Acute Care NP?

Advanced Practice Columnist / Guide · Mar 8, 2008

I am starting in the ICU this month as a RN after four years as a SAHM. In my former life, I was a Pedi NP and Nursing Instructor. The problem with pedi was that I NEVER got any immunity to all the crud pedi patients bring in with them. After 7 years in pedi, I was still constantly sick, so I decided to stay home with my kids for a while. I have never had a problem with adult crud...so I decided to take a job in the ICU at a hospital 5 minutes from my house. If I enjoy it as much as I think I will, I am going to get my Post-Master's Certification in Acute Care.
My questions for the Acute Care NP's out there are:
1) What do you like about your job?
2) What do you dislike about your job?
3) If you have worked as a NP in the Primary Care setting, what are the main differences between primary care and acute care?

1. I like the fast paced routine in the acute care setting as well as the fact that you almost see immediate results of the interventions you do. For instance, when a critically sick patient wheels into the ICU, you start thinking in your head and analyzing what is going on with this patient and what you need to do, do you intubate and bronch? do you put in lines and start pressors? is it pneumonia and do you need to start antibiotics? is it sepsis? The same also applies to a fresh open heart with highs and lows in blood pressure and cardiac index. You have to be on top of these things and order the appropriate med drips. It is such a good feeling when the patient evntually becomes hemodynamically stable and you get to order a weaning trial from the vent and eventually extubate. I also enjoy being called for a patient with a pneumothorax and hearing that swooosh of air escaping from the pleura and seeing the follow-up x-ray with the lung fully expanded.

I also know that there are a lot of nasty ICU bugs floating around but throughout the time I've worked as an NP there, I have not been sick other than the usual seasonal cold which I more likely got from a co-worker.

2. The long hours and the rotating schedule can take a toll on one's physical and mental well-being, I think. We work 3-12's on a rotating 6A-6P or 6P-6A schedule so that is quite unconventional for most NP's. I don't usually pick up overtime because I want my well-deserved break.

3. Because I don't see the patient in the clinic, I sometimes wonder how they are doing after discharge. Some do show up in the ICU after being sick and on the vent for a long time and it's always a thrill to see them doing so well after all that. In the primary care setting, you get to establish a long-term relationship with your patients as you adress their over-all health care needs.

TX_ICU_RN · Mar 9, 2008

Thanks so much! I really want to make an informed choice if I am going to submit myself to nursing school again!

Advanced Practice Columnist / Guide · Mar 9, 2008

...and my role is just an example of the many fields an ACNP can work in. There are many other specialties and roles that fit our training. Some of my classmates are working in Cardiology, Adult ER, Transplant Surgery, Neurosurgery, Internal Medicine, and focused Heart Failure management to name a few.