CCU vs IMC

What are you wanting to get out of working on a tele floor or step down unit before you go to ICU? I think that would be an appropriate question to ask........decide what you want to get out of it, then evaluate if you already have it.......if you don't then look at what each floor offers and decide where you will get it.......if you do, then go straight for the ICU.

Thanks for your reply to my post.

I want to go straight to an ICU but cannot at this time. I have a very young son and the hospitals with ICU openings for new grads are too far away for me (we're talking 1-1 1/2 hour drive each way). I will sacrifice my "Dream Job" for the well-being of my son for a year or two.

What I want to get out of working on a tele floor or IMC are the skills that will make me attractive to an ICU when I'm able to transfer to one (when my son is older).

I guess I just don't know enough about tele, IMC or Progressive Care Units to know which floor would give me the best experience to achieve my eventual goal.

I don't know much about IMC or Progressive Care, but I work on a tele floor. Basically every patient we have is on tele with the exception of some overflow. We see a lot of CHF, a lot of pre-cardiac surgery patients, a lot of patients where they are trying to rule out cardiac issues, a few respiratory failures, and I've seen a few AAA patients as well. We also are located directly next to and directly above our ICU and CVU and we recieve the majority of their patients after D/C from their unit, mainly the ones that still require cardiac monitoring and the respiratory. We see lot's of post-ops that don't need to go ICU, lots of cardiac caths, lots of pacers, and probably about 1-2 vent patients a week. Personally I think it is a great place to see "sick" before you see "really sick". It will probably take you a bit to get used to going from ED to the floor as instead of responding to emergencies you are managing 4-5 patients. It's just different. You'll also get a chance to brush up on tons of rhythms. I think it's a good option, hope that helps.

Thanks so much for your reply. Much appreciated. Your input will help me make an informed decision.

I'm a little confused regarding your option of CCU vs. tele floor. Where I work, these are two different units -- the tele floor is a "step-down" unit much like the one JiffyGriff described.

I work in CCU, which the cardiovascular ICU -- most patients have fresh (1-3 days) CABGs and valve replacements. We also get many acute MI's, carotid endarts, thoracotomies, and S/P arrest patients. Lots of pressor titrations, many are on ventilators; CVVH, Swan-Ganz catheters, trachs and a-lines. Occasionally we get ICU overflow patients.

I graduated in 2004 but am basically a new grad (very limited RN experience before starting this gig.) I've been in CCU 3 months and I *love* my job. One of the biggest advantages to me is the nurse-to-pt ratio (1:2). The acuity is high, but with only two patients to manage, I am generally able to keep up with the challenges from shift to shift. And it is a blessing to have a supportive team of experienced nurses to help me thru the rough spots (they are realistic in making assignments; not to say mine are easy, but I know I can rely on others for guidance.) It's an outstanding learning experience.

We have several ICU nurses who float to our unit b/c we are a bit short-staffed and they are well-qualified to take care of the overflow pts. Most are fine with having a newbie like me follow and learn from them. I'm not wild about ICU at this point; I am a cardio-geek and feel like I'm in my element -- but one can never learn too much.

I've never worked IMC, I am only familiar with it b/c I am also an echo tech and do a lot of portable echos there. But I know their staff floats between there and ICU so I'm sure there is much to be learned. It does seem staff/pt ratios are higher in IMC, though.

So in short, it depends on your particular institution and the dynamics between units. It is difficult but not impossible to go into critical care as a new grad. But if your children and commute time are an issue, I'd recommend talking to fellow employees and managers and get an idea of how you can best grow with an employer in a way that is realistic for you now and also leaves the door open for your future goals.

Now me, I've always been fascinated with ED. I've applied but can't even get an interview. Right now I'm happy where I am, but I'm curious about what your job is like ... another thread, I know

Hello,

I am a new grad in and ED. I'm doing well (so management says) but, for various reasons, am entertaining switching to another position.

Eventually, I would like to work in an ICU. Right now, my choice for a new job would be an Intermediate Care Unit or a CCU (more of a Tele floor).

Which position would prepare me the best for an ICU?

Thanks!

What makes you think that CCU is NOT critical care???

If you are a new grad you need to develop the skills of prompt assessment and treatment to work in a intermediate care unit------which should be a area where patients go that is in between ICU/CCU and regular telemtry step down. Therefore you should either start out in CCU/ICU with good mentoring/support/education or general med/surg with the same in mind.

I just wanted to thank everyone for the replies to my post. I decided to leave the ED for a position on an Intermediate Care Unit.

To answer NurseEcho's question...The ED is great. It's very fast paced, obviously. It wasn't hard to handle the lacerations, kids with temps, people with the flu, etc. What made me uncomfortable, as a new grad, were the patient's having chest pain or other serious problems.

The day that I decided to switch was the day that someone coded and I was thrown the code sheet and acted as the "recorder" (without ACLS and with 1 day of going over rhythm strips). I jumped in, no problem. However, I had to watch the monitor for rhythm changes. The rhythm kept changing. I knew Vtach and Vfib but had to rely on the medics to tell me "it's a wide QRS with a bbb". Also, in the ED, you have to learn the cardiac drips on the fly and hang them VERY quickly.

Personally, I felt a bit unsafe. I had a good orientation and the support of an excellent preceptor. However, having little experience w/cardiac made me very nervous. I switched for my own comfort level.

On the IMC, I'm going to learn how to handle 4 pts (different than handling 4 pts in the ED) and will have more time for learning cardiac. I may go back to the ED someday. If I do, I'll have the background so that I will feel safe caring for my patients.

The experience that you are getting now should be very attractive to an ED....

Thanks