Best floor for experience prior to ICU

[sedation_season]

Hello everyone -

I will be entering my senior year in a BSN program shortly. My hope would to be to get into an ICU right out of school. However, I plan on working in a large, level 1 trauma hospital (where I'm currently a nurse tech at), and they do not hire new grads. I was wondering what floor (that typically hires new grads) would be the best to prepare for an ICU job in about a year or so. For example, CPCU (where I work now), PACU, ER, if they even hire new grads?

I would like to do my preceptorship for senior year on the floor I decide to work on after graduation. I know experience on any floor would be super beneficial before entering critical care, I was just wondering some opinions.

[sedation_season]

I don't really want to get in the middle of this, I'm not trying to be ignorant! However, like PMFB-RN stated, by CRNA school standards, 9 times out of 10 PACU is not classified as critical care.

PACU sounds like an intriguing unit, hence why I would like to precept on it. Doesn't look like that will happen though due to them only hiring ICU nurses.

Unfortunately the hospital I'm at right now, which I would like to stay with after graduation, just ended their ICU internship program. Not sure why but what a disappointment!

Looks like my best option for experience would be a step down tele floor? Good news is where I work tends to hire their nurse techs in as GNs then RNs. Like I mentioned in the first post, I am working on the CPCU (a 75 bed, obviously all tele unit), so I don't foresee a problem getting in there as an RN.

Good luck sorting out if PACU is CC or not

Thanks for all the input!

[MomRN0913]

Some hospitals have IMCU units and PCU units. My hospital hired in from PCU.

[sedation_season]

We have a MPCU (medical progressive care unit). I'm wondering if that would be better than CPCU as I'd like to go into the trauma/neuro ICU rather than CVICU or CCU. I'm not sure what kind of patient's MPCU would get though.

[ckh23, BSN, RN]

Sorry to derail your post. Some type of step down unit would be good. Preferably a floor where ICU patients go when they are down graded. You should also look into a floor that involves running strips and will train you in cardiac rhythms. If you are looking towards a trauma ICU, look into a trauma step down unit. As someone else said a PCU unit will also serve as a great stepping stone into an ICU.

On a side note, if you do get the chance to interview for an ICU out of school DO NOT mention that your future plans of anesthesia school. I would also recommend doing some research on schools you would be considering because some schools favor certain types of ICU's over others.

[sapphire18]

The PACU/critical care thing seems to be a matter of opinion, from what I've found in my research on the matter...I have found professional sources that say that it is critical care. However in terms of experience for CRNA school, it sounds like it's not the way to go anyway, so the point is moot.

As for whether a medical IMCU or cardiac IMCU being better experience for a trauma ICU, it seems like it's probably six a one, a half a dozen the other. Neither deals DIRECTLY with trauma- CPCU is obviously all cardiac, while an MPCU would be everything medical under the sun. Renal failure, COPD exacerbations, CHF, diabetic decompesations and complications, infections, and way too many conditions more to list here.

Good luck!!

[PMFB-RN, RN]

Wake up to a career in PACU nursing

Lippincott, the Beacon of Nursing School Textbooks believes it is.

&PACU nurses are highly trained critical care nurses

*** _IF_ what you claim in true then Lippincotts is mistaken. However the link you provided does not support your claim. No place does it say PACU critical care. It does say that PACU nurses are experiened critical care nurses, but does not say PACU is critical care. Here is the only mention of critical care:

"PACU nurses are highly trained critical care nurses."

This makes sence since in every hospital I have ever worked in the PACU nurses where all former ICU nurses.

[sapphire18]

This is from an article published by ASPAN, the AACN, and ASA's Anesthesia Care Team Committee and Committee on Critical Care Medicine and Trauma Medicine:

"A Phase I Postanesthesia Care Unit (PACU) is a critical care area providing postanesthesia nursing care for patients immediately after operative and invasive procedures prior to discharge to the Phase II ambulatory setting, the in-patient surgical unit, and the Intensive Care Unit."

Here is the link: https://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/8-Joint_ICU_Overflow.pdf

[RNSmith]

I would encourage you to go to the ER if you want to stay at that facility instead of attempting other new grad ICU programs. You will learn invaluable IV skills, monitoring, quick trauma assessments and how to maintain composure during multiple codes. It will allow you to learn start to finish the picture of a patient and recognize when a patient looks like they are going "down" as we say. That becomes a valuable tool when you get to ICU and the patients are changing every minute as far as acuity goes. It will also help when you start taking hearts (assuming you get into SICU) and monitoring drips and hemodynamics become even more important.

[Perpetual Student]

PACU's definitely not the same as the ICU, as the focus is on stabilization and transfer to some sort of longer term unit, whether it be an ICU or the floor. It still is critical care, however, as AACN apparently agrees ( ABOUT CRITICAL CARE NURSING ). If you narrowly define "critical care" as only the ICU, then no, the PACU doesn't fit in. But that does not seem to be the popular definition used throughout the industry.

Our ICU gets very angry if a non-ventilated patient gets sent to them without being recovered in the PACU, something about the acuity rating being too high. I guess attitudes differ from hospital to hospital. There is a ton of critical thinking and problem-solving in the PACU, only it is done very quickly as the goal is to get the patient moved ASAP. It's kind of like the ER in that respect.

From what I understand, CRNA programs are looking for a lot of experience with hemodynamic monitoring, titrating drips based upon those hemodynamics, etc., which I concede nurses in a high acuity ICU will see more of on a daily basis. Someone interested in attending a CRNA program should try to get into a high acuity CVICU or SICU to maximize their learning potential. That said, PACU nurses are required to maintain those same competencies and we do indeed care for those patients.

[SNIXRN]

Our PACU requires ICU experience. At first I didn't understand why, I thought PACU nurses just wake up the patients, make sure they are stable, then send 'em up to the floor - boy was I mistaken. These nurses care for patients who were already very sick then had surgery, pts who needed emergency surgery, patients with VADs, those who had cardiac surgery, patients that are vented, have new hearts or kidneys, etc.

Now to address the OP, Our hospital hires new grads straight on med/surg, intermediate or icu floors however, we don't hire new grads in OR, PACU or ER so I would suggest maybe a cardiac or tele floor :)

[TigerGalLE, BSN, RN]

Our PACU requires ICU experience. At first I didn't understand why, I thought PACU nurses just wake up the patients, make sure they are stable, then send 'em up to the floor - boy was I mistaken. These nurses care for patients who were already very sick then had surgery, pts who needed emergency surgery, patients with VADs, those who had cardiac surgery, patients that are vented, have new hearts or kidneys, etc.

Now to address the OP, Our hospital hires new grads straight on med/surg, intermediate or icu floors however, we don't hire new grads in OR, PACU or ER so I would suggest maybe a cardiac or tele floor :)

I understand why PACU needs an ICU nurse. However I wouldn’t consider it critical care either. But my hospital might be different because any patient that is sick sick comes straight to ICU and bypasses PACU completely.

For the OP. I would suggest Tele or medsurg. You need to learn time management skills and you need to learn what sick vs not so sick looks like.

[HazelLPN, LPN]

Every hospital is different. When I was an MICU nurse, the infectious disease unit took pts with vents and a-lines, although they were not on drips where you had to titrate every time you turned your back. Our BMT nurses in the cancer hospital also dealt with vents and some critical care drips, although if they became unstable and were full codes they would send them to the MICU. Several of our best nurses came from these floors and didn't need the lengthy orientation of a new grad or nurse from a more non acute type floor. When I became a PICU nurse, there were NO vents on any floor although the most acute units were probably still ID and hem/onc. If I were you I would ask the nurse manager of the ICU you would like to work in what she/he thinks would be an ideal background for that unit. That way, you are killing two birds with one stone. You are getting excellent advice AND you are making a human connection which is very important when finding a position.

I agree PACU isn't critical care, but a PACU nurse does need to have critical care skills. More than just a few MICU nurses I worked with who got burned out ended up with PACU jobs that they really liked. You don't see too many old nurses working in MICU...it can be very hard on your body. If you don't believe me, you can ask my new knee.....

Best to you,

Mrs H.