ICU envy?

[CandyGyrl]

I'm an August grad and I have to admit, when I started nursing school my heart was set on working in an ICU. While I was in school, I applied for extern jobs to better align myself for an ICU bound pathway and NO ONE CALLED! I had no medical experience/background other than school. I think things went downhill from there. I got sort of depressed and I didn't work as hard in school. 2 of my friends 1 a medical assistant and the other a nurse assistant, had no interest in ICU jobs and GO figure were called, interviewed and landed SICU nurse extern jobs! What the fudge? I was happy for them but upset that I was never even considered. Now they love it. We have all graduated and of course they get to remain in the ICU as interns where they've worked as externs.

I constantly pine over this all the time. I feel like I didn't do enough to land a position in ICU. I should've campaigned, shadowed in the ICU, met some people, shook some hands, showed some enthusiasm, some drive an eagerness to learn. Now I regret it. And I continue to envy ICU nurses (well new grads at least).

I currently work on a Neuro floor as an intern and my manager is putting me in critical care classes so I will get my CCRN certification at least, and by March I can consider transferring to hopefully and ICU. The green eyed monster is a powerful being. am I wrong to feel this way?

[RN1982]

Miss Candygyrl, you are going to do fine. I would recommmend staying on that unit for a year then moving on to ICU. Get confident in your assessment skills, work on being organized and prioritizing your shift and you will do fine.

[WindwardOahuRN, RN]

Eh, when I worked on step-down, it was considered critical care. A lot of places do consider stepdowns critical care areas. Even the AACN consider step-downs or progressive care units as "critical care". Why do you think they offer a PCCN certification? .

LOL---so they can make more money selling education materials, certification exams, and re-certs?

Oh j/k but I honestly don't think much of the AACN organization nor its present criteria for awarding certification.

:::Shrug:::

But I have my CCRN and I'll keep it up because it's what some folks think is important and yes, it looks good on a resume. I am not delusional at all about its real value, however.

If you check out the AACN site it states that the PCCN certification is for nurses who care for "acutely ill" patients while its CCRN certification is for nurses who care for "critically ill" patients. They stretch the PCCN certificatiion to cover many areas but specifically not critical care so to point to the AACN certificatiion for PCCN as being "proof" that PCU's/stepdown units are critical care units is stretching things a bit:

>>PCCN® specialty certification was introduced in 2004 for nurses providing care to acutely ill adult patients regardless of the geographic location of their nursing care. Nurses interested in this certification may work in such areas as: intermediate care, direct observation, step down, telemetry, transitional care, or emergency departments.

Wow. Quite a catchall. Good for the AACN bottom line to include the masses, I guess.

Nonetheless, PCU/stepdown units can be much more intense than med/surg units and working in them is good experience and if one wants to consider them critical care feel free.

There will be many CC nurses who will not agree, however.

[talaxandra]

Wow, Candy - you don't have a very high option of Med/Surg. With the exception of aortic balloon we manage all those aspects on my ward, and use a combination of observation, experience and knowledge to monitor patients for changes in their condition. In some ways, with less invasive monitoring, change can be more subtle, and can also be trickier as one's attention is split between patients.

I'm not saying what I do and what ICU nurses do is the same, or that one is harder or easier - they're different, with different skill sets and demands, but there is a degree of overlap. Getting a grounding in non-intensive patient care can enhance your ICU practice and add a dimension to your care.

[WindwardOahuRN, RN]

But this was just my feeling and I was venting a bit. I give 110% because your name is worth more than precious stones and gold and I want people to know that when you work with me I've got your back, I'll give my all and patients are in good hands.

It's okay. We all have our moments but one of the difficult aspects of these forums is that we only see a snippet of the poster at a particular moment via a few written words and can't see facial expressions or hear sincerity in a voice.

It sounds like you're in a pretty supportive environment and you'll progress as time goes by. Do the very best you can, where you are now, and your reputation will get you where you eventually want to be.

Good luck! :loveya:

[porterwoman]

1. ICU can be much much much more task oriented than you may realize--even though you would really like to glance at that chart, some days it just isn't possible cause ya gotta wipe poo AGAIN--especially in that first year as you get the "less sick" pts

2. You are right now gaining that "intuition" to know when your pt's condition is worsening.

Bedside nursing is grubby, unglamorous work, pretty much in any setting or at any level. Welcome! Learn all you can and keep searching for your niche.

Best,

Rebecca

[geekgolightly, BSN, RN]

Wow, Candy - you don't have a very high option of Med/Surg. With the exception of aortic balloon we manage all those aspects on my ward, and use a combination of observation, experience and knowledge to monitor patients for changes in their condition. In some ways, with less invasive monitoring, change can be more subtle, and can also be trickier as one's attention is split between patients.

I'm not saying what I do and what ICU nurses do is the same, or that one is harder or easier - they're different, with different skill sets and demands, but there is a degree of overlap. Getting a grounding in non-intensive patient care can enhance your ICU practice and add a dimension to your care.

It's true. There are different skill sets. And I also agree that working in non-ICU settings enhances your ability to care for critically ill patients.

I also understand why someone would not want to work the floor if they have their heart set on ICU. They are completely different environments. I say that having worked numerous different floors and tele and progressive care before entering ICU.

I also agree that tele and progressive care are NOT critical care, even if they may be classified that way by various hospitals. Huge difference there.

[geekgolightly, BSN, RN]

1. ICU can be much much much more task oriented than you may realize--even though you would really like to glance at that chart, some days it just isn't possible cause ya gotta wipe poo AGAIN--especially in that first year as you get the "less sick" pts

2. You are right now gaining that "intuition" to know when your pt's condition is worsening.

Bedside nursing is grubby, unglamorous work, pretty much in any setting or at any level. Welcome! Learn all you can and keep searching for your niche.

Best,

Rebecca

I also agree with Rebecca here with one caveat; ICU affords one the ability to push your critical thinking skills to their limits on a near daily basis. You HAVE to think critically and intensely for your patients, even while cleaning up poo in order to ascertain if their heart is failing to pump adequately related to CHF or tamponade or MI (is it inferior, anterior, septal, lateral, posterior or a combination there of?) or dilated cardiomyopathy etc. etc.. And which medications you need to beg for, from physicians as most don't know their a$$ from a hole in the ground in critical care. (non major metro teaching hospitals wherein units are not closed).

It's intense, it's heartbreaking and it's fun in ways the floors could never be.

[geekgolightly, BSN, RN]

I tend to agree lots, and then disagree immediately after. :chuckle

[porterwoman]

good point, geekgolightly--in the ICU, you are thinking critically at all times, even when cleaning poo!

My 2 cents, OP--stepdown/intermediate units can be great learning places for new grads. Those patients can really help develop your critical thinking skills because they can go "either way"--they can do fine, or they can tank. AND they don't have advanced airways, invasive and/or continuous monitoring, etc. What DO they have? Hopefully, they have a nurse with good assessment skills and sharp critical thinking who can spot something bad about to go down and then act to prevent it--in other words, YOU.

[larry v]

When I was on the floor, I felt inadequate because I wanted to work ICU. Actually, I hated the floor so much I was started working on a computer science degree...

But after 8 years in critical care, I'm kind of over it. This is more related to me ready to move on to advanced practice.

Grass is always greener...just define your goals and create a plan to work towards it (which it sounds like you have).

Good luck!

[GucciRN22]

Obviously, Critical Care is complicated, but when I float out to MedSurg, Oncology, or any other floor for that matter, I find that I rely a lot on all the monitoring we have in the ICU. It's not that you don't watch the patient too, but when you're on the floor, you have a lot less control and you can't just do an EKG if it's not ordered (of course I've NEVER done one without an order:D), draw labs, etc. I feel like doctors listen to me more when I call from the ICU vs. when I call from the floor and it's infuriating.

There are good things and not so good things about both, but that's why I float to other units when I can. That way when our census in ICU is low, I can work anyway and be comfortable on other units (plus, I get to see my old homies!). Don't despair....there's positives no matter how you look at it! :)

xoxo

[lvICU]

It sounds as if you are working on a PCU. That is a great place to start and it will allow you to transition to the ICU once you are able to get a position in ICU. The critical care classes will also be helpful BUT you will not be able to become certified until you actually work in the ICU for the required hours (1000 + at least). And you will actually needs hands on experience to pass the CCRN exam. I didn't take the exam until I had been in the ICU for 5 years and I still found it to be difficult.