ICU nurse vs PCU nurse

[missmollie, ADN, BSN, RN]

Help me with this. I was a progressive care nurse five weeks ago. I'm currently having a great orientation as an ICU nurse. This a conversation I have had.

PCU: The patient is in a lot of pain, not sleeping, and is delirious. Could we get something for pain and a sleeping medication?

Provider: I'm hesitant to order any of those things. Let's wait for the day team.

ICU: The patient is in a lot of pain, not sleeping, and is delirious. Could we get something for pain and a sleeping medication?

Provider: That's a great observation. Let's order both pain meds and 25 of seroquel. If anything changes, let me know. Any other issues?

ICU me: Well, they haven't had a CT of this area, they are requiring one unit of blood a day. Because the surgery was in this area and a CT hasn't been done in a day, it might be prudent to get one.

Provider: Good call. We'll order that after rounds.

WOW!. Why would providers be more responsive to ICU suggestions than PCU suggestions. Nothing has really changed. I'm still the same nurse. I still have good suggestions. Why are ICU suggestions considered but PCU suggestions aren't?

[Sour Lemon]

I'm confused ...is this an example, or something that actually happened? I think hearing the same suggestion twice (from two different individuals) would probably get someone's attention.
If it's an example, there are a lot of variables.

[RNperdiem, RN]

I wonder if your progressive care job providers were not entirely empowered to make big decisions. Dealing with crosss-covering services, NPs and PAs who cover nights and weekends gives you the feeling of your patients being "band-aided" until the surgical or medical team (who are empowered to make big decisions) arrives.

I work ICU dayshift and have to trouble getting my patient the orders they need.

[JBMmom, MSN, NP]

Were both pain/delirium conversations with the same provider? Were there any additional details given related to patient information? I know that when I came to ICU, there were more expectations about nurses giving a recommendation when updating patient conditions/changes, which was a big change for me. At times it seems almost out of scope to be suggesting things, but then again our hospitalists have almost 200 patients and night, with just two of them. Sounds like one request was given on nights, and then the scan request was on days- I find that the providers on days are generally there face to face, while nights is often a remote request. No, you're not a different nurse, but they also have no way of knowing that unless it's someone you work with regularly, and I think there's just an expectation in ICU that you're giving more input. Not that it's right or wrong, but it's just what happens. Enjoy your ICU job!

[missmollie, ADN, BSN, RN]

The above is an example of something I would say as a PCU nurse and an ICU nurse. Not something that was said about the patient twice.

[2Ask]

Sounds like you work nights?

I'm a PCU nurse. On overnights our patients are generally covered by a hospitalist and there are only a couple of them for the entire hospital at night so they are not that familiar with the patient and defer any big treatment decisions to the patient's attending physician who is there during the day.

Sounds like your ICU has an intensivist available on the night shift. The intensivist only handles the much smaller number of ICU patients who are by nature more unstable requiring more hands on management.