In the ICU, the doctors and pharmacists are basically always around. They are easier to get a hold of, and with good reason, because everything your patient needs is something they need right away. Changes can happen quickly and each change is important. On Mother-Baby, you have a lot of different OBs and pediatricians floating in and out, and it can be frustrating if you are waiting for a response or a discharge order etc. But if and when something is urgent, there are always ways to escalate.

3. Character strengths. In nursing, there is something for everyone. Mother-Baby rewards people who have a high degree of empathy and emotional intelligence, who enjoy patient education and do it well. The ICU rewards people who are highly analytical and can keep up with a lot of rapidly changing details. Some ICU nurses have the end goal of being nurse anesthetists. There isn't very much patient teaching in the ICU because so many patients are unconscious. You might get to interact a fair amount with patients' families, but your attention has to be on the patient the entire time. One ICU nurse told me that she felt burnt out because the things she was best at, like helping families cope with loss, were just not rewarded in her job. To be fair, that was one nurse at one hospital. Maybe a really good ICU nurse manager could change that.

4. Tolerance for ethical gray areas. In Mother-Baby, you generally don't have to wonder if you are really doing the right thing for your patient. You might ask yourself if you are pushing a patient too hard to breastfeed, things like that, but the questions are not life and death. In the ICU--and this goes for NICU as well-- you will routinely work on cases where you ask yourself if you're really helping your patients. Classic example: an elderly patient in a lot of pain who has very little quality of life left, but keeps getting readmitted to the hospital for a new intervention. If the patient and/or family wants that intervention, you have to do it. But I've known ICU nurses to convene unit ethics committees because they were so upset about what they were seeing. Depending on the hospital, you might have a lot of homeless patients or "John Does" where you don't even know their names. This comes down to how thick a skin you have. I think a good ICU nurse is caring, but has a pretty thick "emotional callous" to protect from the constant onslaught of stressful stimuli.

5. Plans for further down the line. As a Mother-Baby nurse from the start, I will admit that I don't have all of the med-surg skills that an ICU nurse has. I'm no good at starting IVs, for example. If I want to go into another specialty, I will have to be willing to learn a lot of new skills, but the great thing about nursing is you can do that. Your nursing license is a ticket to learn whatever kind of new skills you want as long as you're willing to work hard. If I were an ICU nurse, I would have more skills and I would probably be able to float to any kind of med-surg unit. (Or switch to any med-surg job, for that matter). An ICU nurse with 3+ years of experience can also look into flight nursing, CRNA school, and more high-acuity options like that. Personally, I am very happy in a job where I never see chest tubes or trachs or pacemakers, and I don't plan to pursue jobs that require those skills.

I suggest you pick apart what exactly started to change your mind when you were in school. MB and LD have a LOT of variety and acuity, so if its boredom you're worried about, don't. And if you do get bored after a year, you can always switch.

Hope this was helpful!

0.9%NormalSarah, BSN, RN · Mar 22, 2019

@lexxa25 what did you end up choosing? Have you started yet?

lexxa25, ASN, BSN, RN · Mar 23, 2019

Thank you @Nurse87EM You really gave me a lot to think about and I appreciate how you broke the differences down. I'm definitely picking apart both units to try and decide. I think what I love about critical care is learning the pathophysiology and having to understand how everything is related and being affected and just being on your toes the entire time and I also love the greater autonomy that there is but I also think it would be really sweet to be with new mother's and newborns because I enjoy teaching as well.

lexxa25, ASN, BSN, RN · Mar 23, 2019

22 hours ago, 0.9%NormalSarah said:
@lexxa25 what did you end up choosing? Have you started yet?

Hi, I still haven't decided. I thought I had my mind made up more or less but I have to make an official decision by next week. I toured the ICU yesterday and spoke more with the manager, it's a huge unit and they receive trauma patients as well. It's very busy and I could have 2-3 patients and during night shift, there'll also be no transport, secretary or PCAs (which I didn't think they had regardless in the ICU). I think it would be brutal but I'm up for a challenge. I also spoke the manager for the other position as well and I would be very busy too, I'll be cross trained for L&D, Mother-Baby and OR which is a lot more appealing to me but I'm still undecided.

Forest2 · Mar 25, 2019

My mother was an ICU nurse. She was there 7 seven years, she said most of the nurses burned out sooner than she did. It was high intensity, very stressful, very sick people. I have never heard about mother/baby burnout. Just a thought.

llg, PhD, RN · Mar 25, 2019

I think you have gotten some really good advice on this thread. There is no one, right answer -- as the best choice would depend on the particular person.

For me, I would be looking at the options down the road. Which choice would give me the best options later, in case I wanted to "move on" at some point. For me, that would be the mother-baby and L&D position. The options after adult ICU would be less attractive to me than a maternal-child position. I wouldn't be interested in an adult med/surg unit, flight nursing, or anesthetist position as I got older. But I might be interested in nursery, NICU, outpatient women's health clinic, lactation consultant, childbirth educator, or even peds position as I got older and wanted a break of the full time, intense career stage of my life or if I had kids and/or other family commitments -- or wanted to work part time as I went to grad school.

But for some other people, I know that the adult ICU is the right choice for them. (I'm a former NICU nurse, by the way.) They love the intensity and won't be happy unless they try it. They like adult med/surg -- and are not that fond of the maternal-child world.

Nurse87EM · Mar 25, 2019

Uh oh, hang on. In the ICU you should never have more than 2 patients. Is this an ICU with a step down unit attached to it? Because 3 step down patients might be reasonable, but if the ICU is right next door, those patients could still be very high acuity. And no secretaries or techs at night... that doesn’t seem right either. Techs especially are so crucial. I would be wary of this unit.

Wolf at the Door, BSN · Apr 9, 2019

Your heart says L&D take the mother baby route