PICU or Ortho to start?

[none the wiser]

I wavered between posting this here or in the New Grad section, but I thought everyone might see it here. I'm hoping to get experienced and inexperienced nurse opinions.

This week, I had two interviews.

First was the PICU. I have really been pursuing this job, and I finally got an interview. It went well I think...it was a typical interview, and she said she would let me know if I get a second interview, as she is interviewing several others for one new graduate position.

Afterwards, I was taken downstairs to a surprise Ortho interview. I felt like she spent most of the time telling me about the floor, and before I left she offered me the job. She said she had not posted the openings yet, so I was the only one interviewing. I really had good timing on this.

Salary is the same, excepting night shift/day shift differential. PICU is night shift, and could be for a couple years. Orthopedics is day shift. Staffing is reasonable on both...PICU is 2:1 with techs 1:15 or so. Ortho is 5:1 and techs 9:1 on the busiest days.

My concerns are this: PICU is so very acute and emotional, and I am a new grad. I know they won't toss me in the deep end but it is still daunting. Also, I do not do well on little sleep as it is. I'm getting married in October, and I worry about a new marriage + night shift.

Ortho, I am worried I am backing myself into a specialty that will not allow me to go anywhere else but more med-surg. Not to mention I am very small and I have some back pain already. I also worry that the skills I will learn on the ortho floor are not as impressive/expansive as the ones I would learn in PICU.

I love both these specialties...I don't think I was prepared for the possibility I'd have two interviews so close together in two places I actually like. And I was definitely not prepared to factor a day shift position into all of this.

As a new graduate, should I accept the position I was offered? Wait to hear from the PICU? What if I lose the ortho position and then don't get selected for the PICU position? I don't want to lose two perfectly good positions because I hesitated to commit.

[Orange Tree]

"Small with back pain" and ortho don't go well together....ortho is very "heavy". You'll find yourself working with your CNA a lot to move and lift patients, and sometimes it takes three people instead of two. You will learn a lot, though!

I don't know anything about PICU, but the patients sound lighter.

[netglow, ASN, RN]

Well, looks like she thinks you would make a good employee. Thing is maybe she knows who she wants for the PICU already. She might have wanted to offer you a job though, and went out of her way to find you one she feels you would be good at, eg. maybe even a good fit for the floor.

Go with your gut, but do not delay!!! I think you have to consider your back and all, but, adult med will offer you the most flexibility should you want a change.

[Sugarcoma, RN]

Both ortho and PICU offer excellent learning opportunities. In my opinion PICU (and I have never worked PICU so take this for what it is worth) Is a VERY challenging specialty where you will be expected to know twice the information (norms for babies, toddlers, preschool, teens, and even adults). You will be exposed to numerious coniditions in PICU. That being said ortho is also a very challenging speciality in which you will see both young and old and will be dealing with patients with multiple comorbities (CHF, DM, renal failure, etc. etc.) as well as things specific to ortho nursing (traction etc.) It is a very HEAVY specialty but the knowledge you gain there will most certainly serve you well in ANY area of nursing so do not worry about pigeon holing yourself into medsurg. Please do not think that because you are not in an ICU that it will be easier or less stressful..it will not. Just a different set of challenges for each unit. If it were myself I would go with the sure bet but I am also older with a family and need to know where my next paycheck is coming from.

[eriksoln, BSN, RN]

I'm familiar with ortho but not PICU, but what I know is this:

I think once you start adult nursing, it will be hard to get out of. If you decide a a year you should have gone with PICU, you may not be able to change your mind. On the other hand, if you are a PICU nurse, they will have no problem accepting you for an adult pt. unit.

I'd go PICU and if I hate it, change. At every hospital I've even been at, the ortho. unit has hiring/staffing issues galore (relatively speaking, compared to the rest of the hospital) and people often feel trapped there.

[laneymaree]

I've worked in PICU for 3 years, as an HUC, and as a summer internship where we were treated like new grads in a PICU for a Level 1 Trauma Center, so here's what I can say about it.

You have two patients, total care, and it is extremely emotional. You learn A LOT. Not all the patients are small, you get a lot of chronic kids up to 18. Some of those teenagers are quite large.

They say you won't feel comfortable for a year and a half. Expect codes. Traumas. Lots of chronic kids.

I loved PICU. But it isn't for everyone. Especially night shift. That being said, if you don't start in peds, it will be harder to transition there.

Ortho is tough, but you do have techs to help. Techs cant do anything in the PICU hardly except stock and help transport.

Don't worry about pigeonholing. Experience is experience. Day shift for a new grad is practically unheard of.

I know that wasn't the most helpful post, but it was just thoughts to add to your pros/cons list.

Good luck!

[Sun0408, ASN, RN]

One thing I have found to be pretty true.. If they offer you the job on the spot, they have a high turn over rate and need people badly.. This is not true 100% of the time but in most cases this is true..

Ortho is very heavy with lifting, medicating for pain and abx treatment. The turn over rate in ortho is high, people burn out quickly. Some love it while others hate it. Of course this is true in all areas of nursing :)

I know jobs maybe hard to come by but if you can wait and see if you get a second interview with the PICU, I would wait it out..

[Guest717236]

I always favor ortho-lot to learn in this specialty and I agree

with everyone the skills you learn you apply in many other specialties.

That said, ortho is demanding physically day in and day out. It is

a plus that they have a day shift which can be difficult to attain

even if you are an experienced RN.

Balance this with the fact you have back issues and are small. Giving you

a "come see ortho on the spot" interview sends signals that there is high

turnover or other issues on this floor.

PICU sounds like a nice fit for you, but be aware nights can be difficult

to transfer out of in some hospitals so they are right, it would be

consistent for a few years at least.

Whatever path you take, wish you the best in the start of your

new nursing career.

[Flo., BSN, RN]

I work ortho. The first year will be rough but it will be with any nursing position. Once you get comfortable with ortho it is all the same and it gets boring. Big things are pain and nausea mgmt. It is a good place to learn basic nursing skills and get time mgmt down. You can leave and go to PICU in the feature so don't feel trapped. If you get offered the PICU position then you have a lot to consider but as of now you only have one job offer.

[Kitty Hawk, ADN, RN]

I work ortho. The first year will be rough but it will be with any nursing position. Once you get comfortable with ortho it is all the same and it gets boring. Big things are pain and nausea mgmt. It is a good place to learn basic nursing skills and get time mgmt down. You can leave and go to PICU in the feature so don't feel trapped. If you get offered the PICU position then you have a lot to consider but as of now you only have one job offer.

I agree with this. I work ortho and it is mostly pain management, it is "heavy" but if you have a decent team there's usually someone that can lend a hand. I have a small frame, no back issues but since I haven't been able to get back to my weight work outs, I've lost a lot of strength. I thought it would hinder me, but so far it hasn't.

I've been told ortho is a great segway to PACU since that's the before and we get them right after. Originally I was supposed to work on a IMC, however I'm much happier on this unit as I wouldn't have felt comfortable on a critical unit with not a lot of orientation, but everyone's different. I eventually want something to do with a pain clinic type setting so this is good for me for now.

I don't know how bad your back issues are, but being smaller built shouldn't stop you.

[kessadawn, BSN, RN]

I have never worked ortho, but I have worked PICU for the last 7 years. Yes it is emotional, but also very rewarding. You will see chronic sick kiddos, but you will see miracles that walk away lucky and blessed. The patient to nurse ratio will be better, but I have had nights running my butt off with just one patient. I think every floor has it's crazy nights. As for your back pain, we do get adult sized people in PICU. Our PICU takes on many patients who are adults by age and size, but suffer from a disease of childhood, and many of those are total care. That being said, at least in my PICU, everyone is VERY willing to help each other out. You will see such a variety of diagnoses in a PICU, it's a great place to work if you love to learn!

Night shift is something that not everyone adjusts to well. I am a born nightshifter, wouldn't have it any other way, but I have seen many nurses suffer trying to adjust to a sleep schedule that isn't natural for them. You MUST be selfish and diligent with getting your sleep, shut off your phone, darken the bedroom, wear earplugs, whatever it takes. You WILL burnout quickly on nights if you don't get your sleep. Turnover in a PICU can be high as well, maybe you wouldn't have to wait too long for a day position to open? It probably depends on how big your PICU is. We have about 23 beds, and most people can get a dayshift position after starting on nights in about a year, many much sooner.

I agree with the above poster that said a position offered in the manner the ortho position was offered could be a floor that has high turnover and really needs staff now. Follow your heart, you'll know where you really want to work! Good luck!

[nurse2033, MSN, RN]

If you are a high performer, highly motivated, and able to take on a challenge PICU could be a good fit. As another poster pointed out, this job could lead you to almost any other unit in nursing, not true of the ortho job. I would also consider what kind of training program they have. If they have an organized training program, take it. If they are not organized and they just have you follow someone around for a few weeks, you will definately be unequipped. Best of luck.