Tell me about your nursing career path!

Pediatric Critical Care Columnist · Jan 7, 2010

When I started my career I took the first job that was offered to me; I graduated into the last mass layoff/to-the-bone budget cut era and it took me a full year to get into a hospital position. I began as a casual in an intermediate care nursery. My eventual goal was to work in a pediatric ICU and after two years in the IMCN I was offered a temporary Level 3 PICU position that eventually morphed into a permanent part-time position. I stayed on that job until I began to feel that I had learned all there was to learn in that particular place. I left there after five years and moved on to a Level 4 PICU where I've been for more than seven years now. I'm still learning new skills and have a way to go before I feel like I'm "there". I have taken several on-the-job learning opportunities, becoming Berlin heart certified, then CRRT certified and now ECLS certified. I attend a number of annual conferences that apply to critical care (not specifically pediatric) and still feel like there's so much more to know. The government has never helped me in any way with the cost of my education, either nursing school or continuing education. My employer provides me with (contractually agreed upon) professional development days for the major conference that I attend (although I always end up having to use some of my vacation days too) but will not provide any financial support.

Transitioning from one area of expertise to another is challenging; some people make the transition without any major problems and others struggle mightily then end up going back to what's safe and familiar. Med-surg is a great proving ground. A new nurse in med-surg develops excellent time management and prioritization skills, proficiency in basic nursing skills and as they grow in place they learn more and more about many different things. Each job we take provides us with the opportunity to build on what we already know, no matter where we end up.

You know yourself best; you know how flexible and adaptable you are and how easily you learn new concepts. If you are able to feel comfortable in a variety of situations with a variety of people, you should be able to change areas of expertise with only the usual growing pains. I have a friend who changes her focus every couple of years. She has gone from med-surg to a medical ICU to a neuro ICU to emergency to PICU back to emergency to endoscopy to management on a med-surg unit. I've known her five years and she's had four different jobs in that time. I know that makes her sound like a ping pong ball, but she throws herself into each job with enthusiasm and optimism. She learns a ton of new things on each job and then carries that new knowledge with her to her next position. I would trust her with the care of any of my family members, and I can't say that about everyone I know!

student_nurse_11 · Jan 8, 2010

Wow! Thank you for your insightful reply! Its really helps me understand the challenges that may take place if I do perhaps decide to transition to another speciality/expertise after med-surg - I'm 99% sure this will happen.

I will indeed start off with med-surg because everyone I have spoken to (including you) believes that it is a good area to start off.

I will be graduating 1 year from now and I have one nursing elective to take for next semester. I'm debating between a critical care and an ER introductory course. Can you make any suggestions for me? Could you possibly list the pros and cons of each?! - to the best of your knowledge?

Thanks!

Corinna

Pediatric Critical Care Columnist · Jan 9, 2010

It really depends on your personality and what kind of nursing care you see yourself providing. ER is fast-paced most of the time, and your contact with patients is brief. The ER is like a revolving door; the patient comes in, their issues are identified and they're either treated and discharged or they're transferred to another level of care (ward, OR or ICU). Then the next patient takes their place. I admitted a patient to our ICU today from ER and while the nurse was giving me report, the respiratory therapist said to her, "You might want to get back down there, you're going to be admitting a code in 15 minutes." She just looked at him - he'd gotten a text page from the ambulance crew who were bringing the patient in - and said that they'd already had 3 codes and 4 strokes today... that she almost cried when my little person came in because she had to move a deceased person into the hallway so there was a place to put the little one. Of course not every day is like that, but I like ot say that it's a good place for people with a touch of ADD.

ICU gives a very different experience. You're with a patient for the whole shift, and oftentimes for several shifts in a row, so you get to know things about them and their families and there's a routine to it that there isn't in ER. It's detail-oriented work with a unique skill set. Having said that, no two shifts in ICU are ever the same, even with the same patient. If they're getting better, interventions change and become less frequent. If they get worse, interventions change and become more frequent and often more complex. Some shifts are super busy and some are more easy-going.

So it all comes down to preference.