FNP satisfaction from ICU background?

[TradHunterRN]

Hey all, just got accepted to an FNP program, will be starting in the fall. Having ICU experience up to this point and loving it, I am concerned that I will be dissatisfied and might miss the ICU experience. Have any FNP or AGNPs on here come from an ICU experience to an outpatient or specialty setting and been dissatisfied with their job? Or do you find that the major change in roles and the increased responsibility/critical thinking make up for the difference in pace?

Thanks for your responses!

[BradS]

How much ICU experience do you have? To me, the job responsibilities seem to be at opposite spectrums, so I would definitely proceed with caution if you love your current job. I've read about FNP's and ACRP's getting back into the ICU in certain places. Have you considered CRNA?

[TradHunterRN]

Thanks for the response. 2 years ICU, and I do understand there are vast differences. However, here is my logic. Where I work, most NPs working inpatient don't have a whole lot of autonomy and honestly some of the groups the NPs just feel like fluff. I would HATE IT if I went and got my ACNP and essentially did the same things I do now; alerting the doctor and taking orders.

I feel like in a more primary setting I would have more responsibility for each patient's case. It is THAT difference, the need for in depth knowledge and critical thinking, that I think may be stimulating enough to replace losing the "rush" of the ICU. Just wondering if my speculation matches up with people's real experience :).

Also I mainly think I would get bored with CRNA.

P.S. Please, if you are an ACNP or other inpatient NP do not take my post as a dig. I am not saying you don't critically think or have responsibilities. I am simply saying this is how the system seems to work where I am at.

[BostonFNP, APRN]

I was never an ICU nurse so take my words with that grain of salt.

I work in both PC and in the hospital; I am lucky in that I work autonomously and collaboratively in both settings.

I can tell you that in some ways it is a challenge in the way you think between the two settings, and when I think about it, I actually feel that in most situations, there is far more responsibility in the PC setting.

When you are managing inpatient you have everything at your fingertips: labs, imaging, specialist consults, the patients undivided attention, nurses, RT, PT/OT, etc. You are managing the acute stage of illness and you know exactly what you are treating most of the time. You have the luxury of micromanaging everything. The caveat here is the patient can decompensate quickly.

The challenge and responsibility of PC is not having all these things at your fingertips while trying to make the diagnosis or improving the chronic management that keeps the acute illness from happening. You don't have the luxury of micromanaging and you need to learn to shift your thinking from objective diagnosis to subjective differentials.

My ICU colleagues have shared these views as they transition to PC.

[TradHunterRN]

Thanks Boston that response gave me a lot of insight. The thing about "everything at your fingertips" is something I have thought about too, and actually that challenge in PC of having to rely on your assessment skills and history taking is really exciting to me. I love performing assessments so I think that would be ok for me :)

[BostonFNP, APRN]

It's an interesting switch; I think you will really enjoy the PC environment if you can embrace that, and can let go of the micromanagement aspect of the unit.

ICU nurses have the best assessment skills I have seen in precepting; remember in PC those abnormal breath sounds, or that subtle murmur or rub, or that "feeling" something isn't right is all you have at your fingertips.

[NerdyNikki]

It is so encouraging to read this post. Though I am in the midst of completing my FNP, I currently have five years of ICU experiences. In the primary care setting in clinicals, I really have to train my mind to understand that everything isn't there immediately.

My assessment skills from the ICU defintely play a key role in my approach to patients and how I view their case. Though I really enjoy being a ICU nurse, I am learning many of these illnesses can be prevented with proper primary care management.

I still enjoy the thinking " on my feet" approach and critical care that involved with ICU, so I am hoping to get my post-masters as AGNP. Though I enjoy the primary care approach, I would still like to be involved in beside management as well.