I am writing to validate some feelings that I have about my experience thus far in the ICU and looking for some input from all of you as well.

A little less than two years ago I started my nursing journey as a new grad directly in a community hospital ICU. I did a bridge/grad program to start simulation and skills checkoffs for ICU competency. In hindsight of everything that I have learned, I feel as though I would be a sub-par candidate for an ICU job in the future that would be more challenging.

I say this because my hospital is limited in its specialties and we are not too far from a Trauma center that takes the bulk of many specialties. My experience is limited to CVP monitoring, sepsis patients, cardiac gtts, DKA, post-op, and basic medical ICU patients. I missed the era of the "Swan Ganz" - have never used one - and we do not have an onsite intensivist. There is pressure on our staff to become CCRN certified - which can be done, however, I feel that I would not be living up to the title especially if I was to apply to a bigger scarier hospital lol.

Are there any of you who feel this way?

Does anyone feel that what is available at their hospital limit their learning?

There are a few ICU nurses whom I work with that have 10+ years on who take extreme pride in themselves for their knowledge - and some have a boasting amount for what we have to offer in our unit - but for some, I feel like we aren't where we should be..

I feel like a glorified PCU nurse most days of the week and some days I get lucky to have a ventilated patient. 18 bed unit full of Baker-Acts and downgrades half the time. I need to grow but I feel limited in my skills for even applying at CVICU, ICU, TICU in the neighboring towns. Its intimidating. Thoughts?

Because you have ICU experience, even though it is limited by your facility, you would be a good candidate for a position at a bigger and scarier hospital. You already know a lot; you have a framework of ICU knowledge. As you learn new things, you'll fit them into the framework. The bigger, scarier hospital will expect you to have knowledge deficits, lack certain skills and need experience. YAY! They'll teach you. My first ICU wasn't at Man's Best Teaching Hospital -- but my last one is.

Agree with Ruby - apply and go from there. Best wishes

I also agree with Ruby. My first job was also in a small community ICU. Eventually I wanted more and applied at the largest hospital in my area, a level 1 trauma facility. I applied to a couple of the most specialized ICUs and not only had interviews, but I received offers from both. Having the albeit limited community ICU experience definitely made me a more desirable candidate.

I agree with the others that responded previously. I too, felt this way as a new grad. I was working CVICCU/SICU combined unit. We were combined because we didn't have very many open hearts. I kept asking if this was a good stepping stone in case I wanted to go to a larger hospital that performed several daily. I wondered if I would be equipped to handle cases at a larger more technologically advance center. Well, to my surprise I applied and was met with open arms. My experience was not only enough but I managed to have impressed one Nurse Manager with my knowledge of a FLOLAN gtt. I even remember my years in LTC, as redundant as they were, I thought they were useless. As an LPN then I so wanted to get into acute care. Well, just so happens they had a open hiring event at the local hospital. I went in thinking they wouldn't hire me because I was only a " nursing home nurse". Well, it was that nursing home experience that landed me the job. I remember thinking a whole new way when I heard the interviewer say " oh you've definitely got the experience we are looking for." All of a sudden that redundant position meant so much more to me. As I started my journey working Flex on Med Surg, Surgical , PCU, Ortho Neuro, Renal and inpt rehab I realized just how much I learned working in LTC. Everyone kept talking about "that little pregnant LPN with the big afro", how good I was. So, from that I adopted a new motto, I am very careful about the thoughts of today, because unknowingly they are teaching us what we need for tomorrow. You will do just fine wherever you go. Much luck to you.

I also agree with the others; seems like you have a great foundation to move on to a more specialized ICU if thats what you want. I worked in a trauma ICU where we had patients flow in by helicopter although i also never saw a swan. When i went to open heart every patient has a swan so it just depends on where you work and the specialty you are in. Although, if you only ever work in open heart you will only see things specific to that unit and will never see the invasive lines/monitoring a neuro/trauma pt has, doesn't make you better/worse of a nurse just the nature of the unit. Apply for the specialty ICU you are interested in and you will learn the special skills/drips/procedures/lines specific to that unit which can always be intimidating for all of us if it is something you don't work with.

I also agree with the others; seems like you have a great foundation to move on to a more specialized ICU if thats what you want. I worked in a trauma ICU where we had patients flow in by helicopter although i also never saw a swan. When i went to open heart every patient has a swan so it just depends on where you work and the specialty you are in. Although, if you only ever work in open heart you will only see things specific to that unit and will never see the invasive lines/monitoring a neuro/trauma pt has, doesn't make you better/worse of a nurse just the nature of the unit. Apply for the specialty ICU you are interested in and you will learn the special skills/drips/procedures/lines specific to that unit which can always be intimidating for all of us if it is something you don't work with.

So true. Sounds like you're ready for the next thing. Good luck!

I am in the EXACT same boat as you and have always been worried about the same things. I have 2 years ICU experience and was recently offered a ICU position in a much larger teaching hospital, but had too many doubts about my capabilities. I took a PACU position instead, and now I am regretting it. I would just go for it and let them teach you the things you don't know. Like other people on the tread have said, ICUs are so specialized now that not every ICU nurse has the same skills or competencies, i.e. CVICU vs Neuro ICU.