ICU or PCU?

[tp1159]

Hi everyone!

I know this is something that I need to decide on my own but I still am desperate for any input. I have two job offers and I am unsure which one is the best fit for me. I have one year of post surgical/medical unit experience, and prior to that 2.5 years in acute rehab.

One is a critical care unit, not close to home. It is a mixture of ICU and PCU patients that I will be taking care of. The director and manager both seemed like they cared a lot about setting their nurses up for success. When I toured the unit, everyone seemed pretty chill and nice. (I could have caught everyone at a good moment, who knows) Overall I had a good vibe about the hospital and I've heard its a good hospital...but its definitely out of my comfort zone. I was looking for more of a PCU setting close to home to see if ICU or ER would be something that would interest me but I knew staying on the surgical unit wouldn't expose me to higher acuity patients. So yes they seemed like they would train me well and look out for my well being, it's just not what I was looking for (closer to home, ICU stepdown) but possibly too good to pass up?

As for the second position, its purely PCU and it would be an internal transfer. So no pay raise (which is a bummer but not that big of a deal to me) but it's closer to home. The thing with this position is...the charge RN seemed rude during my walk through and none of the nurses were friendly/said hi which makes it seems like they are not happy. Just like the other position, I could have caught everyone at a bad time. My gut is telling me that the environment may be similar to my current job which is not 100% ideal.

So...based on your experience with jobs, what are some good points I should make my decision on? Again any advice is appreciated!

[PeakRN]

If you want to be an ICU nurse, go to the ICU. While stepdown units will provide some insight into critical care, it isn't the same as having truly sick patients.

Step down units can still provide a good learning experience, but generally with much more stable patients who only require more frequent care or constant monitoring that can be provided on the floors.

I would guess that in the mixed ICU/PCU unit that you would be starting out with less sick patients and getting more critical patients as you go along. This is probably a great setup for someone without critical care experience and something that I would put a lot of value into.

As far as the ED bit, the only place you will learn to be an ED nurse is in the ED. While the ICUs and ED are both critical care, they are critical care in two very different ways.

ED patients (who aren't completely BS shenanigans, which is no small portion) are sick until proven otherwise. Every chest pain is a MI until we prove you aren't, every back pain is a spinal epidural abscess until we prove otherwise, every headache is a stroke until proven otherwise, and continue ad nauseam. Often this is done rather quickly in triage, but many well patients get extensive workups for this reason. The ED exists to rule out emergency conditions, stabilize, and disposition. There is no solid plan, the best EDs exist in a somewhat controlled chaos.

ICUs exist to manage patients with known critical illness. These patients often have a fairly predictable disease course and a plan for intervention. Rarely are there BS patients, and those that are typically are a function of hospital policy (no restraints on the floors, no trachs on where-ever, and so on). For the ICU to function a plan is mandatory.

This isn't to say that inpatient critical care experience isn't valuable in the ED or vice versa, but they are not the same.

As someone who does inpatient critical care and ED quite a bit, those paths can still cross quite a bit. I've been known to gross out PICU nurses when I carry up a bacterial tracheitis (not wearing a gown of course) because the kid gets angry when left in the bed. I've been known to PO adult ICU nurses when I have pressors running peripherally but I took the time to place an A-line to transduce pressures (or worse, been giving PDPs on top of their drips). I've annoyed my ED colleagues when I set up stopcocks or do a real assessment on a belly (and end of the world if we treat their massive constipation that is pushing up on their lungs when they are here for a breathing problem, because after all it isn't their lungs!).

[PacoUSA, BSN, RN]

I would take the ICU position. You would probably be in a better position to not only learn more, but you are also positioning yourself to springboard to other higher opportunities later on.

[CozyCatRN]

Honestly, management and work-environment have a way bigger impact than anything else on my job satisfaction. If you’re not supported, it’s hard to thrive. ICU would be new and scary, but based on first impressions, you might feel more supported.

I float between ICU and PCU, though I spend much more time on the PCU side. At first, ICU was terrifying, but now it feels refreshing to switch back and forth. Sometimes I feel like chit-chatting with my patients, and sometimes it’s nice that they’re intubated and sedated (I know that sounds bad lol). What is terrifying to you now will one day be routine.

[St.BaptistRN, BSN]

Definitely ICU. I've spent a lot of time floating to PCUs. Often understaffed because of how draining it is. You get 3-4 patients that are sick enough to require a lot of foot work, and they're awake enough to require a lot additional attention. To me, it's the worst of ICU and med-surge combined.