Three interviews on very different units - need advice

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Specializes in Pediatric Specialty RN.

HI All,

I am a new nurse - graduated in April and spent my first 2 months as a nurse on a busy level III NICU. I thought that's where I'd stay until last Saturday when there were back to back traumatic deaths of 24 week sisters. I was not their nurse, but since I was on orientation they had me do all of the post mortem care one one of the sisters. I also had their last remaining sister as my patient that day and the parents were a mess and the whole thing was just heartbreaking. It broke me. It was the second baby in 2 months that I'd done post mortem care on - I came home filled with anxiety and spent the next several days doing some soul searching and I've realized that the NICU is not the place for me. I've seen adults die and that's hard, but I've dealt with that. This....was a whole other level of traumatic for me and while I am in awe and amazed at those who can work with these tiny kiddos, I don't think I'm one of them.

The NICU experience has been disappointing because objectively it was a great job.....management was great and so were coworkers. I was lucky, or at least others would tell me I was. But I was a nervous wreck at all times and I'm still seeing that sweet baby girl's face that I dressed in a pink polka dot onsie for her last picture with dad. UGH....See, I can't.
My hospital system is being AMAZING about it and has offered to transfer me to one of the following units. The good news is I love being a nurse. I just have to find my right fit. I have interviews and shadowing tomorrow and Monday. I need some advice from those who've worked these types of units as to the types of questions I should ask or issues to be on the lookout for:

Ortho/Trauma/Stroke unit - I am an older new nurse (47) and I've read that Ortho/trauma is the hardest on your body. Can anyone confirm that? What would be a normal nurse/pt ratio be? This unit probably appeals to me the most only because of the varying degrees and types of injuries, but I also have to be realistic about my age.

In Patient Rehab - I know nothing about this unit. I'm worried it might be boring, but that's based on nothing. I have no idea what inpatient rehab nurses do.

Behavioral Health - This is the unit they WANT me on because I have extensive background with mental health education and suicide prevention advocacy and education. I have no idea what psych nurses do....is it 'nurse' stuff, or more therapy and group work? The unit is 37 beds with 6 medical beds.


Any advice would be helpful. The next position I accept I'm staying at for a year or more (come hell or high water!) so I want to make the best informed decision as possible.

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Is the Otho/trauma/stroke icu or floor? There’s going to be a difference.

I work in a Neuro/Trauma icu. We have lifts to help turn and get patients into chairs. But I know it’s not the ambulating that the floors do. Stroke patients usually have deficits. So it can be physically taxing to move them. We have a lot of logrolls as well and you can’t use lifts on them.

I’ve been on my unit for 6 years now. I love it. I love the brain and how unpredictable it is. I like treating big strokes. I also like a fresh trauma and all that goes with it. I’m also a little older. Early 40s. I just make sure I use safe lifting.

But, I’m always on the go. I rarely have a down day. Neuro patients though can sometimes drive you crazy. It’s a whole different thing having patients that have damaged brains.

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Specializes in Pediatric Specialty RN.
55 minutes ago, LovingLife123 said:

Is the Otho/trauma/stroke icu or floor? There’s going to be a difference.

I work in a Neuro/Trauma icu. We have lifts to help turn and get patients into chairs. But I know it’s not the ambulating that the floors do. Stroke patients usually have deficits. So it can be physically taxing to move them. We have a lot of logrolls as well and you can’t use lifts on them.

I’ve been on my unit for 6 years now. I love it. I love the brain and how unpredictable it is. I like treating big strokes. I also like a fresh trauma and all that goes with it. I’m also a little older. Early 40s. I just make sure I use safe lifting.

But, I’m always on the go. I rarely have a down day. Neuro patients though can sometimes drive you crazy. It’s a whole different thing having patients that have damaged brains.

As far as I know the Ortho/Trauma/Stroke floor is not an ICU. It's a specialized unit, but not an ICU. So you are saying that would have more lifting etc. than the ICU correct?

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Both rehab and ortho can be physically demanding. Can you ask to job shadow?

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Specializes in Pediatric Specialty RN.
On 8/23/2019 at 3:22 PM, Golden_RN said:

Both rehab and ortho can be physically demanding. Can you ask to job shadow?

I did job shadow on Friday on the Ortho/Trauma/Stroke unit and the Rehab unit. I knew right away that the rehab unit was not going to be for me. I didn't like the structure of the unit at all. The ortho/trauma unit was really, really busy but overall looked like something that I could possibly like. I am going to job shadow in the behavioral health unit on Monday and see what that's about. That unit makes the most sense because of my background, but I am just not sure.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I am really glad your hospital is being so helpful in placing you. I joke that becoming a mother thawed out my cold, black ER nurse heart, but I am really not kidding. I can't deal with injured kids, just can't do it. I hope you find a good fit!

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On 8/22/2019 at 9:45 PM, Nurse Magnolia said:

As far as I know the Ortho/Trauma/Stroke floor is not an ICU. It's a specialized unit, but not an ICU. So you are saying that would have more lifting etc. than the ICU correct?

Yes, because now those patients are starting to rehab on the floor and most of them have some type of deficit. Most of my patients can’t get out of bed. They are vented. So I use lifts to turn them for the most part. We have a few here and there that we can get up. But it’s not anywhere near what the floor has.

If you have a stroke patient that their left side is weak or flaccid it can be difficult to ambulate them.

But, I do love my trauma Neuro patient population. It’s so awesome to see a horrible accident victim who was on the brink of death walk again or interact with their family again. It’s cool to see TPA work it’s magic.

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I think you should seriously consider the ortho/trauma/stroke unit. It sounds like it's a specialized med-surg unit, so you're going to get the best all-around experience there.

Rehab is great, and I do like floating there from time to time for a change of pace, but you definitely won't see the variety you'll get in the ortho/trauma/stroke unit. Similarly, the Behavior Health will be fairly light on the medical side, even if they have six medical beds. One learns to manage medical patients through the experience of having a lot of them and being surrounded by veteran nurses who can be resources. You will see far fewer things on the rehab or behavioral health units, and will be less confident of your ability to manage emergent medical situations because you won't have that med-surg background.

If you go the rehab or behavior health route, and decide you want to do something else, you'll have a much harder time getting back into the main hospital than if you do a med-surg unit to start. If you take the ortho/trauma/stroke job, and decide after a few years that the physical demands are too much, you'll have that med-surg experience under your belt that will allow you to move to another unit, including inpatient rehab or behavioral health, if you so choose.

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Specializes in Pediatric Specialty RN.
45 minutes ago, turtlesRcool said:

I think you should seriously consider the ortho/trauma/stroke unit. It sounds like it's a specialized med-surg unit, so you're going to get the best all-around experience there.

Rehab is great, and I do like floating there from time to time for a change of pace, but you definitely won't see the variety you'll get in the ortho/trauma/stroke unit. Similarly, the Behavior Health will be fairly light on the medical side, even if they have six medical beds. One learns to manage medical patients through the experience of having a lot of them and being surrounded by veteran nurses who can be resources. You will see far fewer things on the rehab or behavioral health units, and will be less confident of your ability to manage emergent medical situations because you won't have that med-surg background.

If you go the rehab or behavior health route, and decide you want to do something else, you'll have a much harder time getting back into the main hospital than if you do a med-surg unit to start. If you take the ortho/trauma/stroke job, and decide after a few years that the physical demands are too much, you'll have that med-surg experience under your belt that will allow you to move to another unit, including inpatient rehab or behavioral health, if you so choose.

I think this is really good advice and I've been thinking along the same lines. Even with my behavioral health background, going into behavioral health at this point in my career seems like a dead end. I'm worried I'd be making the decision right now that behavioral health will be my career from now forward and I'm not ready to say that. I think I will learn a ton on the Ortho/Trauma/Stroke unit and can take those skills with me into other positions down the road if I decide that it's too hard on my body. I have a strong interest in wound care as well and I think I'd be able to transition to wound care after a couple years on this unit as well. It was a super busy, fast paced unit and I actually like that. The ratio is 6:1, but it's pretty much like that everywhere. I'm going to have to come up with a very good "Brain" or handoff sheet!

Thanks for the advice - it cemented in my mind what I want to do. The only way I'll take behavioral health is if they offer me no nights - which they aren't going to do lol

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Specializes in SCRN.

I work on cardiac/ stroke unit, and our hospital has an ortho only unit, so the combination of ortho and stroke is odd to me. Stroke patients need to be Tele monitored, so ortho unit had to accommodate that too, I would guess. Once in a while we get an ortho patient if they stroked out or had an arrhythmia. Then , we have to set up an overhead trapeze, and somehow we always forget how to do it, lol. I would rather not have ortho patients or bariatric surgery patients.

Anyways, I would vote in favour of ortho/trauma/stroke unit here. Inpatient rehab is boring, psych might be worth trying, see what you think after shadowing.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

Behavioral health inpatient is not a dead end.

Don't do it if you don't want to, but it is not a dead end.

As an inpatient psych nurse I gave meds, did a lot of education, used restraints when necessary, ran a group, and on the child and adolescent psych unit I communicated with parents daily.

It opened up some doors for me to a community position that is mon to fri 8 to 4 no weekends, nights or holidays and I always get my lunch.

But psych is really only for nurses who enjoy the population. If you burned out of psych in your previous job, then just don't.

Give the unit a look see before you commit.

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Specializes in Nephrology, Cardiology, ER, ICU.

I agree with above posters - shadow if at all possible, talk with some of the nurses and see what its all about.

Ortho and rehab might be heavy lifting possibilities as mobility could be impaired.

If you have experience in BH and LIKE it (the caveat) go for it.

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