I Want To Do Critical Care!!

[PacoUSA]

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.

[ICURN3020]

I don't look at the big picture in the same way as you. Yes, I am an ICU nurse and take care of the sickest patients. However, if you put me on a med-surg, OB or peds floor I'd be freaking out. If you made me work in the OR or in psych, I'd be lost and out of my element.

We all contribute different skills and knowledge to the patient. You might think working with ICU patients as exciting and ideal, and that's great...but just remember that the home health nurse who spends time educating a patient about their twenty different medications or the drug rehab nurse who sits and comforts a suffering person going through horrific withdrawal symptoms are also contributing their part.

I guess my point is that you should never feel "not good enough" or "defeated" that you are not, in your current role, able to care for someone who needs a more specialized setting. Think of how many patients you took good care of who may have otherwise ended up in the ICU!

It's great that you have goals and I wish you luck! My only hope is that, once you become a critical care nurse, you remember that EVERY area of nursing counts. :)

[ICURN3020]

Duplicate-sorry!

[PacoUSA, BSN, RN]

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 porificer 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!

That is indeed the ideal situation and I would love to take that exam. However, without working in an actual ICU for a year or two beforehand and without any exposure to Swans and vents and such, I don't see how I could possibly qualify for the exam, as ICUman pointed out. I have also read on other posts how being CCRN certified without having actually worked in an ICU is not exactly a good thing to have on your resume, same for CEN and not having worked in an ER at all. I know it shows commitment to a specialty but isn't it the cart before the horse per se?

I don't look at the big picture in the same way as you. Yes, I am an ICU nurse and take care of the sickest patients. However, if you put me on a med-surg, OB or peds floor I'd be freaking out. If you made me work in the OR or in psych, I'd be lost and out of my element.

We all contribute different skills and knowledge to the patient. You might think working with ICU patients as exciting and ideal, and that's great...but just remember that the home health nurse who spends time educating a patient about their twenty different medications or the drug rehab nurse who sits and comforts a suffering person going through horrific withdrawal symptoms are also contributing their part.

I guess my point is that you should never feel "not good enough" or "defeated" that you are not, in your current role, able to care for someone who needs a more specialized setting. Think of how many patients you took good care of who may have otherwise ended up in the ICU!

It's great that you have goals and I wish you luck! My only hope is that, once you become a critical care nurse, you remember that EVERY area of nursing counts. :)

To ICURN3020: I don't know why this is quoting as icuRNmaggie, but just wanted to make sure that i was addressing your post.

Thank you for the pep talk. I'm one of those nurses that never forgets his roots. I'm a nurse almost 3 years and still treat new nurses like they are appreciated and not EATEN. I know what it was like to be new and I promised myself long ago I would never treat a new nurse like I was sometimes treated. I never forgot how some nurses treated me for forgetting to do things that most new nurses would forget due to unripened critical thinking. A couple of these I am friends with now, and when I told them what they did when i was new they both denied they ever did that. But I never forget.

Likewise, when I become an ICU nurse, I will never treat a med surg nurse any less. I know where they are and what they go through. The best ICU nurses ... and ER nurses ... I've dealt with have been med surg nurses prior. Those that go into ICU right after graduation just don't seem to have the sense of empathy for what the med surg nurse endures with multiple patients and the WHY certain things were not done or why they don't know certain details off the top of their head. I know there are exceptions to the rule, but this has been my experience.

I feel incomplete actually not having critical care training. I feel it is what I need to feel more capable of taking care of patients more effectively. If a patients starts decompensating, I start to perform proper interventions but once it gets to the point that a patient must leave my unit to a higher level of care, I become frustrated because I truly do feel defeated. It's like saying, you don't have enough skills to take care of this patient anymore, so we're taking him to a nurse that has more skills to be able to. Well, I WANT to be that nurse! Why cant I be? I feel that I have more potential for that and it is being unused. That is what ultimately frustrates me.

The other frustrating thing about my job is the ratios. I find that I am more capable with less patients than with more, even if I am equally swamped. I can remember more about two sicker patients than I can with 5. The night my patient went into VTach, I had 6 patients. That was unusual for our unit usually @ 5:1 due to a nurse calling out sick and having no nurses to float to us in the entire hospital (there was also a major blizzard outside overnight). 6 patients is way too much to have on a tele unit. I am comfortable with 4 on this type of unit but even then I would prefer less. I think anyone would. But at the same time I would like to learn more complex skills and have more capability with respect to the sickest cardiac patients. Again, since I am a traveler I am limited to these units for assignments I accept until I return to staff, but I don't mind that as long as I can proactively do things while I am traveling to make me more marketable to become an ICU nurse eventually.

I think I just verbalized above more clearly how I really feel more so than I did in my OP when I was on break :)

In about a month, I will be taking a 2 day critical care boot camp course through PESI Healthcare. It's not a full ECCO course as I would like to take but it's the best I can do for now and put that on my resume. I'm hoping that will be a plus towards my goals.

I think I'm rambling now so I'll stop here lol. Thanks for all your help guys in helping me deal.

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[icuRNmaggie, BSN, RN]

I didn't mean for you to take those exams before getting in the clinical hours and I apologize for being unclear.

Many telemetry nurses can handle the VT pt who needs a bolus then the amiodarone gtt, but with those ratios, it's not fair to the new nurses or the other pts. But I get it, you can fix it, you want to fix it, and the unit you are in is limiting what you can do and not allowing you to practice your skills.

Maybe make your next contract in a PCU with drips, then take one in a low level community hospital ICU, then try for fulltime in a teaching hospital ICU. In a year you can be right where you want to be, with the hours required for a CCRN and CMC. Good luck. We have been trying to get ICU travelers for two months, I guess no one wants to deal with the snow that we have been having?

[ICURN3020]

To ICURN3020: I don't know why this is quoting as icuRNmaggie, but just wanted to make sure that i was addressing your post.

Thank you for the pep talk. I'm one of those nurses that never forgets his roots. I'm a nurse almost 3 years and still treat new nurses like they are appreciated and not EATEN. I know what it was like to be new and I promised myself long ago I would never treat a new nurse like I was sometimes treated. I never forgot how some nurses treated me for forgetting to do things that most new nurses would forget due to unripened critical thinking. A couple of these I am friends with now, and when I told them what they did when i was new they both denied they ever did that. But I never forget.

Likewise, when I become an ICU nurse, I will never treat a med surg nurse any less. I know where they are and what they go through. The best ICU nurses ... and ER nurses ... I've dealt with have been med surg nurses prior. Those that go into ICU right after graduation just don't seem to have the sense of empathy for what the med surg nurse endures with multiple patients and the WHY certain things were not done or why they don't know certain details off the top of their head. I know there are exceptions to the rule, but this has been my experience.

I feel incomplete actually not having critical care training. I feel it is what I need to feel more capable of taking care of patients more effectively. If a patients starts decompensating, I start to perform proper interventions but once it gets to the point that a patient must leave my unit to a higher level of care, I become frustrated because I truly do feel defeated. It's like saying, you don't have enough skills to take care of this patient anymore, so we're taking him to a nurse that has more skills to be able to. Well, I WANT to be that nurse! Why cant I be? I feel that I have more potential for that and it is being unused. That is what ultimately frustrates me.

The other frustrating thing about my job is the ratios. I find that I am more capable with less patients than with more, even if I am equally swamped. I can remember more about two sicker patients than I can with 5. The night my patient went into VTach, I had 6 patients. That was unusual for our unit usually @ 5:1 due to a nurse calling out sick and having no nurses to float to us in the entire hospital (there was also a major blizzard outside overnight). 6 patients is way too much to have on a tele unit. I am comfortable with 4 on this type of unit but even then I would prefer less. I think anyone would. But at the same time I would like to learn more complex skills and have more capability with respect to the sickest cardiac patients. Again, since I am a traveler I am limited to these units for assignments I accept until I return to staff, but I don't mind that as long as I can proactively do things while I am traveling to make me more marketable to become an ICU nurse eventually.

I think I just verbalized above more clearly how I really feel more so than I did in my OP when I was on break :)

In about a month, I will be taking a 2 day critical care boot camp course through PESI Healthcare. It's not a full ECCO course as I would like to take but it's the best I can do for now and put that on my resume. I'm hoping that will be a plus towards my goals.

I think I'm rambling now so I'll stop here lol. Thanks for all your help guys in helping me deal.

Sent from my iPad using allnurses

That's awesome that you have the drive to broaden your skills so that you can take care of more complex patients. It just seemed that you were somewhat hard on yourself and I only wanted to make sure you realize that you are doing an important job now. I completely understand that inner need to know and want more and wish you the best of luck in your future! :)

[calivianya, BSN, RN]

You know, technically speaking, the AACN website says this about requirements for initial CCRN cert: "Practice as an RN or APRN for 1,750 hours in direct bedside care of acutely and/or critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application."

I know what critically ill means, but acutely ill? Isn't everyone in the hospital acutely ill? I wonder if, technically, just about any specialty is able to sit for CCRN certification under that very vague qualification.

If nothing else, you could always study a CCRN prep book - even if you don't want to take the test yet, those books have some good pointers that would help you feel more comfortable taking care of sicker patients.

[PacoUSA, BSN, RN]

You know, technically speaking, the AACN website says this about requirements for initial CCRN cert: "Practice as an RN or APRN for 1,750 hours in direct bedside care of acutely and/or critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application."

I know what critically ill means, but acutely ill? Isn't everyone in the hospital acutely ill? I wonder if, technically, just about any specialty is able to sit for CCRN certification under that very vague qualification.

If nothing else, you could always study a CCRN prep book - even if you don't want to take the test yet, those books have some good pointers that would help you feel more comfortable taking care of sicker patients.

Yes, thank you! I have considered doing that as well. I just recently sent back the PCCN books that I bought through Amazon because it just did not feel right for me to take that test when I feel I want to go for CCRN instead. I mean, I could do both, but why bother spending that kind of money if my ultimate goal is CCRN? But at the same time, what is stopping me is not having worked with vents and I think I might find it hard to study about them without having physically worked with one. Perhaps I should seek out some CE course that could teach me that?

As for the definition including acutely ill, I agree with you ... it is quite vague and I guess I could argue that the definition fits my experience. I have definitely cared for past patients that in my mind belong in a stepdown at the very least. I just never have access to the resources to care for them which is why they go to ICU.

[zzbxdo]

Ya. You don't need to have ICU experience, that's a misconception that's stayed right on the AACN ccrn faqs. You may just have to study harder to understand the concepts. Even with ICU experience you won't cover every patient population. Just book up, study, do practice questions. My coworker got his ccrn when he transfered from his imu setting, he had to grind it for a bit and did well. I personally have only seen and played with a Swan like twice as a new grad and still able to score 90% on cardiac.

[PacoUSA, BSN, RN]

So, is having a CCRN without actual ICU experience a plus or a negative when seeking an ICU job?

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[zzbxdo]

And how else would you meet those requisites, (caring for the critically ill), other than working in the ICU?

I did not design the test, and I certainly do not make the rules. But it's clear that having actual ICU experience is NOT the sole requirement. Relevant (acute) care experience and studying can get you a passing grade. It's just some certificate anyway, it's not like the nclex and license which determines your ability to practice. Realistically, ccrn is just for magnet goals, a small pay incentive (i get 50 bucks a paycheck), and a requirement for crna schools. The later/professional development is probably why anyone already in an ICU setting would care for it.

To the op: I say go ahead and study for it. You will learn much more when you drop a few bills to sit for the test within a small time period. You'll have strong baseline understanding of all the systems going into an interview/position/speciality even if you won't many disease processes. I work in a Burn ICU, however we do float and occasionally have overflows. Still gotta do your job, though it will be unlikely you'll have the fresh iabp or whatever.

[whofan, ADN, BSN, RN]

its not necessarily the number of years but the amount of hours. Or it was the last I checked.