Which to choose CICU or CV Step Down?

[jlcole45]

Hi all,

I have received two job offers and I am having a trouble deciding which one to take. Quickly my background is 16 yrs in ICU, CCU, ER but have been away from nursing about 3+ years and I am returning.

Both job offers are from same hospital so benefits are equal:

1. CICU - aka CCU for us old nurses.

FT nights, medical cardac. Post stents and other non CV surgery fixes, arrythmias, CHFers, IABP patients, vents and the occasional patient with a SWAN - I will admit that I like the technical stuff. As with most ICUs the nursing is more autonomus (compared to the floor), the cardiologists (and their PAs) are rumored to be a great group to work with. The major negative is that it is a night shift position (unsure of how long I would be on nights - could be 6 months or 3 years just depends on turn over)- I am a day person and my hubby is on days. Patient to nurse Ratio 2:1. Nurse manager has only been there about a year, is new as a manager, high energy, talkative sort, who is career climbing - which he admits to readily.

2. CV step down - All post CV patients, less autonomy, but patients are sicker then on regular floors (they have some drips, lots of tubes, pacer wires, etc...). I hear that a few of the CV surgery PA's are butt heads (and one is dangerous), Ratio is 4:1 max, lots of back up, the big plus is that it's a FT day shift weekend position but not Baylor. Still have to work 3 days but are paid more for committing to the weekends. My husband works on this unit and they have said they would try to coordinate our schedules, which would be great for planning things to do on our days off together. Though I don't want us to always work the same schedule - I have to have some time alone! Hubby and I get along the vast majority of the time and have worked together in the past. Nurse manager has been there about 6 years, strikes me as a serious, no nonsense type, but one who will fight for her staff and who isn't afraid to come help on the floor when necessary.

The pay is almost the same for either position, both floors have experienced long term nurses.

Thoughts, questions, comments???

[Christie RN2006]

It sounds like there are good things and bad things with each position. I think that only you can make the decision. You need to base it on schedule and things you enjoy. Talk to other employees and ask them what they like/dislike about where they work. What I would do would be to make a list with the pluses and minuses of each position and decide what things are absolutely important to you and what things you can do without.

To me, 4:1 sounds like a fairly high ratio for patients with drips, tubes, etc. The step down where I work is normally 3:1 or if you have really good patients, 4:1. On stepdown, do they have aides to do vitals and assist with patient care? Do you think you would be ok with working nights? Do you really want to commit to working every weekend? Would you rather have CV patients or other non-cv patients?

Good luck with your new job!!

[ebear, BSN, RN]

My husband and I get along fine but there's NO way in the world that I would work with him. Too much "together" time is not a good thing, IMO. Also, you carry work issues home and over time, I think it's not good for a marriage. If you have a disagreement at home, you carry it to work. If you have a disagreement at work, you carry it home.

[anonymurse]

For what you'd learn, I think it would be well worth following RNs 1 day and 1 night on each job.

[jlcole45]

Thanks for all the comments so far and please keep them coming.

I too have a bit of concern about working with my hubby. We've discussed how we might do this and we decided if we worked 2 out of the 3 shifts a week together that it might be enough alone time.

The nice thing about the CV step down unit is that it's large - up to 40 beds, with each nurse having 3 or 4 patients a piece, so it's not like I'd be with him all 12 hrs. it would be more like in passing. It's a busy floor but really well run. They have a charge nurse, unit secretary, aides who do all the adls but not vitals, and of course monitor techs.

If both positions were day shift I would choose the CCU position, because I am an intensive care nurse, and it would provide more autonomy and allow me to have my own thing - separate from my husband.

I have worked nights but it's been a few years. I am sure I can do it again, as long as I can sound and light proof the room enough. The major negative is that our schedules would be opposite and we might have less time together then we do now (which is one of the reasons I am leaving my current manager position).

Either position will have it's conflicts -- working with hubby has it's obvious potential problems.

Working opposite shifts will have it's problems - one of us trying to sleep while the other is home trying to get stuff done around the house. And I don't function as well on my days off when working nights. But I think I can do it for a year or so.

It's not a requirement to enter into nights to work in CCU but most nurses who go to days were previously on nights - they rarely hire directly to days.

As it stands the step down unit right now is the only day shift position that I have been offered.

Boy this is a tough one! Has anyone else has a similar situation?