Options for Advancing Your Nursing Career

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With Laura Gasparis Vonfrolio RN, PhD and NURSING.com.

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Podcast Transcription

what’s going on guys? My name is Jon Haws, RN pounder of nursing.com and welcome to another episode of the podcast. Thanks for joining me. I know a lot of you are probably driving to and from campus. Some of you are listening as you work out or walk or whatever. And I always find it really fun to, as we go to conferences and as we meet students throughout the country, uh, to hear that, you know, you guys listened to the podcast and I think that’s so cool that um, we get to spend some time together every week and chat and talk and, and stuff. So if you do see us at one of our live events or whatever, come up and let me know you listen to the podcast. It’s always fun to meet you guys and, and uh, kind of see the, the other side of the headphones or whatever. All right.

So what I want to talk about today is basically in response to a question that we got on our Facebook group for members of nursing.com and the question was that they wanted to hear an overview of the many different areas of nursing we can go into after we graduate. We can only see so much during our clinicals and a lot of the time you’ve just placed where there is an availability. So I think this comes down to, you know, we know that nursing is a wide open career space. Everybody tells us that as we’re preparing to go into nursing school. But then we get into nursing school and all we end up doing is is community health. Then maybe a little bit of Medsurge or, or geriatrics. And so it’s like, well where’s all this excitement that everybody’s talking about or where there’s all these different things that we can do. So I approached this, maybe not the way that you guys are hoping to listen to this, but I kind of approached it from kind of listing out some of the different, uh, areas that you can work. And then what, uh, different things kind of fall into that. And hopefully that helps. And I’ll provide a little bit of explanation of each of them, but I basically broke it out by hospital clinic and then some fun stuff. All right. And so we’ll talk about that and uh, hopefully it gives you guys a little bit of insight.

And now before I really talk about that, some people ask, you know, should I start an ed or ICU or should I start in med-surge? Look, I’m, I’m the type of person who will tell you to start in the area that you’re interested in and hopefully you’ve had a chance to rotate through that area. And so you kind of know that you’re interested in it before you just kind of get thrown to the wolves and start in a new area. I’ve met nurses who have started right out in surgery, ed ICU, med surge, uh, different clinics and things like that. So start an area that interests you and see if you like it. Hopefully you have a chance to test it out before you graduate. I think it does help to be in a place where you get a chance to, um, practice skills like Ivy and stuff like that.

But if you have no interest in that, then go for the area that interests you the most. I started neuro ICU and I loved it. I knew I wanted to do ed or ICU starting out. Now that I look back, I’m super glad that I did ICU verse ed. Um, and I’m incredibly glad I did that. Versus med surge is just more my personality. But I meet a lot of nurses who med surge is what they want, it’s what they’ve always wanted and they love it. And others who it’s OB or it’s peeds or it’s whatever. So there’s this wide range of things that we can do and just realize that if there’s something that truly interests you to look for that job and to try to rotate in there as much as you can. All right, so let’s just get into some of the jobs and some of the places that you can work.

First of all, I wanted to talk about the hospital. All right. In the hospital. That’s where most of us are going to end up working. Uh, and there’s a lot of places you can actually work there versus just med-surge. Some of the places you can work are the emergency department, we call it the ed. And in the emergency department a lot of them will work three, eight hour shifts or or they’ll work 12 hour shifts and nights, days. It doesn’t matter. The biggest difference that you’re going to see here is the level of trauma that your emergency department can get. If you’re in a big trauma one hospital, you’re going to see more things like the gunshots and the massive car accidents and the, the heart attacks and the strokes and things like that where if you’re in a lower a level trauma, like a trauma three or a community hospital, you might not see those kinds of things.

You might see um, less of that because all those types of things are going to go straight to the bigger, higher level trauma hospitals. But either way, if you work in ed, you are going to see all the walk-ins and you’re going to see some things that are much more kind of clinic like of the cold or the or the rash or those different kinds of things. So that’s what you kind of see in the ed no matter what. You’re always on edge there because you don’t know what’s going to come and you don’t know what’s gonna walk through doors. So it can always be a pretty exciting area to work. Then we have trauma. Trauma is, is you have trauma EDS where you’re going to see really the things that are, are the more, uh, trauma things, you know, the accidents, uh, and the big things that kind of happen, the gunshots where it’s kind of the emergencies that happen with trauma.

Another thing that you could work in is the ICU. Now the ICU isn’t just the ICU. You have the cardiovascular ICU, you have the neuro ICU, you have a med surge. ICU can also have a surgical ICU and you could even have a burn ICU. We’ve had a, here in Dallas, we have the Parkland hospital, which is one of the leading burn hospitals. So they have a burn hospital or a burn, a ICU specifically where you’re seeing a critical burn patients in a surgical ICU, you’re going to see patients who go, who have large surgery, they’re coming out a lot of cabbage patients and things like that come into there. And they also might be mixed in or they might be part of the, uh, cardiovascular ICU. Then you have a neuro ICU with your neuro ICU. It’s a lot of stroke. You’re going to see a lot of, uh, hemorrhagic and ischemic strokes, uh, and these patients acutely, uh, right after they have the stroke.

And then you might have a med surge ICU where you’re gonna see your critical medical patients, uh, things like your super aggressive DKAs are your big liver patients, things like that or what you’re going to see there. So ICU doesn’t just mean ICU. There’s a bunch of different kinds of ICU and different ways that you can work in an ICU. Um, if you work in a, again, a smaller hospital, there’s probably one ICU where you have all of these mixed together. If you work in a bigger ICU or a bigger hospital, they might have a floor for each of these. Um, in my hospital for example, we had a medical, a surgical and a neuro ICU and I was in the neuro ICU and we had, uh, something like 34 beds, usually about 18 of those were critical and the rest were step-down, uh, patients.

So we also got a lot of the surgical and medical step-down patients. Another place you could work would be med surge. This is kind of a general Medsurge floor where you have your medical patients who come in, they’re not going in for surgery, they don’t have any surgery planned. They’re coming in, uh, for maybe diabetes or for, uh, exacerbation of heart failure or things like that. Uh, and you’re going to see just these medical cases that come in. This is a very busy job. I mean, all the hospitals, jobs for nurses are busy. But, uh, as a med surge nurse, you might have four or five, six patients. And so it can be a very busy job, but you’re going to see a broad range of disease processes. And so that’s pretty cool. And you’ll see a lot of different population, anything out of pediatrics, so 18 to death across the medical spectrum.

So it can be a pretty exciting place. Another four, you could work on the hospital, be the neuro floor. A lot of these patients will be seizure patients or stroke patients that aren’t critical enough to be in an ICU and be monitored like that. Uh, but you might see Gilliam Baret you might see a seizure, you might see stroke. And so it can be a fun place to see different disease processes that a lot of people don’t get to see and work with. Another floor that you might work on is a respiratory floor. This was kind of like the step down in the hospital that I trained and it was the respiratory floor where you saw these, um, patients who needed, um, maybe a little more respiratory support, but they weren’t ICU patients. So they’d been extubated, but they were maybe see CPAP, BiPAP patients, um, or a lot of them had breathing treatments of their asthma, pneumonia.

Uh, these of patients who had different lung conditions that were going on another floor. Now we’re going to get into ortho. So ortho, you’re going to see a lot of times these will be post surgical ICU patients. Maybe they’ve had an ortho orthopedic surgery and they’re coming in and they need, um, you’re kind of watching them as they prepare to go home. Then we have oncology. Oncology is a place that I never really wanted to work. I didn’t have the emotional stamina for it. Uh, you’re taking care of a cancer patients and a lot of times these patients, uh, become friends with the unit because they come in a lot. And so you’re taking care of them throughout their cycle of, of, uh, cancer and throughout their oncology treatments. And so you’ll get to know these patients and you’ll work with them. You’ll give chemo meds.

Um, and so it can be a very fulfilling work for a lot of people. For me, it was always a little bit too much emotional draw. Uh, then you might be able to work in surgery. You might actually get to be in surgery and work as a circulator where you’re scanning the patients, preparing the patients, um, hanging meds, giving meds during surgery. Uh, and with that you could advance through being like a first assist and actually build to get in on surgery, uh, and, uh, work in an OIR. Then there is mental health. Mental health can always, uh, be, uh, kind of a busy place to work where you’re going to work with a lot of different, uh, mental health disorders, schizophrenia, bipolar, depression, um, and you could work pediatric, adolescent or adult with this. And so you’ll see a whole lot going on here and hopefully you had a chance to rotate through mental health, uh, in the hospital.

But it can be kind of eye opening to see all the different mental health disorders, uh, when they’re acute, right? Uh, an acute, uh, schizophrenia or acute bipolar or acute depression and, and build a C there with these patients and hear, uh, them, share their stories and talk to them. And so that can be really interesting. I enjoyed doing the clinicals of it. I thought it was really, um, eyeopening, but it wasn’t a place that I really wanted to work. I really wanted to see the sick medical and surgical patients. Other places you can work would be radiology as a radiology nurse you might prepare patients for, um, bring them in, get their scans done. But then you also might build a work in interventional radiology, which is like procedural radiology where you’re putting Stinson and caths in and things like that. And you might actually be doing some of the meds there.

And I had a chance to work in that a couple times as an ICU nurse because they were giving different drips that, uh, you kind of needed to be trained on. And so I was able to go down and do that a little bit. It was pretty neat to see the procedures. Um, and I enjoyed it. But again, I was more interested in the, the excitement of the ICU ER, uh, of the ICU. Then you’ve got to have an endoscopy and cath lab where these are kind of more procedural based as well, where you’re working in a lab where they’re doing an into scopes or they’re doing caths. And so a lot of this is kind of like the surgical environment where you’re preparing patients. You might be in there during the procedure talking, working with the patient or with the doctor, uh, charting. And so there’s a lot of that that goes on in that.

Then obviously we have paeds, uh, impede, you’re working with the child population, so you’re working really close with the child. You’re working with the parents who are working with the whole, uh, pediatric team on these patients where you’re, see all these different specialties, but in a pediatric setting. So you might see, um, pediatric ortho, which Tammy who works [email protected], she does pediatric ortho as a surge tech. And so she would see a lot of these are orthopedic traumas and they would take care of these patients. And then progress them along. And so you would see mental health in pediatrics, you can see all different kinds of things, but if you work like medical pediatric, you’re going to see all the disease processes, you know, the, the adult patients have, are not all that, you know, uh, but in a pediatric setting, um, and so for me, having children, I always felt like it was too close to home and I wanted to work with, uh, the elder population more.

And then OB of course you’re working with the mom, um, helping through the delivery process. If you work in the nursery, you’d be working with the babies. And then again, you have peds ICU, you have, um, uh, neonatal ICU where you’re working with these critical patients just after birth or as a pediatric patient who’s in critical condition. Whew. So that is a lot of the hospital jobs that you can have. There’s a huge number of places that you can work. Um, just starting out in a hospital is a great way to get in there and get some skills, uh, and learn what, what opportunities there are in the hospital. And then get to know different, uh, places throughout the hospital. And then moving around once you’re in a hospital is much easier than getting that first job in a hospital. So if you are offered a job, um, in an ICU or in a medical surgical department, get in there and get to know it because then moving around is actually pretty easy.

Um, just with the nurses that I started with, some went into pediatric ICU, some went to [inaudible], some went to surgery, someone to travel somewhere to see RNA school. There’s so many places that you can go once you just get into a hospital. Now let’s talk some of the clinical settings. You could work, you could work as a school nurse, um, and seeing children in the school, um, making sure they’re getting their medications taken care of. Anything that goes on inside a school nurse and that does in a lot of States requires a little bit of a certification. So getting that certification and then going, working with the school, you get summers off and so it’s kind of a cool job. You could also work in a doctor’s office, preparing patients to see the doctor taking medical histories and doing those types of things, giving shots and all that.

You could also work college help, uh, where you might see, uh, college students come in. Um, and dealing with some of the clinic things that they would see. You could also work like in a storefront in like a target, uh, where you’re, again, taking a lot of medical histories, preparing patients to see the provider. Uh, so working in that type of setting can happen as well. And then also, um, working with health insurance companies. So like if someone signs up for health insurance, you might be able to take assessments. You might be able to go and actually visit them in their home. Um, like when you get life insurance, they’ll send somebody over, take your BMI, take your blood pressure, uh, do all that checking claims, uh, and stuff like that. Now let’s talk about some of the fun stuff. So some of the fun stuff, did you know that cruise ships have nurses?

Cruise ships have a, so you can actually become a cruise ship nurse. A lot of times this will take having like a nurse practitioner, a nurse practitioner working on the cruise ship. So you get to travel around, take care of patients, seasick, Nick, motion sickness, but all these other medical issues that might occur. You’re the provider there. You can also work at events like concerts. We’ll have uh, nurses and medical staff there. One of the best ways to get in that is to actually be an emergency room nurse or um, EMT and actually be able to be at events at concerts and things and take care of, I mean if you think about it like football games or whatever, have 30, 40, 50,000 people there. There’s going to be some medical things that occur. And so being able to be there and take care of that, but you could also be a flight nurse.

I always thought this was where I was going to end up, um, after ICU was being a flight nurse. So flight nurses work in a helicopter, they get to go to traumas and they get to take care of the patients and bring them into the hospital. I always loved being night-shift ICU nurse when the, when the helicopter would land and they would run them down the halls to our ICU and I got to take care of that patient. I just love that adrenaline of getting everything set up immediately and giving report in a scattered environment and trying to make a organization out of chaos. I just love that so much. And so flight nurse was pretty neat. One of the best ways to get into that is to have some prehospital experiences, what they call it. So whether you’re writing in the back of a quote unquote rig is what they call it, the, uh, ambulance and getting some of that experience working in the ed then and taking care of that transition.

Then a couple of years of ICU experience and then getting flight nurse training. So truly guys, the places that you can go. And then one other one is, um, Oh shoot, I can’t remember. Um, it’s the nurse lawyer thing. Uh, like expert witness and stuff like that. So working in law, providing expert witness in cases and helping either claims companies or attorneys kind of understand the medical side of things. So there’s so much that can be done with nursing. Uh, and so keep these things in mind and kind of have a little target of the, the ones that you want to learn about and investigate whether that is starting just immediately in one of those fields or getting into the ICU or getting into med surge floor and learning. Now, the only thing that we haven’t talked about here is all the different degrees of course that you can take.

So you can get an MSN and teach a, you can get an MSN and practice as like a clinical educator in the hospital. Um, being the one who’s teaching either the nursing staff or being the one who’s teaching patients. Um, you can be a care coordinator who helps patients who are in the hospital, figure out how they’re going to move on and get out of the hospital and take care of themselves. You can get your nurse practitioner as a nurse practitioner. You can either be in surgery, you can be prescribing, you can be seeing patients on your own. There is just so much here and you can even go on to education. Um, for those that love education, reach out to us and nursing.com we’re always looking for great nurses, uh, to help us, uh, teach and everything. So you guys, there is so much you can do here and don’t feel limited in what you can do with your nursing career and really investigate those areas that interest you the most.

And realize that taking that first step is the most important step. Graduated nursing school. Getting a job is the most important first step because then truly everything opens up and then get that first job. Work your ass off, do really good, create some references and then see where it takes you as a career. It’s such a fun career and there’s so many places you can go. So I’m excited for you guys. I’m excited for those who are just approaching this end of the journey or the at the end of the nursing school journey and those who are farther away realize there’s so much that you can do no matter where you are. In your stage of the journey, though, we can [email protected] and see all the different, uh, resources, tools, courses that we have for you to help you throughout your journey. All right? We love you guys. Go out and be your best selves today. Happy nursing.

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