Advice, Please! Need to Leave ICU...

[jack1971]

I am a relatively new nurse. In May, I will only have two years under my belt. Currently, I work in an ICU. I have been in the ICU for a little over a year. I still have so many questions and it is obvious the other nurses think I should know more than I do by the questions I ask. However, I am so afraid of doing something wrong and harmful to a patient, I ask anyway and just let them laugh behind my back. But it's really starting to take a toll. For the past month now, I have not been getting ICU level patients. Which means I haven't been getting vent patients. I haven't had a vent patient in so long, I worry I will lose the knowledge I have gained working with these patients. Apparently, the charge nurses are giving me the easier assignments due to a lack of confidence I portray.I am seriously contemplating finding another job because I worry I have formed an impression I won't be able to shake.

With that said, I don't work real well under the pressure that goes along with ICU nursing. And taking care of several patients at a time is a lot for me, so I guess that counts a regular floor out of the option also. As you all probably know, there is a "type" of nurse in the ICU and I am not that type. As juvenile as this may sound, I truly don't fit in. I don't enjoy the adrenaline rush of a code and have a really difficult time thinking fast when an emergency happens.

I think I am in the wrong area of nursing. Because of my experience on the patient/family side of the spectrum, I tend to be more attentive to my patients AND their family members than my co-workers do. I have been told time and time again I am "too nice." I really love my patients and care that they are comfortable, have everything they need while keeping their family members just as happy and comfortable. Maybe that is not the way a nurse needs to be in the ICU? Either way, It will be hard for me to change and be so professionally focused that I lose the ability to see a grandpa, grandma, mom, dad, daughter, or son lying in that hospital bed.

To sum it up, I am thinking I either need to leave this profession or find another area to work in. My worry is, what answer will be considered acceptable if asked why I want to leave the ICU? I am very bad at lying and I hate interviews. Thank you in advance the advice!

[thoughtful21, BSN, RN]

This sounds like a rough situation.

First, don't be too hard on yourself. I've heard that it takes a year or more to feel comfortable as a new grad, and then when you switch specialties it's like being new all over again! And ICU is an intense department to work in.

Kudos to all the amazing ICU nurses!! But I don't think I would do well in the ICU either, and it is not an area that I would choose to work in. I don't think I would do well, personally or professionally, in an area of nursing where my patients were ventilated and extremely sick. For me, one of the best things about nursing is being able to talk and form relationships with patients and their family members. I enjoy those conversations about grandkids, pets, gardening...anything under the sun. Not that ICU nurses don't like to connect with their patients! -but I think the focus/approach is a little different. For example, I think a hospice nurse would take a different approach to patient care than a pediatrics nurse, because of the patient population and circumstances. We nurses have different personalities, and we have to find a specialty where we fit. I don't feel like I'm explaining this very well. :/ I hope an experienced ICU nurse joins this conversation, and is able to explain it better.

It's ok to switch specialties! What other areas of nursing are you interested in?

[Crush]

Be gentle with yourself. It most certainly takes a while to be more comfortable as a nurse in any area. Have you thought about just a regular med-surg floor in hospital with a nurse residency program? I am not sure how those work cause, they were not an option for me but I hear good things about them. That might help diversify skills and help with confidence. What other areas have you considered?

[jack1971]

Thank you both for the kind words.

Since I have been out of school for almost 2 years, I don't think I would be a candidate for a nurse residency program. And floor nursing would mean a huge patient load, which I have a hard time with also. I Honestly have no idea how nurses with 6-8 patients do it.

I have considered working in a clinic. I know I will more than likely take a major pay cut, but it will be worth my sanity in the end. The problem is, I am not sure how to find these positions because they are not advertised like hospital positions are. And I worry about the golden question--"Why do you want to leave the ICU?"

[Crush]

Thank you both for the kind words.

Since I have been out of school for almost 2 years, I don't think I would be a candidate for a nurse residency program. And floor nursing would mean a huge patient load, which I have a hard time with also. I Honestly have no idea how nurses with 6-8 patients do it.

I have considered working in a clinic. I know I will more than likely take a major pay cut, but it will be worth my sanity in the end. The problem is, I am not sure how to find these positions because they are not advertised like hospital positions are. And I worry about the golden question--"Why do you want to leave the ICU?"

Those are few and far between ( at least around here ). Not all places have that high of patient load. I usually only have 4 pts and once in a while I get a 5th on days. If I work nights I have 5pts and maybe a 6th. ( on med-surg units )

I work float pool and needed to brush up on some areas I have not encountered in years. I was proactive with the nurse educator who was super helpful and discussed my concerns with my nurse manager who gave me a few extra days training on the units I had concerns. I also ordered a nurse magazine to stay current and when I encounter anything I feel funky about, I YouTube it and ask a co-worker I trust.

Why do you want to leave ICU? I am at a place in my career where I feel it is time for a change. I have decided my current job is not the direction I thought I wanted.

Although I am happy where I am, I feel I need a change with better hours that meet my families needs and that was not available in the ICU. Or something along the lines of ICU was awesome but it no longer meets my long term goals. Yadda yadda.

Keep your eyes on job boards daily for those clinic jobs. Those get filled quick.

[KatieMI, BSN, MSN, RN]

"As I developed and matured as an RN, I discovered that my strengths are (A, B, C) and things I love to do are (X, Y, Z). ICU specifics do not allow me to get enough of above so I hope to find more opportunities to do all that (where you are applying)".

Just like that. It is simple enough.

Much more difficult is to think about those A, B, Cs and about what you REALLY do NOT like in ICU. You need to realize that in modern US healthcare number of nursing positions where you can sit at bedside and gently hold hands of Auntie Sally speaking "there, there, dear" is extremely limited. Practically, sparing momentarily flashes which happen everywhere, the range of specialties where such old-fashioned view still can be used on regular basis is limited to hospice nursing and some (few and far between) geriatric/ECF units, both of them coming with their own serious problems. Clinic nursing can be extremely hectic and intolerably limiting in terms of knowledge and skills application, to begin with.

There are specialties which, while still being "techy" and requiring knowledge base close to ICU, offer more prolonged contacts with patients and families, such as onco, burns, renal, hyperbaric oxygen/advanced wounds, respiratory rehab (chronic vents), acute neuro rehab and long term "acute" acute care. These fields can be inpatient and sometimes outpatient as well but they come with their own flashbacks such as huge workload, seeing patients deteriorating and dying and families who are, speaking politically correct way, definitely not "normal".

If you are an introvert and bothered with "communication" part of nursing (including gossiping and politicking), consider acute dialysis, wound management or line management/PICCs. They all will require longer transition, but later you'll be on your own and participate in the rest of care just as much as you like at that moment.

[thoughtful21, BSN, RN]

I worry about the golden question--"Why do you want to leave the ICU?"

I agree with Crush - Keep it positive during the interview. :)

Tell them about the good things about working in the ICU - the things you learned, the skills you developed - but then go on to tell them that you're looking for a change. Talk about the positives of the new job that you're applying for. If it's a clinic position, the positives would be better hours, a different work environment, being part of the clinic team, supporting the clinic's mission, etc. You can tell them that even though your ICU experience was very valuable, you realized that you don't want to spend the rest of your career there. You can discuss your strengths, and how they would help you fit well in the new job. The interviewer will probably be very understanding about it!

In any interview, you want to make sure that you are more positive than negative. They usually ask you "What didn't you like about your last job?" This question can be a bit tricky. Everyone is leaving their job for a reason. If they were completely happy in their last job, they wouldn't be leaving it. But it is never a good idea to get too in-depth about the things that you didn't like about your last job. The interviewer is looking for someone who is positive, resilient, and excited about the new job, as opposed to someone who just really wants to get out of their old job. You have the power to set the tone in the interview, share only the information that you want to share, and leave them with a great impression of you.

There are many different specialties that would give you a chance of pace. A clinic is just one of your options. You can take some of your extra time now to start researching different options and polishing your resume, and ask a friend to help you practice interview questions.

[MirageRN]

Hey Jack1971!

Did you end up leaving the ICU to take on another role? Any updates? I too am considering leaving the critical care area but too scared to take the jump. Would appreciate a conversation with you.

[Been there,done that, ASN, RN]

xxxxxx