I Want To Do Critical Care!!

So I currently work on a cardiac telemetry unit, which is not considered a stepdown where I am. It's a travel nurse position which is what I signed up for, but once I'm done with travel I want to transition to critical care, ideally a CCU or CTICU. Have also considered the ED.

Last night I had a patient that went into sustained VT, we ran to the room to find him sitting up in bed, totally asymptomatic and pleasant (!!!) ... Long story short, he was transferred to CCU. Since I've been on this unit it is the 3rd time one of my patients has had to be upgraded to CCU. When I transfer the patient, I always kick myself for not starting out in CCU or critical care. I always seem to feel like I am not good enough of a nurse to take care of sicker patients, it's like I feel defeated, like saying "You are not capable of taking care of this patient, you are so basic, let's take them to a nurse that CAN." The thing is, I WANT to be the kind of nurse that does not need to escalate patients to other units. I want to be that nurse that takes care of the sickest patients. I want the skills and the knowledge they have.

I was just starting to study for the PCCN but this empty feeling has left me wanting to work in a cardiac ICU and pursuing CCRN instead. I feel like getting a PCCN is like saying I'm not good enough for CCRN and that professionally I might be pidgeonholing myself into acute and stepdown territory permanently. I know I shouldn't feel this way but I do.

Also, I seem to find a LOT of ICU positions want critical care experience already, which I don't have, and I also see a lot of new grads getting into ICUs frequently now, so what is an experienced med/surg/cardiac tele nurse to do? I feel like no one will give me that chance. I did interview last summer with a CTICU, tried to transfer when I was staff but didn't get the job. It was then when I decided to start traveling.

I'm currently on my break and thought I'd rant a bit about how I've been feeling since yesterday. Sorry for the brainstorm. Thanks for reading! I welcome feedback.

calivianya, BSN, RN · Jan 28, 2015

CTICU is hard to get your foot in the door of if you don't start out there as a new grad, it seems like. I applied to several with a little over a years' worth of MICU experience and my CCRN. The CCRN and the MICU experience were enough to get me an interview, and the interviews seemed to go really well, but I didn't get any of the CTICU jobs. I got offers for the MICU jobs I applied for, which is a no-brainer since that's the experience that I have, but I was hoping to branch out my experience to possibly do what you're doing right now. CTICU seems to be a great field to have experience in if you really want to cherry-pick your travel assignments.

MICU seems to be a little more forgiving as far as giving people the chance to learn how to be an ICU nurse - lots of the people hired in my hiring group at my current hospital came from non-ICU floors. We even had a psych nurse hired right into ICU. You do see a wider range of patients with a wider range of diagnoses than some of the more specific ICUs as well. CTICU may get the fresh hearts, but at my hospital, MICU gets 90% of the post-codes from the floor, the CRRT patients, the fresh septic shock going through sepsis protocol, etc., so MICU definitely gets its share of crashing patients. It also gets its share of the super-aggravating permanent ICU "residents" who can't get out of ICU for months because of unstable respiratory status/blood pressure issues, but can use the call bell just fine and develop massive anxiety issues, but hey - no unit is perfect!

PacoUSA, BSN, RN · Jan 29, 2015

Thanks for your input. I don't want to do MICU because it's too general, I'd rather work in a specific specialty I know I enjoy.

26.2, BSN · Jan 29, 2015

Is there any step down units you can work at and then make your way into ICU. The step down unit I worked on we did treat SVT. We did Amiodarone, Dopamine, Dobutamine, Nitro, Cradizem drips.

I want to work in a ICU too. I am stuck on med surg now and want to get out of it.

PacoUSA, BSN, RN · Jan 29, 2015

That would be my backup plan, to start out in a stepdown and work my way up to the ICU. But this plan is reserved for when I'm done with travel nursing. I'm only interested in cardiac though so will be limiting to that. I used to be on a general medicine floor and did not like the variety. I like specializing.

I.C.UNurse · Jan 31, 2015

CTICU is a place many ICU/Step down RN's want to go, but you have to put in the work at the same time. Get into a step down unit, get your PCCN, show you have the skills to advance and people will take notice. Some people get very lucky and graduate and go into a residency program, but if your like most RN's, you have to work the floor and work your way up over the years. That is just how it is sometimes.

zzbxdo · Feb 1, 2015

I think you technically don't need ICU experience to take the ccrn. Take a closer look at the requirements when you get a chance.

guest769224 · Feb 1, 2015

I think you technically don't need ICU experience to take the ccrn. Take a closer look at the requirements when you get a chance.

Critical care nurses must care for critically ill patients for a minimum of two years to be eligible for the CCRN certification exam offered by AACN.

Where else would this be obtained outside the ICU? ER is debatable and most patients there are not critically ill.

zzbxdo · Feb 1, 2015

It's actually 1 year. And I took it recently and the per AACN materials it doesn't actually require ICU experience so long as you've met the other requisites. It was new news to me when I went over it.

icuRNmaggie, BSN, RN · Feb 1, 2015

Hi Paco,

If you are certain about CICU and CVICU, the best way to make your resume stand out, and make it past the resume parser software, is to take the CCRN and CMC exams along with the ANA Cardiovascular BC credential.

These certifications will make you a better nurse and open a lot of doors for you, whether as staff or a traveler. Good luck!