IMCU

Published

Specializes in IMCU.

Hello! I have an interview for an IMCU position and was wondering if anyone else here has experience working in an IMCU and would be willing to share what it is like? As in, do you like it, why/ why not? what are the most common types of patients/ conditions that you see? how do you think it compares to ICU and MedSurg? Good place for a new grad? Thanks!

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.

What do the letters IMCU mean? We have a High Acuity Medical Unit at work and it's basically a unit where patients who no longer meet criteria for ICU (no q 1 hour needs) but are too sick or fragile for Medical Unit are placed.  California RN staffing ratio for step down is 1:3. Many patients have tracheostomies, chronic wound care, or total care. It's a heavy patient load for a nurse.

1
Up Vote Up Vote ×
Specializes in IMCU.

Intermediate Care Unit, my understanding is it is a step-down unit for patients who no longer need ICU but are too unstable for a MedSurg floor (like you described). If you could tell me more about your experience with step down I'd really appreciate it! 

1
Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
7 hours ago, CamperNurse said:

Intermediate Care Unit, my understanding is it is a step-down unit for patients who no longer need ICU but are too unstable for a MedSurg floor (like you described). If you could tell me more about your experience with step down I'd really appreciate it! 

Thanks for clarifying. I've never worked there as an RN.  As an NP, I have been called in that unit to assess a patient multiple times for possible ICU transfer.  I've also responded to code blue's there a lot.  The unit is indeed busy but the RN's are well respected.  They know their patient population well and are very reliable informant for us providers when things aren't going so well with their patients.  It's almost a given that if a nurse in that unit is worried about a patient, you go and assess the situation right away.  I would consider it as a nurse if I couldn't get an ICU position or as a stepping stone to an ICU position but that's just me because many nurses have been working in that unit for a long time.

Up Vote Up Vote ×
Specializes in IMCU.

Thanks for the feedback! ICU is my goal and I have heard/ read that IMCU/IMU/Step-down is a good place to start if you want to go into ICU. 

If anyone else has any experiences/opinions I would love to hear them!

1
Up Vote Up Vote ×
Specializes in Neurosciences, stepdown, acute rehab, LTC.

It’s fun I love it! Somewhat fast paced but with my 3:1 ratio I feel like I can develop relationships and really make a difference. It’s a bit of a jazzed up med surg , a little more going on as the patients can become unstable but you still send them back to the ICU if it gets too bad. I feel like there is a lot of non stop talking though as there are a lot of people still following the patient very closely and a lot of orders. 

Up Vote Up Vote ×
Specializes in IMCU.
On 12/5/2020 at 6:55 AM, anewsns said:

It’s fun I love it! Somewhat fast paced but with my 3:1 ratio I feel like I can develop relationships and really make a difference. It’s a bit of a jazzed up med surg , a little more going on as the patients can become unstable but you still send them back to the ICU if it gets too bad. I feel like there is a lot of non stop talking though as there are a lot of people still following the patient very closely and a lot of orders. 

Thanks for the info! I did get the job, yay! I have not begun the residency yet, but will soon. I have so many questions! I wish they would send out all details now. 

How long have you worked in IMCU/IMU/Step-down? As far as  I know, the unit I will be in is not specific to any one thing (eg Cardiac, COVID, etc) are there any disease processes that you frequently see? I do not have ACLS yet, but my understanding is I am required to get it in the first 30 days (they will pay for it). Any tips/ suggestions with that? Also, do you mind if I ask about what part of the country you are in? Are you in a large magnet hospital? Small rural? Lastly, any recommendations on specific knowledge/ skills to brush up on before starting? LOL, sorry, I am just eager beaver over here right now. 

1
Up Vote Up Vote ×
Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I do work in a ICU, but we float to the step down unit. Our ICU is only 12 beds, the step down unit is nine beds. I know of a hospital near me that has 72 hour limits for the step down unit, then they either need to go to the medical floor or back to ICU. That seems like a great idea because patients sometimes get stuck in our stepdown beds for weeks. Usually they're too weak to remove a BiPAP that they still need for respiratory support, so they can't be on a 6:1 assignment. Sometimes they're just deconditioned from ICU, and the hospitalists are afraid to move them to medical. 

Our main admission diagnoses (other than COVID, which will hopefully pass soon) into the stepdown unit are most likely: COPD, CHF, DKA, altered mental status, alcohol detox, and stroke. 

Good luck starting your new position! PCU seems like a great place to start and learn the flow of things. 

1
Up Vote Up Vote ×
Specializes in Neurosciences, stepdown, acute rehab, LTC.
On 12/8/2020 at 3:33 PM, CamperNurse said:

Thanks for the info! I did get the job, yay! I have not begun the residency yet, but will soon. I have so many questions! I wish they would send out all details now. 

How long have you worked in IMCU/IMU/Step-down? As far as  I know, the unit I will be in is not specific to any one thing (eg Cardiac, COVID, etc) are there any disease processes that you frequently see? I do not have ACLS yet, but my understanding is I am required to get it in the first 30 days (they will pay for it). Any tips/ suggestions with that? Also, do you mind if I ask about what part of the country you are in? Are you in a large magnet hospital? Small rural? Lastly, any recommendations on specific knowledge/ skills to brush up on before starting? LOL, sorry, I am just eager beaver over here right now. 

I work in neuro at a large magnet hospital ! My unit focuses mostly on strokes and brain tumors and our sister neuro unit tends to get general neuro like myesthenia and epilepsy. No tips with ACLS! It’ll be a 12 hour class with a mega code at the end that you have to “run”. I find that class oddly fun as long as the instructors are pleasant. You’ll understand the whole process once the class is done. I live in NC. This is going to sound boring, but as a new grad I would focus mostly on safety and day to day stuff - falls prevention , assessments , knowing your resources. You should get classes like rhythm interpretation there. We see normal skills like g tubes, foley insertions, IVPB , blood transfusions , and trachs. We also see a couple of more advanced skills on my unit such as a-lines and EVDs. We do a few drips too. Just know where your protocols are so you can follow the formula for those and ask a lot of questions. In other words , start with foundations and get them down totally pat in the beginning and the more advanced critical thinking and skills will come over time. You can always brush up on your basic patho and pharm too ! 

1
Up Vote Up Vote ×
Specializes in IMCU.

Thank you to everyone who has replied! I appreciate you taking the time to share your experiences. 

Up Vote Up Vote ×
+ Join the Discussion