Specializing as a new grad

[hopefulSN]

Hi all!

I am a nursing student, graduating this December, and I wanted to see if anyone had any advice or opinions on my situation.

I have been very blessed to have two very amazing opportunities while in nursing school. I have been tech in a surgical trauma ICU for a long time, and I absolutely love it and my manager is planning to bring me on as an RN after I graduate. That being said, I am also the mother of an infant who was born extremely premature and spent months in the NICU, which was a life changing event for me, and this summer I was so very blessed enough to be chosen as an Extern in an area NICU, and it is looking very promising that I will be hired on come December.

NICU nursing is the dream job that I never knew I wanted until I lived the experience of being a NICU mom. I have enjoyed every moment of my extern experience, and I feel that it is just an amazing place to work. I am very conflicted though because it is a relatively small, less busy level II NICU, and I fear that my opportunities for advancement may be limited since we are not willing to move out of our area. Coming from my background in Trauma, I do worry a little about getting "bored" in this NICU, getting low census frequently, limiting my skills, and not having a much opportunity for advancing to perhaps the NP route. The trauma center I work in is level II and excellent...my opportunities for advancement seem endless, the work is never boring, and I would be gaining an amazing skill set. That being said, I worry that after time my passion for Trauma may get overshadowed by stress and anxiety and burn out, as a lot of the nurses on my Trauma unit seem to be in nurse practitioner programs or actively looking for other opportunities because over time it gets to be too much.

I am just very torn about which way I am thinking of going, and I would appreciate any input that might get me thinking about things to help make this decision (assuming I have the privilege of choosing).

Thank you all greatly!

[Ruby Vee, BSN]

It seems that the trauma job offers more opportunities, and when you get burned out you can go to the smaller NICU.

[RNperdiem, RN]

Your chances are better in the unit you are working in now. A new grad in a trauma/surgical ICU is a dream job for a new grad. If later you still want NICU, it will still be there. A lot of new grads start out at less than desirable jobs that are all they can get and those jobs will burn you out faster than anything. Get a good first job, and you will be more marketable for anything.

Surgical ICUs, especially in level one, academic teaching hospitals attract a lot on nurses who view the unit as a stepping stone to CRNA school, NP school or something else. They do a lot of hiring in the summer when nurses head off to CRNA school. The turnover is not necessarily burnout.

[HouTx, BSN, MSN, EdD]

I've worked in both areas. NICU was the only type of ICU that I couldn't deal with . . . too many ethical issues = lots of moral distress. Neuro/Trauma is my absolute favorite practice area. You can't beat the variety - continually challenging and a wonderful place to learn and develop. Plenty of day-to-day evidence that you are making a real difference in the lives of your patients and their families.

[llg, PhD, RN]

My clinical background is that of a NICU nurse -- and that is where I started out as a new grad.

I think your analysis is spot on target. While I loved being a NICU nurse, it can be limiting. After a few years there, you will probably lose a lot of the knowledge and skills you have developed related to adult patients. It can be very hard to switch OUT of NICU to another clinical area after a few years. However, if you are truly a "NICU person" and will be happy caring for those babies for the rest of your career (and the ethical issues don't bother you much), it can be a great career. You can develop a true expertise for those patients and explore different roles within the NICU specialty. For example, you could focus on parent teaching, or lactation support, or developmental care, or some other particular aspect of care.

Another thing to consider ... How well can you separate your personal experiences as a NICU parent from your role as a NICU nurse? I have know some nurses who could do that very well -- and others who could not help but internalize what was happening to their patients as if it were happening to their own child. I've also known others to have the bad habit of wrongly assuming that the NICU moms "felt the way they did" when they were a NICU parent and had trouble relating to parents whose reactions to the experience were far different. Finally, is your interest in the NICU really a true interest in a NICU career that will last over time? Or is it a way of "working out" feelings you have as a result of your patient experience -- and that will fade once that personal patient experience slips further into the past. Only you can answer that.

The trauma opportunity will open up more doors, as someone with trauma adult trauma experience would develo a lot of skills that could be relevant to many other types of units -- and be a desirable hire by many possible employers. But that doesn't mean it is the right choice for you.

I would ask yourself 2 big questions:

1. What does your heart say about the type of career you want to have long term?

2. What does your brain say about the type of career you want to have long term?

Then imagine yourself choosing either one over the other. How does that feel to you? Will you have regrets and always wonder "what if" with either choice?

That's how I would make the decision.

[ThePrincessBride, MSN, RN, NP]

We are in very similar positions. I am also graduating in December and am hoping to get a preceptorship in the NICU my final semester. Working in the NICU is my dream, and I would love to become a Neonatal Nurse Practitioner. However, you are correct when you say that the NICU can be very limiting, HOWEVER...

It also has very low staff turnover and high satisfaction. Most of the nurses I've talked to who work in the NICU say they LOVE it and couldn't picture themselves working anywhere else. NICU is highly unusual in that it is truly a world of its own, a super-super specialty. If you do not see yourself working in the NICU long-term or see yourself working somewhere else, I think it would be better to start off in trauma ICU. It does have great opportunities for advancement and many CRNA/NP schools LOVE nurses with that kind of critical care experience.

My personal plan? I hope to work full-time in the NICU and get a PRN job on a med/surg floor on the side.

[calivianya, BSN, RN]

If that's really how you feel about NICU... don't limit yourself to that NICU. Start bombarding every NICU within driving distance (and those much further out, too, if you're willing to move) with applications. You have the perfect background to get hired in NICU as a new grad, so apply to the biggest, most critical NICUs you can find. They will like that you have seen what it's really like to be in the NICU from both sides.

Of course apply to the job you're currently working at, too, because it sounds like a great gig, but if you are sure that NICU is your dream, it's worth applying for right out of school.