How do I approach the ICU 2 year wall?

[theopenroad54]

I haven't been on for awhile. First off, let me thank everyone for their kind words and insights. You've all been a great help.

I've been having a little trouble with an obstacle to the type of position I'm seeking. I've been talking to some recruiters and looking into some travelling assignments in various ICU's, and I've been hitting this wall concerning the need for recent 2 year ICU experience. I have extensive Telemetry/Cardiac and ICU experience, working with many forms of high end monitoring procedures and treatments, including Swan-Ganz catheters and hemodynamic monitoring with recalibrations and determination of the various parameters and thier significance to patient treatment, and have even assisted with the insertion of these catherters and a full working knowledge of the various waveforms that occur during insertion (dicrotic notch, Z-point, Etc) ; art lines and cvp, again including all of the insights into the readings, insertions, blood sampling and abg interpretation, etc; ICP/EVD's with zeroing per the phlebostatic axis and the parameters involved in maintaining pressure and its significance to the patient; paralytics and sedatives with train-of-four monitoring and associated adjustments per orders/protocol; as well as a variety of bedside procedures and treatments, including tracheostomy insertions, whipple procedures, use of the full spectrum of emergency drips and meds, chest tube insertions and maintenence, post cardiac surgeries and stenting/bypasses, femoral sheath removals with ACT protocols, all types of pacemakers, conversions ,etc, etc.....

From the above, you can see my interest in working on an ICU. The problem is that for the past 5 years, I've been working in an LTAC. But this LTAC had its own ICU section without the more advanced procedures. We were more focused on the long term basis, and were responsible for ventilator maintenence, use of a wide variety of emergency drips, including dopamine, dobutamine, norepinephrine, heparin, nitro, among others, etc. Anything "too complicated" was sent to the larger hospitals. This situation has placed me in a grey area. "All dressed up with no where to go" kind of a feeling. I love this stuff, and feel it a shame to lose.

Some of the options i've found would be to work med/tele or pcu with the possiblity of ICU float, finding a "rural" ICU to re-wet my feet and work my way up, or simply taking a full time job on an ICU somewhere for a year or 2. I really had my plans set on travelling for a number of reasons, including paying for schooling without the need for student loans.

I was also considering taking the CCRN, which I believe I have the knowledge base to pass, as a means of having a bargaining chip. But when reviewing the requirements, I found that I must have a full year of recent ICU to take the test. Now let's not make this too hard, right! You've got to have experience to get experience, which I already have extensively, but can't use unless it's recent experience. Pretty frustrating.

Any suggestions or personal experience with this problem? How should I proceed? Help!?!

[NedRN]

Doesn't your current ICU experience at your LTAC make you eligible for CCRN? Your manager should be happy to attest to your current experience but usually such specialty certifications take you at your word. Fudge a little if you have to. I can promise you that there are assignments for travelers like you. Perhaps a stepdown who is looking for a little more depth of experience to help with 1 to 2 fresh heart scenarios.

[meandragonbrett]

Sounds like you need to go back and get some more recent actual ICU experience at a tertiary/community facility. While you can sit there and say that you know these things.....(and I am not saying you don't) you can talk about anything over the telephone and make it believeable.

Say you're up against another nurse who has 8 years of recent high acuity ICU ranging from trauma, CV, Liver transplant, and Neuro critical care. They are board certified. And they have also worked per diem PACU on their days off.

That person with recent ICU experience is going to be "more valuable" and quicker to easily jump into things in the eyes of the manager....It's hard to discern things via a telephone interview (even with asking clinical questions).

Definitely get yourself back into the ICU! Pick up in PACU, work some agency ICU/PACU shifts, etc to get your feet back in the water and then go from there.

I am *NOT* discounting your background and experience in any way. And this day in time (depending on facility) PA caths are times of the past. I am working in a facility now that doesn't use PA's hardly ever....I showed up for work one morning and I was the only RN working that had ever taken care of a patient with a PA Cath.

Good luck to you!

[NedRN]

I agree that PA caths are kinda over. That said, the facility I'm at does one on every open heart. I'd bet reimbursement changes will be needed to kill it completely. I will point out that PA experience is good background that a lot of nurses don't have. So that experience still enhances your resume.