Torn Between 2 Job Offers

[Polo]

Hello! I am trying to decide between two very different jobs/job offers and interested in any input. I received an offer at a level II NICU in a rural hospital which I was really excited about, but while waiting to hear back I took some other interviews, and unexpectedly got an offer at a clinical decision unit/emergency obs in an inner-city hospital. I have a wide array of interests as a new grad, top interests being critical care & peds/nicu as well as emergency. 

The pay at the city hospital is significantly better (like $10k/year) and there's a sign-on bonus as well as help paying off student loans (10k over 2 years). 

I guess one of my main concerns is how much CDU really is a good place to be, if my main interests are critical care & emergency, if the "stepping stone" idea is kind of a myth. But then again, level 2 nicu also isn't high acuity, so maybe either job would just be a stepping stone.

[klone, MSN, RN]

I would go with the second one. Level II NICU is not going to be very stimulating if you're interested in critical care/ED. Your opportunities to see different things will be greater at an inner city hospital. 

[Polo]

@klone do you have any thoughts/knowledge on relative ease of transferring from NICU level II to a higher acuity NICU (level 3-4) after a year/few years experience? my gut goes back and forth but feeling like nicu/peds is where I want to end up, ideally higher acuity patients eventually.

[Nurse Beth, MSN]

Congrats on two job offers!

The CDU would give you a broader experience in your first year. There's an advantage in going from a wide to a narrow specialty rather than vice versa.

[Been there,done that, ASN, RN]

Cannot  give advice on a level 2 NICU. I have worked three different CDU's.. and they were all different. You would expect to see many different diagnoses, learn telemetry interpretation, and IV drug administration.

Try to shadow the unit for both job offers.

 Best of luck with your decision.

[Wuzzie]

A rural Level II is going to have feeder/growers, rock stable babies on antibiotics, TTNs on a teeny bit of supplemental O2 and that's about it. There will be some scary stabilizations that were unexpected (shoulder dystocia, late decels, an occasional mec aspiration) but by and large the high risk moms will be transferred out and you will likely call the closest Level III/IV transport team to be present or at least en route for anything significant. I have worked NICU, CCT, Flight and ED. You'll get your best learning in the CDU/ED environment when compared to the other offer. With ED experience you should be able to transfer into any other specialty of your choice. Level II NICU experience (especially in a small hospital) may not get your foot in the NICU door as much as you might think. The hierarchy is real if you know what I mean. 

[Polo]

Thanks @Wuzzie. Would you say the same for CDU as ED though? 

[Wuzzie]

Polo said:

Thanks @Wuzzie. Would you say the same for CDU as ED though? 

Yes because those patients are being kept for a reason. Also, there's a good bet that you wiil end up cross-trained. 

[Lipoma, BSN, RN]

Definitely do CDU if you wish to get into ED/Crit Care. Reason being, CDUs are usually attached to the ED and these patients are technically ED level patients being observed for 24 hrs. It'll be much easier to cross train in the ED from the CDU. Where I was a traveler they would float the ED nurses to the CDU when the ED was adequately/over staffed.

[ErinDel, ASN, BSN, RN]

Congrats on both job offers.. I would take the CDU position. It will take you further in your career and set you up for more success with other jobs in the future.. You can always switch to NICU once you gain more experience.. Good luck!

[choughlesRN]

I think all new grads should start in med-surg, any specialty. You learn so many valuable skills that will take you anywhere. I'm not sure how a Level II NICU stacks up in terms of "normal" vs abnormal babies, but I know of a number of new grads who really struggled starting out in specialties like ICU, L&D, etc.

[Lipoma, BSN, RN]

choughlesRN said:

I think all new grads should start in med-surg, any specialty. You learn so many valuable skills that will take you anywhere. I'm not sure how a Level II NICU stacks up in terms of "normal" vs abnormal babies, but I know of a number of new grads who really struggled starting out in specialties like ICU, L&D, etc.

I think this should be left up to the applicant/new nurse themselves. I started in a high acuity ED as a new grad with multiple other new nurses and we all survived. Other times, there might be 1-2 new nurses who did not make it off orientation but that can be said for many new nurses despite the specialty. If I had started in med-surg I would've given up on nursing 5 years ago. Not everyone is built for med-surg just like not everyone is built for other specialties.