ICU Nurse Considering Ambulatory Care

theRNJedi · Feb 24, 2015

It's smart and prudent of you to consider how your patient care impacts your back health. That is a legitimate concern, and one that should be taken seriously. Ideally, you would be able to work with your department manager, quality committee, and/or facility leadership to encourage a change, especially in light of the fact that 3 recent employees went on light duty; that alone should motivate leadership to re-evaluate policies. (if they are as 'excellent' as you say). You may have to be the 'champion' for that; maybe you can do some research, identify evidence-based practice, and write a proposal suggesting how to create a lift team and manage it.

Your question is intriguing because you are using one element of your current job (albeit valid) to justify transitioning into an entirely new nursing specialty. I think there's a lot more to consider. In general though, ambulatory nursing is a stark contrast to critical care; neither is better or worse than the other, just very different specialties with different approaches to practice. For one thing, your patient population and acuity are very different. Ambulatory centers usually have well-patient populations, have mon-fri day shifts, no weekends, holidays off, and minimal to no call. However, the trade-off could be less money (critical care usually pays the highest rates), you may be giving up weekend/night differentials, and because patients aren't as sick you will not use some unique nursing skills, equipment, and invasive interventions you use in critical care.

I've worked in ambulatory care for several years and I currently work in acute care at a level 1 trauma center...these two worlds are night & day. I like the variety, but some of my ambulatory colleagues who came from critical care miss the 'sick' patients who require life-saving interventions and acute monitoring; it's a thrill and a rush to be on the front lines of critically ill patients. Then again, ambulatory care requires a lot of patient education and you experience a greater level of interaction and interpersonal communication with ambulatory patients. Critical care nursing may assign you to the same patient for an entire shift and even multiple shifts; and on the flip side, ambulatory nursing typically is faster paced with high turnover, so you experience a greater number and variety of patients in one shift. Both specialties have their pro's and con's with unique perks. You would simply need to prioritize what you need/want out of job and make a decision. Then again, if you don't try something new you may never know what you're missing.

-TheRNJedi

firstinfamily, RN · Feb 24, 2015

It is so very difficult to transition within nursing. It often seems that once we are working in a designated area we are 'labeled' to stay within that area. With critical care experience you have a lot of skills that can be used in other areas. If you are wanting to get out of that type of nursing completely, then looking at Ambulatory nursing is a good option. Plus, it would seem that as the medical world is constantly changing, less hospital stays, more out-patient services will become the norm in the future. However, I must warn you that a transition from critical care to ambulatory care is a huge step. It might be easier for you to transition to a lower acuity level of acute nursing first. Gradually transition yourself into an Ambulatory care environment. I totally understand the physical demands of nursing, and with our obese population we are placing ourselves more at risk for injury every day. Have you considered areas of nursing that require critical care skills but not as much physical such as recovery room, PACU, cardiac cath?? These areas would use your critical care skills and usually do not require as much physical lifting etc as ICU. When I left critical care with 16 years of experience I transitioned to a telemetry floor, I then took a supervisory position in a LTC facility, I returned to acute care within 2 years and stayed on a telemetry floor until I took a Cardiac Nurse position in the Cardiac Stress testing area---that is another area you could look into Cardiac Testing which your hospital or another may have available. I enjoyed this type of nursing as I was using my critical care skills, but doing cardiac testing and helping patients, there was very little physical aspects of nursing involved, but challenging in diagnosing skills. Look around before you take a giant leap!! Good luck!!

lassenlake · Feb 24, 2015

Thanks for both of your thoughtful replies. I should have mentioned that I have about 5 years of ER experience in high acuity and fast track....so I have an idea of what multiple patients can be like. In some ways it can be more stressful I think having multiple MD's writing orders and the pressure of discharging quickly...so thanks for reminding me of that.

The company I work for has simply superior health and other benefits so at this point in time the only reason for moving away from the ICU is the turning of morbidly obese patients which must be done Q2 and pen. All other employers have lift teams. Our company does not. Now at 60 after many years of rewarding work, I simply cannot do that lifting without risking injury so I must consider alternatives.

PACU is a natural choice and I plan to talk with some of my friends who work there, but I rarely see a job posted. The other +'s are 8 hour shifts and a predictable schedule. Don't get me wrong I love ICU and have won awards (humbly) for my work help out on the emergency room and other duties. But after 5 years I am confident that an injury MAY be just down the road and when I look down that road as I see other nurses it is alarming the workers' comp mess and light duty and rarely a good result.

It is to bad, and although originally I made a point of the no lift team and was told I would talk with decision makers those meetings were never offered though I did pursue the idea in private and public forums. Over the years I have seen really good nurses injure themselves.

I have made an appointment with an ambulatory care specialist to speak with her and plan to get my ducks in a row. My high points are cardiology and mentoring or training other nurses so I have seen coach and mentor positions as well as RN cardiology office for many doctors to start IV's etc. I am good should a crisis ever befall a patient, which in ambulatory care happens as you know.

Again, I really do appreciate your thoughts and pointers. They are really helpful. I opened the door o change quickly (at least more quickly for me) and so I am open to your ideas. They are very useful and appreciated. =)

FlyingScot, RN · Feb 24, 2015

I was in much the same boat as you OP. My entire nursing career was in some sort of pediatric critical care with a seven year ED stint and a ton of transport/flight experience. In 2008 there were 36 HEMS personnel killed in helicopter crashes, I was working nights and commuting almost two hours. I just couldn't do it anymore. I applied for and got an ambulatory oncology position. It was the best decision I ever made. I learned the difference between the science of nursing and the art of nursing. All the things we used to have like time to interact with my patients and educate them. Opportunity for one on one without call lights or Voceras going off. But here's the flip side, ambulatory nursing has changed dramatically over the last several years. In many cases it can no longer be considered sub-acute care. Patients are being discharged much earlier and are being seen in follow up when 5 years ago they still would have been admitted. Our patients are acutely ill. We also try to keep them out of the ED if we can because of the risk for infection. So we see them in our clinic instead. We have been in our new building for about 8 weeks now. So far we have had three true codes and three rapid repsonse calls and these were just scheduled patients not add-ons. Although I haven't dropped an NG or ETT in awhile I still must continue assessing my patients at an advanced level. We do not have the support or the equipment available to us that in-patient staff do so we must be on top of our game when the you know what hits the fan. Now I know not all clinics are as acute but many of them are. These are the types of clinics that might be most suitable for someone with your experience. In fact, almost every nurse that has been hired into my clinic either comes from an ICU or ED and we are all ACLS certified. We need to be. While it's true I sometimes miss the rush and the adrenaline but the flip side of it is I am loving having weekends off, my evenings free, no call and no holidays. I am doing much more living than I ever was able to working as an "acute" care nurse. I'm nearly 50 and my priorities have changed. Family and friends have become more important. As my parents age I want to spend time with them. Being with my SO makes me happy. I feel more human and I enjoy life because I'm not physically and emotionally exhausted.

lassenlake · Feb 26, 2015

Thanks. There is an opening in urgent care in our system and I have applied to it. At this point if I get interviews it will be very informative and helpful in my path to migrate out of what has become a really great job as my career winds down. It's a transition with all that implies. The downside is that I have an excellent job right now with experienced colleagues and we are all good for one another. I just cannot risk an injury due to lifting of moving one of these morbidly obese patients which we see more and more.