ICU Acuity - Advise?

[ninja-nurse, BSN]

Ok, all, please forgive the long post, but I want to lay the situation out properly.

I managed to get into a Neuro/Cardiac ICU. Yay, me! Loved the area, so I got a little house. Figured I'd get a few years experience, then I'd have my tax home and a place to come back to in the winter (Florida ALWAYS needs nurses in winter).

Fast forward 2 years, and... I may have a problem. What I had thought was great and exciting now seems fairly low acuity for an ICU.

I almost never see much cardiac equipment. We get an Arctic Sun or balloon pump MAYBE once every 6-8 months. I've seen a rotation therapy bed ONCE, and CRRT maybe twice in 2 years. We don't get external pacers or cardioversions all that much. And I've never even seen a PA catheter.

We mostly seem to get STEMI/NSTEMI, HTN crisis, CHF, COPD, strokes, tumors and the occasional sepsis. I can do drips and vents. I can pull lines post-cath. I'm comfortable with monitoring EVD's (not setting one up - our docs take the pt down to OR for that), I'm NIHSS certified, and I think I could do neuro checks in my sleep.

I really want to travel, but looking at some of the skills checksheets on different sites, I'm a little concerned that my ICU experience may not be as "Intensive" as I'd originally thought. I am planning to sign on with a local temp. agency to do some per diem at other places, but the only hospitals within a halfway reasonable driving distance from home are just as small and have about the same acuity as mine.

Some of my co-workers who came from traveling have said I'd be fine in smaller towns/hospitals, and I was thinking maybe stepdown/IMC units on larger ones. Does this sound feasible? ARE there a decent amount of stepdown units or small hospitals needing travelers? I just don't want to get out there and hurt my patients or my license by jumping in if I'm not reasonably ready.

Thank you to anyone who takes the time to read this, and virtual hugs for any advice.

~N. Nurse

[RNAvatar]

Honestly, your experience sounds more like intermediate/step down care/telemetry. Those were the kinds of patients that I had on a tele/cardiac/med-surge floor and granted, we were more like a step down tele floor. That said, I'm not quite sure what ICU nurse entails, but seeing that your patients are like mine on a tele floor, maybe you would be more comfortable working on an intermediate/tele floor if you really want to go traveling now. Otherwise, you should go get some experience at a big teaching hospital ICU first if you are not comfortable traveling as an ICU nurse yet!

[NedRN]

Congrats on planning your travel career in advance, great job! A bit unlucky about acuity perhaps but it is very difficult to know these things right out of school. You do have an excellent knowledge base and I would say you are good to go. If you push hard, you can gain the experience needed while traveling. Try for more difficult and bigger ICUs every assignment or really gnarly step down units. Enthusiasm and good skills go a long way in landing good travel assignments and good patient assignments. Even if you don't get what you want in every assignment, I think you will find that your skills improve with just scattered good cases here and there until you can confidently take neuro trauma and even hearts. Some large open heart centers may keep their fresh hearts several days on a large unit so you can take second day post ops and work your way up when ready.

PA catheters are fairly rare these days by the way, I wouldn't sweat that one.

[wanderlust99]

I've worked ICU for 10 years, and your experience sounds great to me. What is wonderful is you have experience with strokes and EVDs. That will really help you find assignments. It doesn't matter that you haven't set an EVD up, you will learn. Tell them you can manage one. I wouldn't shy away from big hospitals either. If you can get into a large academic hospital for an assignment that'll look great on your resume. You'd be great in a neuro ICU. Also there are many general ICUs at mid size hospitals (250 beds or so) that sound similar to the unit you're working in. The ones where you rarely see CRRT and they only do a few open hearts a month. As a traveler, you wouldn't even care for those patients.

When you apply you'll speak to the manager of the unit and just be honest with your experience. Tell them what you are comfortable with. I think you'll be fine. I wouldn't worry or think you have to work step down as a traveler.

[blackeyedsusan]

I've been an ICU nurse for almost 5 years, and traveled for the last 2 1/2. My experience when I started traveling was similar to yours. But when you're a traveler, you generally don't get assignments that include balloon pumps, CRRT, Swans, or even EVD's. The exception I found to this was at my last assignment at Wake Forest in NC - ended up having patients on CRRT and with Swans. But this was the first time in 2 1/2 years that I encountered that. Be honest about your experience, but also confident in the skills you have. And don't be afraid to ask for a different assignment if something is going on with the patient that you're just not comfortable handling. And ask, ask, ask questions, even about things you think you know - policies and procedures that you're used to at your hospital might be completely different at another hospital.

[thewandereRN]

I am in the same boat as you. Thanks for posting!

[Find]

Blackeyedsusan, I'd like to tag along to Ninja-Nurse's query. I've worked at a MICU for four years- my entire nursing career, at a moderately sized academic hospital. I'm confident in my bedside skills and communication. I have not taken care of one patient with CRRT, IABP, or a Swan. A ghastly number of nurses on this unit have not had these experiences. If you don't mind my asking, was this your situation before you started traveling?

[ninja-nurse, BSN]

Thank you, everyone!

I had thought that I was about ready, but then I started reading those skills checksheets. Halo's, IABP's, open heart recovery, PA caths, trauma.. I read all of that on the list and freaked. This is the only ICU I've worked at, so I wasn't sure how it would compare to anywhere else. It was my nightmare to think that I'd take an assignment only to arrive and find out that EVERY patient on the unit was one of these high-skill/rare machine.

You've all made me feel SO much better! Hugs!