jv503

Fortunately, and unfortunately I suppose, nearly every type of unit is short staffed beyond belief right now so I think you could certainly get hired to a unit similar to one you previously worked on. Just really highlight the things that are your strengths and you worked on in your outpatient experience, and be honest about things that you will work hard to improve on in acute care.

Hi! I had the opportunity as a new grad to experience basically every kind of ICU in a rotation as part of a critical care internship over an 8 month period. I currently work in the cardiovascular ICU. What I love about it is the variety in high and lower acuity. Sometimes we have someone who doesn't appear too "sick" in hypertensive emergency but they are on a nitro drip and obviously high risk. Or a post STEMI patient who most of the time has a successful outcome but you have to be ready for anything. But you can also get patients on an aortic balloon pump or ECMO and have 15 drips running. I know a lot of people in cardiac surgery facilities also love the surgical cardiac cases-- I'm hoping to work somewhere like that for my next move. Medical ICU was good for consistent work with ventilated/sedated ARDS patients, complex care with renal and hepatic patients, but also quite a bit of overdose and withdrawal patients as mentioned above. They get a ton of CRRT which I'm a bit jealous of haha. Surgical/Trauma (combined in my facility) was my favorite for a while. I like the relationships you can build with the surgical teams. And there's a ton of variety from breast flaps to open abdomens. Surgeons can be super picky (for good reason). There are also often q1hr assessments like pulse checks, pupil checks, etc. The trauma side is amazing because you'll never have two cases that are identical. From my experience there, the difficult part is that a lot of these trauma patients experience a ton of pain and at least in my facility there are some rowdy folks who come through especially the GSWs! Keeps it interesting. The burn ICU is really unique. Those patients can get so sick and their pathophysiology is so fascinating to me. Wound care is brutal, and with open skin you are just altering every part of your nursing care. There is a lot of pain in these patients because current practice avoids heavy pain meds and sedation. Pediatric burn cases are just so difficult. You often get to accompany these patients to the OR. Burn resuscitation is super interesting. I didn't love it because it just feels too specialized for me and there aren't enough high level burn facilities out there for potential transfers eventually. And you know plenty about neuro it sounds like! haha, and I have to agree with you there.

Hi there! I am a nurse from the PNW who has worked in DFW for 2+ years. First of all, unions are really hard to come by in Texas as far as I've found... In Dallas you have the major hospitals-- Baylor, UTSW, Parkland. Then there are branches of Baylor, Medical City, Presby all over the DFW area. From my experience and what I've heard: I worked at Parkland's ER. It is the busiest in the country, and has its fair share of issues like any other hospital. Unfortunately we are pretty overrun by psych and social work related issues. The turnover is pretty high and there is a lot of youth in the department currently, but also some incredible experienced nurses who have stuck around. Pay is competitive especially for an experienced hire, and there is still a ton of $40 extra/hour critical pay available as well as sign on bonuses. Critical care cases are treated in a specific pod of the department so you only get true critical patients (2:1 ratio) on certain scheduled days, and trauma is entirely separate from the main ED (this is important in my mind because a lot of people come to Parkland because of the trauma/burn draw). Besides the critical care pod, ratio is typically 4-6:1. Once you are pod lead though, sometimes you get 14-20+ patients in your pod with 12 beds! One thing that bothered me the most was that since the entire hospital is rather busy, the ER has to hold admits wayyy longer than most hospitals, but I know leadership is working hard on this. The good about the department includes decent management who are always present even on nights. Assistant managers are awesome as well, at least on nights. Night shift director is the best and is present. You get the Parkland name on your resume which is a lasting positive effect. Physicians are mostly amazing-- it is a teaching hospital but the residents tend to be great and so attentive and smart. The hospital is less than ten years old, and the facility is pretty nice overall. You will NEVER be bored haha. As far as the other hospitals go, I will leave that up to other people for the most part. I have a friend who transferred to UTSW Clements from out of state and really enjoys the team and the acuity-- they have sicker transplant/cancer/etc patients more often. I have also heard good things about most of the med city ERs, that even though they are smaller they are well organized and pay well. Hope some of this helps! I think it's important to get the brutal truth haha!

All that I really have to say is that nursing is an incredibly dynamic career with SO many options that you should be able to pivot to something that makes you feel like you're meant to be there. This idea is exactly why I studied nursing-- you can do everything from critical care, to education, to esthetician nursing. Acute bedside nursing, and certainly critical care AND certainly in the wake of a pandemic, is not for everyone. However... I agree with what you said regarding this being a "new grad feeling". It takes months and months to feel comfortable. When you are released from your preceptor you will not feel ready. When you have been on your own for a few months you will probably still feel shaky. What you need to remember is that you are part of a team and no one wants to see you fail, especially when critically ill humans are involved. Only you can know what is best for you, but I do think you should give it at least a year to make sure that it is not the place for you to be. And it is smart of you to be open and honest with your nurse educator. Good luck!

Very exciting things ahead! I have experience in multiple ICUs and the ER, currently working in a CVICU. I think this all depends on what kind of FNP you want to be! I think working in the ER is NOT for the faint of heart and you really have to be passionate about the work and enjoy the wildness of it all to survive. You do get to see a little bit of literally everything, however, I don't see a ton of benefit unless you are interested in being an NP in an ER. The NPs I worked with in ours worked in a triage-like position most shifts, and some days they worked alongside residents under an attending doing very similar work. If you are interested in outpatient or ER I think it could be great experience. If you want to work critical care/other inpatient I think there are probably better options for more appropriate experience (managing patient cases longer term).

I feel similarly to the above comment. I signed a contract as a new nurse (no bonus received) but I was in a rigorous new grad program/internship which offered 8 months of classroom experience paired with precepted clinical work in 5 ICUs and the ER. The contract was 3 years (including the initial 8 months) with a $20,000 penalty for breaking contract the first 1.5 years, $10,000 the second. I do not regret taking this opportunity but I would definitely stop and think much longer if I were to do it all over again. At least I knew the reason for the penalty-- they poured a ton of resources into me to learn and become a competent critical care nurse and they didn't want me jumping ship right after gaining all of that experience. I also had the flexibility to transfer within the facility if I wanted (which I did after almost 2 years) and it saved me at a time I was really burnt out in my previous unit. I've noticed a big trend in postings with bonuses for new grad jobs, but a contract associated with them. I would absolutely hesitate and learn as much as you can about the opportunity before you do that. In my eyes, that shows that they are extremely understaffed if they are trying to recruit new grads (nothing unique to contribute, sorry but true haha) with large sums of money and binding contracts. You should be able to learn and grow in a stress free environment. Especially in a time where nurses are in such high demand I recommend finding a job that either offers an incredible learning opportunity (like mine) OR is flexible so you can figure out what you are actually interested in before you commit and not get stuck somewhere. If your plan with the bonus would be to just stow it away in case you quit, I don't think the bonus is worth it.

Hi all, Looking for advice as I navigate the next few years of my career. I have a background exclusively in critical care nursing since I graduated nursing school. I was in an intensive training program across multiple ICUs and the ED, then worked full time for a year in the ED and transferred to the CVICU full time last year. I am committing to another year in the CVICU before I leave this facility and pursue something new. I graduated right at the beginning of the pandemic, and like most nurses, I am completely burnt out. From angry patients and families, workplace violence, and traumatic witnessing of death and suffering these last few years I just know that where I am working is not sustainable. All of this is to say that I have a dream of working in a Neonatal ICU. I know that every specialty has its difficult sides but working with neonatals/pediatrics was my dream before the pandemic (lack of residency opportunities when I graduated crushed this a bit). What advice would you have for me if I were to make this transition next year? Are fellowships or something similar common? What are the best and worst parts of the job? Any educational topics that are helpful to look into in the meantime? Thank you in advance.