Is ICU worth the stress?

[gennn19, BSN, RN]

I second the user above me. The stress is NOT worth it, in my opinion. I recently, ~6 months ago, made the switch to a very high acuity peds cardiac ICU, and honestly, I dream about leaving every day. Yes, it can be rewarding, but the stress, anxiety, and just overall frustration happen far more often. I was in a similar position as you. I had a very laid-back job before this in a very happy low acuity specialty. I wanted a challenge because I was bored. And even though I don't want to go back to my old unit and I have learned a lot in the ICU (and am very grateful for the experience), I know it is just not for me. People keep telling me to give it a year, but honestly, I don't know if I want to. If you're happy where you are, stay. If you really want to venture out, go for it, but you might end up like me. 

[Corey Narry, MSN, RN, NP]

commitmentphobe said:

Part of me has always wanted to work there--I won't really feel like I've "made it" as a nurse until I can take care of the sickest patients. 

But then again, I currently have a pretty cushy procedural nursing gig. Low stress, day job, no weekends. Sure, I might not be fully actualized as a nurse, but maybe that's okay for the sake of my mental health?

I think those are feelings you have to explore on your own.  There is always this thought that ICU nurses have bragging rights for being hardcore, and there is a reason for that...but it also requires a steep learning curve if you're someone coming from a procedural setting.  As a long-time ICU NP, I feel like nursing is nursing, and unless you have a passion for caring for the sickest patients in the hospital, the effort won't pay off.

[NurseNelly24, BSN]

It's worth trying if you really want to explore it and see what it's really about. If you have a good relationship with your current employer, you can either 1) go per diem, so you maintain your status as an employee, or 2) if you work at the ICU and realize it's not for you, you can always go back. 
 

The ICU, depending on where you work, can have its exciting moments, but it's still a high level of stress and can often be overwhelming if bedside nursing isn't your thing. Even when I do have mentally challenging/stimulating experiences at work, it's still a job, LOL. There is definitely a boring/task-oriented/job, no matter how sophisticated the unit/specialty is.

[dogmombyday, RN]

In short, yes, it’s worth it...BUT only if it’s where you’re supposed to be. I think the only one who can answer that is you. If you’re truly happy in your job, then stay. But if you think there’s always going to be a part of you that wishes you could have/should have tried it out, then why not give it a shot? A lot of units (maybe not now with Covid) allow people to shadow a nurse there, just to see what it’s really like. 

I’ve been an ICU nurse for most of my career (which is only a few years at this point ?) and I know it’s where I belong. After going through some truly “unique” (not in a good way) situations that caused a mass exodus from our unit, I made the switch to an outpatient OR nursing position. Pay was decent, no holidays or weekends. But I felt deeply unfulfilled. I was back working ICU in 7 months ??‍♀️

Like I said, the only person who can decide what is most important to you is you. There is so much to learn in ICU and it is, at times, a very exciting place to work. It makes me feel like I’m really contributing to the world (not that any nurse doesn’t  do this!) and like I’m where I’m supposed to be. But there are times when it’s incredibly frustrating and sometimes even a little boring. 

Best of luck, whatever you decide!

[marienm, RN, CCRN]

I started in an ICU and am still there. But I don't think it's the "pinnacle" of nursing for a bunch of reasons.

1) Depending on the structure of your hospital (especially now during COVID), ICUs are very different from each other. In some, you'll basically not have vented, sedated patients. As soon as they get extubated, they're moved to step-down or the floor. So you'll learn a lot about vents, invasive treatments, drugs, and certain types of time management, but you won't necessarily have a "holistic" view of these patients because you really won't get to see them recover. On the flip side, some ICUs keep their patients the whole time, and you may actually get to see patients go from completely dependent on machines to heading out the door to rehab. (This'll introduce you to a whole different type of time management. Trying to titrate drips on your unstable patients and keeping up with the call lights of your "stable" patient!) Neither of these structures is wrong, but they're very different!

2) In the ICU, you'll need to learn a lot of new assessment skills, charting, and also technology. If you like troubleshooting, you might like this part. If not, it's really aggravating to try to figure out why the arterial line pressure wave won't show up correctly on your screen. (It's a simple fix...buried two or three clicks down in a menu!)  Or why the defibrillator isn't pacing your patient anymore. There's a learning curve to all of this, of course, and I hate to say that some people just aren't "tech-inclined," but it might be true...think about how *you* feel about it, especially if you can get a chance to shadow on the unit.

3) The ICU isn't always fulfilling. Sure, we save lives sometimes (so do floor nurses and lots of other nurses!...the ICU just keeps them alive after the CPR is over.)  But sometimes, the patient wants to die peacefully, and the family pushes for "doing everything."  I've had shifts where all I wanted to do was apologize to my patient. Sometimes you do everything for a patient who wants to live, and they die anyway. I've had shifts where I know I did my best, and it still wasn't enough. And also shifts where I questioned everything I did, wondering whether it was really my best, whether I could have been faster, called the provider sooner, etc. Also, ICUs have their share of frustrating frequent fliers:  drug overdoses, DKA, missed-dialysis-and-now-my-potassium-is-8, endocarditis (see: drug overdoses), etc...  It can be hard to feel like you've made a difference in someone's life when you see them back on your admissions board every other week.

I'm not trying to talk you out of the ICU. But I don't think that being an ICU nurse symbolizes the "full potential" of nursing. I learned ICU skills, and you learned procedural nursing skills--if you want to learn ICU nursing skills now, go for it! Your schedule will be worse (probably), and your stress level will probably be higher (at least for a while). Learning new things is a good challenge, and if you work off-shift, you might make more money. But I'd suggest you only do it because you actually want to work in the ICU, not to fulfill an abstract idea of "actualization."  If I could make the same money with less stress and a more predictable schedule, that would be valuable to me too.   

[Guest856929]

It depends on what your end goals are. ICU nurses are relatively over-glorified, and bedside nursing, for the most part, is quite overrated. Most nurses who have been in the ICU for >20 years look like they have been in the ICU for >20 years. 

[Abetterway, BSN]

I've worked in ICU for most of my career, from Neonatal ICU to Pediatric ICU (the hardest emotionally for me, especially after I became a mother), even neuro ICU (very difficult families), and cardiovascular ICU and now for the last 12 or so years a MICU. I love my current unit; we have a fantastic team and NPs on all shifts. However, some shifts are truly horrendous, and with the Covid crisis, we have had way too many changes, short of equipment, and bad attitudes at times (short-staffed and clueless management). Our unit went from 14-16 beds to 23, and soon it will be 25 beds. All of that is Covid related, don't ask. Being charge nurse over that unit right now is, well, difficult; we take turns and get through the shift with a lot of good teamwork. I thought I was flexible, and I had to learn a whole new meaning of flexibility. Sorry, bad grammar! What I'm trying to say is ICU is always stressful, and occasionally, we have a bit of downtime.... (15-20 minutes!). Then it's back to the patient. We have more than our share of end-of-life type patients on this unit. It is the nature of the kind of ICU we have; sometimes, the families do not want to let go. I feel bad for the patients in these cases, I pray, and I sometimes cry. In different ICUs, you will have different issues; for instance, in Neonatal ICU, very few deaths.... the parents are easier to work with than in Pediatric ICU; in general, the neonates are in need of expert care, and medications must be double /triple checked but for the most part is a more positive place (lots of smiles, adorableness abounding, some nurses decorating isolettes, volunteers knitting caps and sewing gowns for the fetal demise babes.) one can be part of a team for a micro premie who grows from 12 ounces to 3.8 kilos after a five-month hospital stay (one can get attached at times) whereas in pediatric ICU the children are extremely ill, usually quite suddenly and the parents, grandparents are in a much more crises mode, and some of their coping mechanisms forced us to call security. What I'm trying to relay here is the kind of ICU you select makes a big difference. I did a stent as a travel nurse years ago, and it lasted only one day in a trauma unit. The nurses there were absolutely top-notch, it was me with the problem, and my travel agency was able to switch me to a coronary care unit on the night shift. More my speed, I know my strengths and weaknesses. We train many nurses in my unit; some love it and stay, and some choose to move on, and that's OK. That is the aspect of nursing I love. We have a choice to move on and move around, and most employers understand that. If I was in a different profession, I doubt if there would be very much opportunity for this many different kinds of opportunities. 

[Farberglar, ADN]

I also once thought that hospital nursing was the pinnacle of nursing, and then I started as a visiting nurse. And let me tell you how absolutely fulfilling it is. My job is all about educating patients so they can stay well/independent in their homes and OUT OF THE HOSPITAL, which is so incredibly important for both the patients in particular and the healthcare system in general. I take my job extremely seriously, and I absolutely love it. Like you, I don't work weekends, but I'm also in charge of my own schedule every day, don't have the bullying/attitude/drama so common among hospital nurses, and I get to manage my patients' care, including scheduling their PT, OT, SLT, and MSW consults. It is very gratifying.

The beauty of nursing is that there are so many facets and so much one can do. Don't paint yourself into a corner believing there is only one "real" nursing job; it's just not true. You can impact the lives of your patients in so many ways!

[JBMmom, MSN, NP]

I don't think there's a "pinnacle" of nursing. Every nurse has a skill set that meets the needs of the patient population they serve. If you're happy doing what you're doing and it works for your overall life balance, you're not less of a nurse for it. But, if you feel like ICU is something that genuinely interests you for a specific reason, then you should definitely check it out. You're probably a great nurse doing your job, and you'd probably be successful in the ICU if it's what you want. But don't think you'll be a different nurse; you'll be the same nurse in a different place. Good luck!

[NurseBrittRN]

It can be a little overwhelming in the beginning. I was a new grad ICU nurse (and pregnant), and I felt like that first year, being pregnant, having a newborn with zero sleep, and trying to learn how to be a nurse, let alone an ICU nurse, was a lot. But at the end of year 2, I felt much more confident. 

I will say that "stress" is an individual factor. The few times I've had to work as a med surgeon or step down unit were MUCH more stressful to me than working in ICU, where I can monitor my patient closely, and I'm in much more control of their care. 

ICU nursing is hands down worth it to me, but I know it's not for everyone. I suggest trying it for at least eight months and seeing how you feel. 

[LadyStark]

I would definitely stay in the cushy job you have now. Yeah, you do learn a lot in the ICU, but the stress is not worth it, imo. Your health/mental health is much more important. I've been in the ICU for a few years now, and I'm severely burnt out and looking for a change. Everyone is different, though.

[Robmoo, ADN, BSN, RN]

Are you bored and looking for the next challenge?  Will you be disappointed if you don't try?  The ICU is not the pinnacle of the nursing career.  You've made it when you become a master in your field, whether that field is ICU, med surgery, nursing, or any other field.  That pinnacle could be becoming the mentor who trains new nurses in the specialty, becoming a unit manager or high, or earning your NP to practice in that specialty.  

If you do decide to go into the ICU, do it for your own professional development and satisfaction, not out of some false expectation.  

As for the stress, whether or not the ICU is stressful is more a matter of the nurse's temperament than anything else.  Some nurses enjoy the bloody trauma, the post-surgical ICU patient who needs early ambulation and moves out within 1-2 days, or the post-CABG patient who is on multiple drips and needs weaning, extubation, and mobilization and is going to be in the ICU for several days working towards these goals.