What's next?

[Nrseisme]

Hi everyone!

I wanted to post here because I was hoping to get some advice and/or direction from those who have been there.

I have been working on a cardiovascular intermediate/step-down unit. We see a lot of patients with heart and lung disorders. We do titratabe insulin drips, heparin drips, nitro drips, and various others (some are constant rate only). We also do O2 up to the point of intubation (hi-flow, heated hi-flow, and bipap). I have charge experience and had the opportunity to do some additional training like moderate sedation and US IVS. I have really enjoyed my time there, but it is almost time for a change. I have a BSN and this was my first job as a nurse (2 yrs).

I am at the point of considering whether my next steps should be a travel nurse assignment or two, maybe trying out ICU (I do get FOMO sometimes when I have to transfer a patient out), or trying out something a little milder.

Anyone have any suggestions? How do teaching hospitals compare?

[JBMmom, MSN, NP]

You're contemplating some very different options there and all have some benefits and drawbacks. I can't speak much to travel nursing from personal experience, but I know that my hospital is cutting back on travelers and for those still working they decreased their pay mid-contract (which seems to defeat the purpose of a contract, but I guess there are some loopholes in there somewhere). I'm sure you can get travel feedback from others.

As for changing units, there are positives to making either change you're considering. If you want to see what happens when your patient transfers to the unit, you have a good start for ICU experience and will build on your knowledge base with mechanical ventilation, additional titratable drips and following the plan of care when a patient experiences a change in condition.

If you're considering a transition to something like a med-surg unit, your experience will serve you well in dealing with stable patients that experience a change in condition. You may have a larger patient load, with more stable patients, and your time management and assessment skills will be key components.

As for teaching vs non-teaching hospitals, I have experience with 2 non-teaching and one teaching hospital. I have found that the nurses have less autonomy in the teaching hospital environment. I'm sure it's NOT applicable to all teaching hospitals, but in my teaching hospital, providers have to place NG/OT tubes, there are very few nurse driven protocols, there is very little autonomy with the statement that "residents need to learn" thrown around alot. But I'm sure that some teaching hospital environments are great for nurses.

Good luck with your next move, you can't really go wrong, there's always room for moving around if something doesn't work out.