Pick my "poison"

[ThePrincessBride]

So I will be interviewing for three adult, step-down units: Cardiac, Neuro and Medical. Granted, these are not my top choices and I doubt I will get offers for all three, but I am a new grad, so any offer would be fantastic.

I don't know how to do a poll, but which of the three would you prefer to work in? Which is most suitable for a new grad? Do you think a step-down unit is an inappropriate place for a new grad?

I am leaning towards cardiac because I find the heart to be fascinating, plus telemetry experience is a positive (though all step-down units would have them, right?) For those who have worked in any of these settings, what did you like/dislike about them?

[dream'n, BSN, RN]

I personally would Not want to do Neuro. But that is just me, many people feel otherwise. Medical would expose you to many different types of patients and procedures, but if you think Cardiac nursing might be your wanted specialty then I would go for that. Basically if you're looking at getting a foot in the door, but believe that none of these three will be where you would want to go eventually, I'd pick Medical.

Sometimes a nurse can get specialized in one area, then realize that's not really what they want to be doing in the future, but then find they are kind of pigeonholed.

What I'm saying is if your ultimate goal is Mother/Baby, Pediatrics, Surgery, etc. take the Medical job as it will be seen more relevant to those positions in the future. Hope this makes sense.

[LadyFree28, BSN, LPN, RN]

All three specialties sound great. I would choose based of the unit, culture, and manager. Go with you instincts. The people you work with can Mae or break your career.

THIS.

I would choose whichever unit that will feel a "fit" for you; the nursing knowledge and skills that you will learn in your practice will transcend where your find yourself in your career-you might find that you like where you land!

[Kooky Korky, BSN, RN]

Why refer to it as poison? Good luck in whataever you choose.

[meanmaryjean, DNP, RN]

Figure of speech is all.....

[FurBabyMom, MSN, RN]

I think one important thing to remember is that while the unit might be primarily cardiac, neuro or medical - you will probably have times you take patients of that acuity but from another "group". This may not happen all the time, but it will probably happen. Particularly when beds are in high demand. I work in the OR. We try to send patients to the preferred units or ICUs - but sometimes it doesn't happen and you get the level of care right and make it work.

I worked neuro stepdown before I worked in the OR. We had the highest number of tele beds in the hospital on our unit - so we got a lot of random stuff that needed tele monitoring too. We'd have patients just south of ICU status on our unit (still on q2 neuro checks/vitals) and patients who were in for post op surgical site infections too. I like neuro stepdown because of the "cool" things, but there were a lot of hard situations to deal with. Lots of sweet people transferred to our hospital for neurosurgery because of a brain mass, they'd be on stepdown before the OR related to new onset seizures or something like that, go to the OR, then ICU for a day and back to our unit. Final path would come back and would almost always be something like GBM and it was hard watching patients and families struggle with that one. For things to be fine and then you have some event that causes you to have a head CT then transfer to a bigger hospital then brain surgery to find out you have very aggressive brain cancer and will die in the next year or so (highly likely anyways)? It's hard to work though (especially when you are primary for a patient through a 5-10 day admission, are so involved in discharge planning and "bond" with the patient/family).

NOT that there aren't difficult things on other units - there are. It makes sense, these people are really sick and they're sick for some reason... I'm just glad, even though I likely see MORE difficult things in the OR, I have less connection with patients/families. I have enough and enjoy it - it's definitely a challenge - make someone and their family trust you with their lives in under 5-10 minutes?

[TU RN, DNP, CRNA]

I started on medical stepdown and have to agree with whoever referred to it as a dumping ground. Anything and everything that the admitting resident or stepdown team thinks would need closer monitoring comes to us. We take neuro stepdown and surgical stepdown patients. We are a liver transplant center so we get lots of people with ESLD from all over the region. These are some very sick people. We send patients to MICU, SICU, CCU, OR, Cath lab, whatever their clinical deterioration calls for. We also send patients to med surg, rehab, SNF, or home. Do I think it's a great all around learning experience? Absolutely second to none. Do I think it's the best place for a new grad? Well I did it and am pretty burned out from nursing in my two years. Everyone is different. Make your call and good luck to you.

[ThePrincessBride, MSN, RN, NP]

Hey everyone, thank you so much for your replies. I did not realize that a medical step down unit was considered a dumping ground for the hospital and my concern as a new graduate nurse is that it might be too overwhelming.

However, I do not want to be pigeonholed into a certain kind of nursing as I think it is becoming more difficult to switch specialties. I want to keep my options open. Of all of the step down units, my least favorite would be the Neuro step down unit.

I will keep an open mind and take whatever I can get and learn as much as possible!

[imintrouble, BSN, RN]

I'm on team Neuro. I think it's fascinating.

Medical, which I work, is just a revolving door of the same patients over and over. Easy burn out.

The choice between cardio and neuro is just a matter of personal preference.

[NurseSpeedy, ADN, LPN, RN]

There are pros and cons to each area and it really depends on the individual which unit would be best, as well as what those units are like in a given hospital that you are looking to seek employment.

Med/Surg is a general area that many new grads end up starting off working, usually for at least six months at the facility that I worked for in the past. It would give you a chance to work with generally stable patients and see a variety of different conditions and how they are handled. However, working this area in the past I will say that at my hospital it was the dumping ground. The minute a horrible patient was taken off telemetry, telemetry suddenly needed to transfer them to medical (even though there were several open beds). The patients that started off on tele and didn't need it anymore but were "good" patients, they hoarded from us. This was also the floor that got the least staffing. If another unit needed a nurse, they would take one from medical mid shift to got to another area in need. I had days when I had 10 patients with an aide to share between two other nurses...on DAY shift. I ran from this floor once I was able to but I learned a lot there, especially time management.

Many cardiac floors are also med/surg, just for patients with cardiac issues along with other diagnoses so this may be a good floor to start on too.

Step down, considering the facility, could be okay for a new grad. If it is a hospital that is small and does not take on serious cases, then you may be fine, especially if you are confident in your abilities. However, if it is a large hospital with complicated cases and/or trauma, I would advise taking on a less intense job if possible in the beginning. Transitioning from a student nurse to a staff nurse takes a bit of time and while stress can be a good thing, you don't want it to burn you out of the profession before you've had a chance to really get into it.

Best of luck!

[ElizabethStoneRN]

OP: They are all interesting in their own way and you'll get a "feel" for the unit via the manager and hopefully you will get taken on a tour of each of the units. I've seen some on here even advise to ask to shadow for a shift which I think is a good idea. Good luck!!

I totally agree with the above advice. I would actually base my decision on the culture of the unit and the feel of the unit- a combination of how supportive you feel management is, and how you feel the staff work as a team and support new graduates. I suggest asking to shadow on each, for at least a couple of hours if not more, before making your decision. Pick brains, ask questions of everyone (nurses, techs, etc)- observe how they treat one another. good luck with your decision! congrats :-)

[Libby1987]

I would think a nurse with a year or two of cardiac would be more marketable and have an easier transition to a med/surg dept than a new grad.

IME, and it's been a long time, the cardiac floor had a different culture, one that I liked anyway. In a more recent experience with my dad over several admissions to the cardiac floor, the nurses weren't running. It did not seem overly stressful, not in that omg I could never work here sort of way.

[Libby1987]

Why refer to it as poison? Good luck in whataever you choose.

I always think of cocktails..