I am a new grad (sort of) with 4 months of hospital experience in the MSICU and cardiac intermediate care. I haven't found my niche yet. Where is the best department to go to in order to better develop my communication and critical thinking skills?

I have worked in almost every department in the hospital. I retired last year after 38 years. I would think the unit you are in will help develop critical thinking skills. After a year in MSICU you should be ready to move to the Emergency Department. You develop close relationships with your team- physicians, mid level providers. Other nurses, Techs, paramedics, radiology, and lab. Communication among your team can be a great learning experience, add in the patient who is typically critically I’ll. Critical thinking skills are quickly developed. You are the first to see the patient. You make independent decisions to give emergency care after assessing the patient. You will give life stabilizing treatment before the physician sets foot in the room. Treatment is based on ENA standards of care and approved protocols. You will have a working diagnoses decided, as labs and X-rays that you ordered come back, you will review with the physician and together decide next strips. ER nursing is one of the most autonomous nursing positions you will find ( unless you are an advanced practice nurse)

Congratulations! I have worked on the floor as a nursing home nurse, OB nurse, ER nurse, and I am currently a practice administrator in a cardiology office. There isn’t one department that has superseded the other in terms of communication and critical thinking skills. Every area that touches a patient is vital.
The one thing that I have learned is that you have to practice and gain so much knowledge and expertise in that area so that you are able to communicate what you have assessed and observed. I have seen nurses become complacent, and think that they know everything. This can be very dangerous because they are closed off to what patient report, families report or staff reports. This one bit of information that is given to them can be life changing to the patient. Successful nurses are great listeners and great researchers. They treat the person individually and listen to their story.
I wish you all the best

Probably right where you are. These things take time to develop and going to a different unit isn’t going to expedite that.

Dig in to where you are. Take your time, learn, get better little by little. Just stay the course and you won’t recognize yourself professionally a year from now.

Regular floor or specialty floor. Also, night shift.This will give you ample opportunity to practice communication with both staff, via report and experience with more families. Also the families will also be, on a whole, in a better place for communication as their loved one is not actively critically ill. The less critical status of each patient will allow, once night time assessments are complete, you to leave ok up each disease process the patient is experiencing, and think of how it is affecting them. You will have less commodities working together, so the individual effects will be easier to spot. (I understand that the number of patients and acuity of each patient has gone up drastically, but there is still more time free on night shifts with a non critical floor. You just have to be willing to spend the time chart diving, and asking question of mentors and charge nurses.

Few nurses enjoy Med-Surg nursing (floor nursing) but if you really want to learn time management, critical thinking, assessments and communication this should be your starting place.

If you are feeling confident in your clinical skills then an adult psychiatric unit would help at working with communication and critical thinking.

I agree with Matt (above). Be patient with yourself and stay on your unit.Sounds like you have two needs, so share these with your preceptors and managers. Critical thinking skills come with experience, and you need oceans more of that. Communication is another thing, but will be easier as you get to know your teammates. These are both challenges for nurses new to the practice, so you are experiencing what all new nurses experience. Also,if you are not already doing so, keep a journal so that you can go back and reflect on your experiences.

I would say MedSurg. You develop a lot of critical thinking skills there.

I have been an RN for 52 years. I have worked any department you can name. After retiring at 69 years old, I returned to nursing 6 months later and now have been working going on 3 years. What I have observed throughout the years is that the nurses who did not "specialize" in the first 3 years of their nursing career but worked a medical-surgical nurse, which is truly a specialization in actuality, had much, much better transparent communication and developed their critical thinking skills based on their own senses, not on what a machine told them was happening. These nurses learned to truly observe, using their eyes, their ears, their hands, their nose. Nursing is the only career that you can truly use not only your nursing skills but other skills, such as I loved administration, oncology and interior design. When I got the opportunity to literally build a cancer center from the ground up, I got to do administrative work and used my love of architecture and design to make this cancer center absolutely beautiful. I started out as a medical-surgical new graduate and it has been an awesome career, especially once I learned my niche. You will find yours but you will have to lots of different experiences. Don't be afraid to step out of your wheelhouse! Best always, Lucinda

Float Pool. You will gain knowledge of all things and then find the area that you like best.

Absolutely STAY in ICU! You will become a Absolutely STAY in ICU! You will become a detailed assessor, refine your intuition, become a great communicator with physicians, patients & their families as well learn valuable teaching skills. You will be able to write your ticket when & if you choose to go to another hospital. Critical Care Nurses are extremely valuable & needed. Plus you will be an optimum candidate if you choose in the future to go into supervision, case management or telephonic nursing! Good luck & congratulations ♡

It might be worth shadowing for a few hours in different areas. I found mine in Endoscopy. Procedural areas are my favorite!

Its to early to know your nich. My first nurse experience was cardiac and critical care step down. I learned a ton doing that just 6 months. Hold on! If you just have to switch try surgery or the emergency departments. Your still new enough they should train you well. You are to hard on yourself. In four months NO one was great at communication and critical care skills. Its hard at first but it does come and from those floors you can wing it any where else. 22 years experience as a nurse i started where you are and loved the things i learned, so much! I used it in every field after that.

In my experience it is better to go in the ICU both Cardiac and general .4 months is not an experience still you need to go further to get good experience. All the best

Believe it or not, I have found correctional nursing to really help with communication skills. You learn how to be honest and upfront while keeping the peace, especially with difficult conversations that they might not want to hear. Critical thinking also can be improved here because you’re not always getting the full story from your patient!

ER

Try Tele or Med Surg and move up from there as your comfidence grows.

Communication and critical thinking skills? Hospice care. I have been a nurse since 1995 and like many others, did a little bit of this and a little bit of that-but nothing compares to deciphering non-verbal signs of pain, agitation or anxiety in comatose patients (or a combination of symptoms) while simultaneously educating a family about the dying process. Ushering patients and families from a place of uncertainty and despair to a place of acceptance and joy is sacred ground. Not many can do this work but those who can have a perspective on life that changes the world. A lot of communication occurs while remaining silent but fully present. Heather Wills BNSc DNP candidate

You are a new grad. Not sort of a new grad. Stay where you are for a minimum of two years, unless you can get a position on med-surg. Then stay on med-surg for a year. Work all three shifts, or both shifts, if they are 12 hour shifts. You don’t mention if you graduated from a two year associate degree program or a four year baccalaureate program. Makes a big difference. If you don’t have a bachelor’s degree, work a year in med-surg, then go back to college for a bachelor’s degree. You will not find your niche for a while, maybe years. Got to work, study hard while in college, and you will eventually find your niche, or many niches. I’m retired now, and I’ve been a nurse since 1984. My favorite niche was my last one in the cardiac cath lab. Good luck and keep learning. Put your patients first

ER!

Oncology. But after four months, stay put for now. If only for your resume that is just not long enough to jump anywhere!

I would go to CVICU. You will master all of those things there over time . It will take you at least 5 years. Good luck 😊

Hem/Onc nurse here. I’d say probably the ED would give you the widest variety of skills experience and challenge your critical thinking skills because we don’t really know what’s going on with those patients when they first come into the ER. I also believe a hematology oncology floor gives many opportunities for experience with communication in a high stress, challenging environment.

I gained a lot experience where I really got to hone in on critical thinking and communication skills working in an inpatient rehabilitation hospital (IRF). Just to clarify, it is nothing like a skilled nursing rehab, where you get far less of the experience I think you’re looking for. My hospitals acuity was above average which probably helped, but I think it is a unique setting where you get the med/surg and acuity minus the critical care (which is a different beast and niche of experience). In my experience (those of you with more critical care experience please correct me if I’m wrong here) the critical thinking and communication skills get built because you don’t have as many protocols, algorithms, and providers/specialists to rely on in house. You are forced into interpreting the data collected through assessments, labs, etc., and then communicating them to the providers and notifying them of changes and needed orders and anticipated care you need to provide. IRFs have a higher loss of reimbursement when patients are transferred to the ED for escalation of care, so they are usually delayed and you’re trying to treat things that you would not in a standard med/surg, and you have to be able to present the case in a way that expresses the need for the escalation of care. IRFs are usually freestanding, so you can’t just transfer them to another unit or upstairs for imaging, and specialists aren’t just at the hospital to round on the patients routinely when stat issues present.

Hi I am a medically retired nurse of 25 years experience with Obstetrics including OB, PP, WBN, and GYN. My best advice is to recognize that you will never "know" nursing. Everyday brings knew situations and while things maybe similar there is always something that comes up that you can learn from. The best nurses around are the ones that recognize when they don't know something and they are smart enough to ask questions and never assume that the " way I learned it" is the only way to do something. When you communicate with your peers and ask those questions you are gaining knowledge which is the key to medical "practice ". My best example is when a patient crashes and a small OB departments staff is attending to the crashing patient you don't send a psychiatric nurse to help a patient push. Just because the RN can count to 10 does not mean she knows anything about delivering a baby, monitor strip, among many other issues that comes along with that. Always bounce things off another nurse there is never a dumb question except for those that go unasked. Best wishes to your future. I love nursing and would still be there today if I could.

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Those skills will develop over time, not based on specialty. Be kind to yourself and allow yourself to learn and grow. 🤗❤️

Four months as a nurse isn’t long enough to leave your current position. After you’ve been there a year, I highly recommend psychiatric/behavioral health nursing. In nursing school I was taught by the med-surg instructors that if you can do med-surg, you can do anything. Wrong! If you can do psych, you can do anything! In psych/behavioral health, you must have superb communication skills and think critically. Psych nursing requires being on your feet at all times to assess patients and also to think critically about their presentation; is this a psychiatric issue or is this a medical issue, such as medications or another disease process? It isn’t for everyone, though. You could always shadow someone for a few hours to see if it’s your cup of tea. You could do that with any specialty you’re considering. In the meantime, try to stay where you are for awhile; facilities have different policies for how long you have to be in a position before you transfer or leave. Hopefully you can stay for two months. Whatever you do, please don’t ever say to nurses who chose another path and never did critical care that critical care nurses are better or smarter. Nothing could be further from the truth. We’re all needed and we’re just different. Best of luck in your journey!

you can try occupational health. It varies everywhere but it usually includes preemployment physicals, workers comp (assessment and follow up for clearance to go back to work). Sometimes you give allergy shots, treat emergencies until parameds arrive. It is different any place you work but maybe you can check out your occupational at your hospital (or work per diem there on your days off)

I had the same issue, but personally I took the leap and switched specialties. I am in love with ED nursing. In the ED you are challenged with health problems from all areas. It test your communication between patients, families and even your colleagues. A lot of the times all you have to go off of in hectic situations is your critical thinking and your prioritization skills. The ED forces you to tap into your nursing skills!

Emergency department great place to develop communication and critical thinking skills.

Case Review. Case review is one of the best ways to develop clinical judgment, especially with nurses new to the specialty. ...
Peer Review. Guided peer review is another way to develop clinical judgment skills. ...

Nicu Paeds icu are the best department for increase knowledge

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Surgical wing

MSICU OR PCU

If you are feeling confident in your clinical skills then an adult psychiatric unit would help at working with communication and critical thinking.

Emergency Room

Non emergency communication would likely be Case or Utilization Management, employee health, or Infectious disease. Emergent communication would be EMS or ER or Surgery.

Telemetry unit

I have experience of MMICU