Which should I choose?

[ArmaniX, MSN, APRN]

So this is one of those very nonspecific, only I could truly make the right choice, type of questions. Mostly looking for your opinion based on your knowledge/thoughts/experience.

I've been offered a position on both a neurosurgical icu and a multisystem icu. They are in a level 1 trauma hospital. I have over a year experience as a stepdown nurse (multisystem).

I was hoping that the selection process would occur by me receiving one offer but I got offered from both units. Same hospital so pay / shift is a nonfactor.

I feel multisys icu would give me a more natural progression and make my transition to icu the easiest. This floor has a lot of experienced seasoned nurses, which to me means lots of opportunity to learn. But I hear that there is a lot of hot heads and sense of superiority

The NSICU is a younger crowd and very friendly. I hear they frequently run into staffing issues and require nurses to go to 3:1 if needed. Having no experience with intense neuro as far as cranis/icp/evds and bolts it is both intimidating and exciting.

I could see myself on either unit. I see both pros/cons and im still 50/50. Hoping some comments will help sway my decision..

[Here.I.Stand, BSN, RN]

You lost me at 3:1. In a level 1 trauma center, you get some BAD heads, and they can get even worse VERY quickly. I'd be terrified trying to watch 3 of them. Not only that, but in my experience when neuro emergencies happen, you're probably going to be married for the next couple of hours (between giving 23% NaCl, starting new drips, running to head CT, cooling the pt, etc.) That means you're going to have to count on your colleagues to help with your other pt(s)...and they'll have to count on you to help w/ theirs when it's their pt headed south. Again with 3:1 ratios, that sounds terrifying.

[dah doh, BSN, RN]

Although the neuro ICU has a younger friendlier crowd, did you ask WHY the staffing issues??? 3:1 for any ICU patient stinks! I personally couldn't do ONLY neuro patients every day, but then I feel like that about every body system; hence why I work in a mixed ICU.

As for your other ICU, other than experienced hot heads, what else is good or bad? How is the staffing there?

Which unit is a better fit for you? What interests you more (familiar or the unfamiliar)?

[calivianya, BSN, RN]

How frequently is frequently with that 3:1? And, perhaps a better question, how many nurses are tripled at a time? If there is just a slight shortage, other coworkers would probably be able to help if just one nurse is tripled. However, if they are so short multiple people are tripled at a time, there will be no help for anyone if things start going south.

I would pick the multisystem ICU just for the better ratios. Even though you have seen multisystem type problems before, odd are you may have equal amounts to learn in either ICU since ICU-level and stepdown-level management for the same problems can be different beasts, so I would advise against making decisions on familiarity with diagnoses alone. Good luck, whichever you choose!

[ArmaniX, MSN, APRN]

Thanks for your responses. I wasnt directly told about the 3:1 ratio bythe management but by a friend who works in the icus there. Also the manager who set the interview up was not able to interview me themself because they took a team on the floor that day instead of being out of staffing (kudos to them helping the team tho).

With micu the level of experience on those nurses who also do the RRTs is just amazing to me. I very much want to be near them and sponge up the knowledge. People at the hospital continue to tell me to NOT go . Micu because its the "dump site" meaning they get any and all **** patients... but that kinda is what micu entails to me, being able to take most any patient.

My only fear with micu is that I will get bored quickly with it being "similar" to my current unit. The only difference, saying this having not worked the icu, is my current floor doesnt sedate or intubate or do vasopressor drips. My current floor is 3:1. We have chronic vents. Drips. Bronchs bedside etc. So there is still a lot to learn and learning how to become an ICU nurse will take time. But I worry I'll become bored sooner than neuro.

The newer nurses and lack of years of experience on the neuro unit is the main turnoff for me. Id rather be surrounded by nurses who dont lose their cool during emergencies. My current floor has had tons of turnover and there have been many nights where I'm the most "experienced" and that idea scares me :)