Interest in switching from M/S to ICU - advice

[acerbia]

I'm currently a med surg tele nurse with almost a year of experience on this floor. I have 6 pts per shift, all of whom have varying levels of acuity. Sometimes I'll get heavy surgical patients, basic medical diabetes and cellulitis-type pts, and even psych (DTs mostly and suicide). I feel like I'm a med passer and that's about it. Sure, I spend time with my pts and their families, bonding and what not. But when it comes to taking care of acutely ill pts, the others tend to get left behind. I really liked being with one of my pts tonight. He is very sick, dialysis and surgical pt. Wound vac, foley, PICC, tube feed, g-tube, HD accesss cath, infusing heparin and 0.9. I had to manage all his lines and tubes, checking the meds, flushing them through the PEG, etc. I really enjoyed that and I had to put a lot of thought into what I would do and prioritize. He was only 1 of 6 patients, the other 3 demanding pain medication and getting angry with me because I couldn't bring them their pain med immediately. I'm getting sick of this, quite frankly. I don't know if it's pt ratio, short staff, or acuity that bothers me the most, but it's getting to be tiring. I like working with fewer patients that are really sick. I feel like I have a chance to use critical thinking skills and assessments that I feel I lack on my current floor. I like managing lines and tubes, and working with technology, on a more independent basis. I have a very limited view of what an ICU nurse does, but it's always something I've been interested in. What kind of qualities make for a good ICU RN? I'm thinking about applying and doing a transfer as soon as I'm able, but I feel like I have more learning to do to prepare myself to be successful. Any advice or suggestions for how I should proceed? Thank you in advance!

[cess186]

You're ICU material. You're only one year in, hang in there and move on.

[RT->CRNA]

Most ICUs will put you through a critical care course even if you are experienced. I was a RT for 10 years when I became a nurse this year. I told myself that I was going to get into an ICU or nothing at all. Thank God that I was hired on in the ICU of my choice. There are times that I feel like a med jockey, but more frequent than not, I get to enjoy an increased autonomy, and exercise my critical thinking skills. You are going to come in with better time management skill, and disease process experience than I had, but for the most part, you will be placed with a preceptor that wants to see you succeed.

[OUxPhys, BSN, RN]

Kinda sounds like me. I like having fewer sicker pts I can focus on instead of running around passing pain meds, getting refreshments etc.

[Here.I.Stand, BSN, RN]

Qualities that I can think of off the top of my head: eager to learn, empathetic (you will care for people in the scariest time of their life), assertive, have the ability to focus and stay calm, and have excellent critical thinking skills. Actually my first ICU manager during my interview said the most important thing is "independent critical thinking."

I too do better caring for one or two very sick patients. LTACH could be hell on some days, with 4-5 sicker than stepdown pts! Working one night during my first job (floor), one of my pts was going into respiratory distress. Rapid responses we're really a thing then, so until it was decided to transfer him to the ICU I stayed in his room and monitored him, adjusted his position and O2 etc.

Before that I didn't at all have the confidence to consider ICU nursing. But realizing then that I had done a good job with him, I thought maybe I could do it.

[TaylorICU]

Hey there! It blows my mind how many patient's you all take on a regular basis. I work on a MICU, and that's where I started out as a nurse. I have trained 2 nurses that came from med/surg settings that transferred to ICU. They certainly didn't struggle with patient load! We typically take 1-2 patients. But what both of these nurses struggled with was going from lack of autonomy to expected level of autonomy in the ICU. Example, we don't call the MD every time we need a fluid bolus...Another thing they found challenging was the increased amount of drugs that we give titrate and know. I never worked in any other type of environment than ICU, so many of the things that are second nature to me weren't to them. It wasn't that they weren't smart (they both are extremely smart) but there was definitely a lot to learn.

If you want a head start on learning before you proceed I would suggest learning all of your vaso-active drugs. (Neo, Levo, Dobutamine- just to name a few)

In the ICU we also do a lot of procedures at the bedside. This was difficult for the people coming from med/surg also.

I hope that you find what you are looking for!

[OUxPhys, BSN, RN]

See I love drips. On my stepdown we can titrate nitro drips. We also can have insulin drips, dobutamine, heparin, dopamine (maybe?), amio, push metop/hydral/adenosine etc. Id love to go to our CICU because it it literally one of the busiest in the country and the acuity is high but Im also terrified.

I know the autonomy would be something new for me (we have to page for everything!).

[Nicola94]

Definitely sounds like ICU would be your niche. I would go for it. See if the manager will put you through a course. I loved my critical care course, learned so much