Do I have critical care experience?

[pepino23]

I am currently an adult cardiac progressive care nurse with 3 years of experience and my PCCN. We do 1:4 but we have very high patient turnover between transfers in and out of MICU, people going to open heart, or discharging. It is normal to turn over half of the floor in one day. We have 33 beds and handle all the patients from the cath/ep labs post procedure. If they didn't use a closure device we will pull our own arterial sheaths, and often they will still have integrilin or angiomax still running for a certain amount of time. We get all the ER admits for heart failure and arrhythmias, chest pain, etc. We have patients that are on continuous bipap, we have cardiac gtts-nitro, cardizem, primacor, dobutamine, dopamine, amio, lidocaine etc and can titrate to a certain amount. Ex-nitro can go up to 100mcg before needs ICU transfer. We run our own codes, but an ICU resource nurse or two always will come since they go to any code in the hospital. We also will get the severe sepsis patients at times.

An example of my last shift: 1 patient was running Amio and Lidocaine gtt, another patient was on cardizem that I had to keep titrating since HR and BP were going all over the place, one patient who was severe sepsis lethargic MAP in the 40s when she was admitted to me from ER, I eventually did end up transferring her to ICU after wasn't responsive to fluid challenge, or albumin that dr had ordered me to give, another new Tikosyn start, and a post cath that I sent to the cath lab earlier because he became a STEMI on my shift and later on in the day ended up being a code stroke alert because he had a TIA.

My question is: would I be considered to have critical care experience? I am trying to switch from adult cardiology to pediatric cardiology. On the job application there is a yes or no question asking if you have at least 2 years of critical care experience. I know by AACN's definition PCU is critical care (even if it is the lower end of the critical care spectrum). However, by no means am I trying to pretend like I am an ICU nurse, because I know I am not. I do not use certain medicines like Levophed, we have the art lines that we set up with the femoral arterial sheaths if we can't pull it right away, but that is as much as it gets with invasive monitoring.

I just want to give an honest answer for my job application, that is all. :)

[Ruby Vee, BSN]

I'd say that progressive care is not critical care; that's the opinion held at my hospital. But I'm interested to hear what others say.

[Charge200J, BSN]

That's a great question. Sounds like a well run, fast paced, high acuity awesome progressive care unit. You have acquired an incredible amount of experience and sound like a strong nurse caring for multiple sick patients from what you describe.

Tricky question regarding the job application. You could probably answer either yes or no and be totally ok either way. Because your unit can up-triage sick patients to an ICU (unstable hemodynamics, requiring vasopressors, mass transfusion, ventilator management, etc) I would answer that question on the job application that no, I probably wouldn't call it critical care.

However, you will have such a strong interview with so many fantastic examples of prioritization/critical thinking and a wealth of cardiac experience from a high acuity progressive care unit. Wishing you the best - the peds cardiology job will be lucky to have you!

[WestCoastSunRN, MSN, CNS]

I would say that yes, you do have critical care experience. Most definitely. You are certified by the AACN as a PCCN nurse. The fact is the acuity you see in your PCU is the same acuity you would see in a more outlaying hospital setting ICU. Not only that, the cardiac focus of your particular unit gives you experience that some ICU nurses don't have -- depending on the focus of their work setting. I have seen far less than what you offer pass as "critical care" experience. That said, you are a person of integrity and want to be able to defend your check mark. I think you can do that. Get your foot in the door -- you can check the box honestly. Unless they are going to hire someone already experienced in peds cardiac ICU, they know there will be a learning curve. The biggest for you will be going from adult to peds. You will have an opportunity to expand on your exact experience in an interview. Also, attach your resume -- this can spell out what you are already experienced in.

Good luck to you!

[pepino23]

Thank you very much for the replies! I appreciate everyone's input!

PS-Thank you also for those nice comments. I always try to put 110% into my job every day! :)

[Cowboyardee]

For the purposes of checking a box on a job application, you should probably mark 'yes' in your situation. It's an ambiguous question and you should generally answer job app questions honestly but ALSO giving yourself the benefit of the doubt.

For the purposes of talking with fellow nurses and other hospital personnel, then not really. You have PCU experience, and if that term doesn't translate, I'd probably call it 'step down.'

[MGMR]

I would say your PCU deals with more acuity than many units that are considered intensive care. I'd say to put "yes." You can elaborate more about your experience during the actual face to face interview.

[PeakRN]

Do you have unstable patients for whom you manage their conditions within your own unit or do you have a higher level unit respond to your unstable patients? Do you change patients medical treatments for unstable conditions based on your assessment or do you call a medical provider first?

I don't necessarily believe that a set of treatments or interventions are required for critical care; there are many ICU units who do not perform every treatment and have to send their patients to a higher level of care at different hospitals and yet we wouldn't be having this discussion about them. In our own system we require at least a month of cross training between the Adult ED, Peds ED, ICUs, PICU, and NICU before we allow nurses to work independtly in the new unit and yet we are all critical care.

In our hospital we have units that are considered critical care but are not ICUs, this includes the Adult ED, Peds ED, high risk OB/antepartum, BMT, and Peds BMT. We do not have any progressive/intermediate care unit patients, they are either placed in an ICU or one of the above inpatient units. While our telemetry units take high risk patients, if a patient becomes unstable the ICU will come up and manage them and therefore we do not consider them to be critical care (the same goes for our PACU, unstable PACU patients are managed by ICU nurses until they are either ready for discharge, transfer to a non-critical care unit, or back to a critical care unit).

[ruby_jane, BSN, RN]

I know by AACN's definition PCU is critical care (even if it is the lower end of the critical care spectrum). However, by no means am I trying to pretend like I am an ICU nurse, because I know I am not. I do not use certain medicines like Levophed, we have the art lines that we set up with the femoral arterial sheaths if we can't pull it right away, but that is as much as it gets with invasive monitoring.

I just want to give an honest answer for my job application, that is all. :)

You're awesome. You are doing more than I did when I was on a medical ICU, with the exception of the Levophed. I think it depends on the hospital's definition of "critical care." Best of luck!

[chacha82, ADN, BSN]

!!!!!!!!!!!!!!!!!1

[MunoRN, RN]

I would declare your experience on an application as what it actually is; progressive care. There's certainly nothing wrong with progressive care experience, but it is by definition a different level of care from critical care. As someone who as served on hiring committees, we would be more likely to consider progressive/intermediate/step-down experience when we're looking for critical care experience then we would be to continue considering someone who wasn't honest on their application.

[Here.I.Stand, BSN, RN]

As someone who as served on hiring committees, we would be more likely to consider progressive/intermediate/step-down experience when we're looking for critical care experience then we would be to continue considering someone who wasn't honest on their application.[/Quote]

This was my thought as well. If the OP answers "no," there is the opportunity to "sell" their experience. However if they answer "yes" while the prospective manager is looking for ICU experience, it's much harder to backpedal and explain why they reported experience they don't have.