Discouraged from becoming and NP because I hate critical care

[koster22]

I have been a BSN RN for about a year and a half. I took a job in pediatric CVICU right out of school. After staying for almost a year, I left because I was completely miserable. I am very detail oriented, and though adult ICU intimidated me in school, I was a good student. I truly was open and ready to learn and dive completely into pediatric critical care. The feeling of knowing I had done everything "right" all day long, only to lose a patient despite my efforts was just something I just could never compartmentalize. I would go home and agonize over every decision, praying I would not have a patient as critical the next day. Despite encouragement and support from peers and a director who constantly told me she felt like I was meant to be an ICU nurse, my constant anxiety told me it wasn't right. I left and started working in a Well Baby Nursery and really love it. You could say it is "mindless" compared to the tasks I had to perform and knowledge I was required to maintain in ICU, but I love the babies and I love educating parents. It is an area where a LOT of education is needed, especially among new parents and I feel like I am good at it. While boring at times, I really feel like I am the kind nurse I always wanted to be working with "well" patients. I am caring, kind, and feel valuable.

However, I always imagined myself in a pediatric primary care setting and lately find myself dreaming of going back to school for FNP or PNP. I knew leaving critical care meant that I would also be leaving behind an orificenal of skills and knowledge that would not maintain itself in a less acute setting.

I would love the advice of the NPs who work in the primary care/clinic setting. Did you work in critical care and love it before going to school for NP? Are there any NPs out there that hated critical care and flourished in NP school? Thank you!

[ICURN7]

Hi Koster,

I am not an NP yet, but having worked in adult ICU and enrolled in an NP school, I can tell you that this thing is of the mind. I would go with what my instincts tells me to do. Having said that, I want to say that you really don't have to have worked in an ICU setting to qualify to enter an NP school. If you like you can apply for the PNP program and since everyone does the same course work called core curriculum the first year or so(not all schools does that, some might do it differently, so find out before applying), you can start off and see if you like it, if not, then you can switch to FNP or any other that you find more interesting. It might also help to talk to a counselor. Good luck!

[ghillbert, MSN, NP]

Critical care expertise is not a prerequisite (or even relevant, really) to becoming a good NP, particularly in the area of family NP which focuses on primary care and not acute care. It sounds like FNP would be a great fit for you.

[zmansc, ASN, RN]

Not liking doing critical care does not disqualify you for becoming an NP in the least.

I would suggest shadowing and working with some providers (NPs and others) who deal with the population you think you would like to work with, i.e. peds. Ask lots of questions, try to get as good of a feeling as you can about the job, and how well you would like it. If it's what you want, which it sounds like it is, then go for it.

[koster22]

Thank you for your input, everyone! While I get that not liking critical care doesn't disqualify me from becoming and NP, I have been discouraged from seeking an advanced nursing degree, even if it's not in acute care. A lot of the nurses I worked with in ICU truly believed that anything outside of critical care isn't real nursing and won't prepare me for adequately for advanced practice and I think some part of me still believes that idea. I think I was just wanting to hear from other nurses who are interested in staying in and thriving in primary care. I definitely need to shadow some primary care NPs! Thank you all again!

[anh06005, MSN, APRN, NP]

I've gotta say I worked cardiac step down for about 1.5 years and then moved to home health where I have been for 3 years. Home health is pretty much on the opposite end of the nursing spectrum from ICU BUT I feel like I have learned more, become more independent, and more sure of my assessment skills in home health than I ever was in the hospital. Even in my knowledge base really. I am almost done with FNP school and my home health experience has been invaluable!! I have seen what happens when that patient leaves the NP (or MD) office and has NO idea what they said it changed but didn't ask questions. I have learned more about medications and side effects than I ever did in the hospital (if my patients don't ask what a med is for you can be dang sure their son/daughter/spouse/sibling will.

Anyway I'm kind of rambling here BUT being outside of ICU DOES give you good experience and IS REAL NURSING. You can't do much teaching to an intubate patient. When you do some teaching to the family I'm sure they're so stressed they only hear every third word or so. It's ok to not be in ICU and it doesn't make you any less of a nurse. For me being a nurse is when my CHF patient calls to report a weight gain overnight and we are able to intervene early to avoid a rehospitalization (possibly to the ICU to see you).

Don't do something you don't enjoy just because of what some others might think. You have no idea what nurses in other areas do (NURSING things) until you've done it.

[anh06005, MSN, APRN, NP]

Pardon the typos....iphone over here is a little loopy....

[Go-GetterRN]

If you like working with "well" patients and enjoy educating them, then you would make a great FNP. Whoever told you that ICU is the only good experience for advanced practice nurses is wrong. ICU experience is essential if you are wanting to be an APRN who works in the ICU. Otherwise, you would be better off getting RN experience in a field similar to that of which you want to work in as a APRN.

[BostonFNP, APRN]

In all honesty, in my experience precepting student APNs, ICU experience is a double edged sword. You get the good along with the bad.

Sent from my iPhone.

[carachel2]

I worked cardiac critical care and ER for years. Hated it. Everyone else seemed to be getting off on a fresh crashing post-op CABG with fifty million lines, drips and tubes and those types of patients left me quaking in my shoes. I did well with them, don't get me wrong. But I *hated* it. My absolute favorite thing to do was pull up a chair in my "about to be discharged" CHFers room and talk to them about daily weights, draw out their heart with an illustration of their low EF and talk about how low sodium diets, moderate exercise and daily weights could keep them out of the hospital.

Flash forward about 10 years and I love being an NP because I feel I do a great job at connecting with people and really teach them about what is going on. My critical care experience taught me enough to stay on edge, but it sure is nice to be in a situation where I can "pull up a chair" instead of flapping around an ICU unit like a chicken with its head cut off!

[adventure780, BSN, MSN, RN, APN]

I haven't gotten the chance to really work medsurg, so no way I would be able to do ICU, until that happens, however I am going ahead to look into NP programs anyway, if you want to do Acute care then ICU experience will help you treat very sick patients, if you want to do outpatient or work at a clinic FNP is better choice

[Riburn3, BSN, MSN, APRN, NP]

Being a CVICU nurse and graduating with my FNP next month, I feel like I have a decent perspective. While I think higher acuity knowledge is useful and really helped me with pathophysiology, pharmacology, and assessment, it also hurt me in that it took me a while get out of a "worst case scenario" mindset in a primary care setting. Even when doing my differential diagnosis worksheets, comparing my early ones to later ones, I can see how I initially wanted to diagnose patients with rare zebra diseases instead of looking at the horse starting right at me.

The point of all this is to not be discouraged by your peers. Even if you stayed in Pedi ICU, if you get your FNP, there's still whole different sets of populations you are going to have to relearn about. Even going the PNP route will be difficult since your knowledge will be limited to worst case pediatric scenarios. If you want to be an NP, go for it. While I think experience is beneficial, it can also be a double edged sword like BostonFNP said. Don't let nurses in other units that aren't APRN's tell you what it takes. NP's come from a rainbow of backgrounds and experiences, with critical care in no way being a prerequisite.