LTC to PCU? Freaking out!

[Dani_Mila, BSN, RN]

A little about me, I have almost 4 years experience in sub-acute rehab/ LTC/ hospice/ palliative/ and a little psych. I am currently working in a COVID unit initiated by my facility. My goal is to increase my critical thinking skills and be able to have an acute experience at least in a hospital setting.

I recently applied to 2 positions (PCU because it only has nightshift position available  and surgical unit) at a hospital near my house. I just did the interview with a ICU/PCU nurse manager and the assistant NM at a community hospital. The interview went fine. They were talking really fast regarding what kind of patients they have in their unit. So, I wasn't able to jot a lot of things down.

What I did write was that the floor has 23 patients with 2 techs. Nurse/patient ratio is 1:4-1:5. They said they did 1:6 at one time because so many nurses called out but she does not expect this as norm. Most of their patients seems mix. They did mention cardiac monitoring (she said nurses do this), titrating drips such as cardizem or insulin, as well as patients being on continuous bi-paps. They also have stroke patients. The NM said she is going to give me 8 weeks of orientation with at least another week if needed so a total of 9 weeks. I asked her if I needed more would she give it to me, she said she tries not give too much orientation because budget wise.

Impression from NM seems scary. She was straightforward and strict and pretty hardcore in my opinion. She expects her nurse to be a "positive but a hustler" and "not to sit down until everyone does". So, she expect you to be on your feet at all times. ANM seems pretty chill.

After the interview, the HR called me and told me that the NM was offering me the job. HR said differently of course with the duration of orientation weeks when she interviewed me because I did mention how I do not have acute experience and if taking PCU job would be quite a jump since that is above med-surg. She did mention about how nurses needs time to find their own niche. She said if PCU is not for me then "we can re-evaluate and find the right place suitable" for me. IDK how true she is to her words or she's just fluffing me up, but I did have a pleasant conversation with the HR. I asked the HR to give me a day to consider. 

I am having anxiety because this is quite a big jump. I wanted a job nearby because it's closer to my house, 10 minute drive. The only downside is that the only available jobs are ER, ICU, and PCU. I see a lot of seasoned nurses working here. I heard there are nurses who worked for more than 15 years.

In this hospital, according to their career website, they are mainly hiring a lot of ICU nurses and I see only 1 PCU dayshift nurse job availability (I took the nightshift). They do have a main teaching hospital (same organization) with more job options to choose from but it is 20-30 minutes away.

****Fast forward, in the end, I ended up having to accept the job offer but I am having anxiety because I don't think I have the critical experience/thinking for this type of setting and have been thinking of what if I don't do well during orientation and be let go or what! I would like to do well on this job because I want to further my nursing experience in critical care, but I am just scared of the possible what ifs. It's a big learning curve as well. What do you guys think?? Anyone have transitioned well form LTC to a PCU? How was your transitional experience?

[JBMmom, MSN, NP]

Take a deep breath, it will all be fine. I transitioned from LTC to med surg and then to ICU about a year later. Is there a big learning curve? Yes. But you have gained many important skills in your time in LTC so don't discount what you already know as not important. Yes, there are sicker patients in the hospital than you had in LTC, but you had less monitoring tools and less staff to rely on, so you've probably got better assessment skills than you're giving yourself credit for. 

Hard to know about the unit itself. These days people are being pulled off orientation earlier than they might like, and maybe earlier than they should be, because of staffing and budget issues. Hopefully you will get the appropriate training and orientation. Best of luck, you can be successful!!

[Dani_Mila, BSN, RN]

On 2/4/2022 at 3:53 PM, JBMmom said:

Take a deep breath, it will all be fine. I transitioned from LTC to med surg and then to ICU about a year later. Is there a big learning curve? Yes. But you have gained many important skills in your time in LTC so don't discount what you already know as not important. Yes, there are sicker patients in the hospital than you had in LTC, but you had less monitoring tools and less staff to rely on, so you've probably got better assessment skills than you're giving yourself credit for. 

Hard to know about the unit itself. These days people are being pulled off orientation earlier than they might like, and maybe earlier than they should be, because of staffing and budget issues. Hopefully you will get the appropriate training and orientation. Best of luck, you can be successful!!

Thank you for the reply. I am still freaking out since I am definitely leaving my comfort zone/work area. I have bought some nursing books to brush up on since I forgot a lot of things. As the days goes by and I get closer to my start date, I am getting more and more nervous ?

[NRSKarenRN, BSN, RN]

http://www.icufaqs.org/  has a clickable list of easy read FAQ files with humor bent that the authors wrote for new RNs coming into a MICU --- very similar to situations handled in a PCU unit.

Subacute rehab and hospice/palliative care along with COVID experience will serve you well as skills used in PCU setting too.   Rephrase your thought -- You will be ADDING to your current skill mix.    ATTITUDE: The Difference Between ORDEAL and ADVENTURE!!  

Take time to smell the roses prior to starting to decrease anxiety.   Best wishes!

[Arisztel]

Hi! Im the same. My husband and I moved and I really wanted to get out of LTC/skilled to gain more experience and now have a job offer in Med/Surg. I have 1 yr experience but now I’m feeling nervous transitioning. They told me I will get 5 weeks orientation but can ask more if needed. 
 

Have you started your new job yet? How was it? Really love to hear from you and good luck. 

[Dani_Mila, BSN, RN]

8 hours ago, Arisztel said:

Hi! Im the same. My husband and I moved and I really wanted to get out of LTC/skilled to gain more experience and now have a job offer in Med/Surg. I have 1 yr experience but now I’m feeling nervous transitioning. They told me I will get 5 weeks orientation but can ask more if needed. 
 

Have you started your new job yet? How was it? Really love to hear from you and good luck. 

Hi how are you! Congrats btw about your new job! 5 weeks is not enough in my opinion. My friend who also went from LTC to a stepdown unit said it should be at least 10 weeks. I was given 8 weeks with an additional of another week if needed. You need to emphasize to the NM that you don't have an acute experience and this is a different setting to what you're used to. I specifically told that during interview. I actually just started this week and today was my shadow day. I shadowed the nurse and received a lot of helpful tips. I was honestly very anxious to be on the floor because it's been 4 years since I've applied to another job. So far, I thought that it is definitely interesting and quite challenging. I've seen the nurse do blood transfusion which you would not see in LTC. Everyone is on cardiac monitors. You do huddles in the morning and any concerns you can literally ask the doctor instead of calling on the phone. One patient need his IV to be redone. He had two and everytime you flush it, it causes burns and pain. The nurse called IV team and they were there in minutes. Concern about patient's mobility/transfer mode, PT is on the floor. My point is that in the hospital all of these things are available to you within minutes compared to LTC where you prioritize what you immediately call to the doctor and what can wait until he sees them. At first I was scared because I'm going from sub-acute/LTC to critical care/acute, but once you see how they work it just reminds you of patients that you took care of in LTC/skilled but they are more sick than usual. For example, there was this patient who was tachypneic and tachycardic whenever he takes off his Bi-Pap. He just looks like the grandpa that you would take care of at LTC. With one look, I knew right away that this patient looks anxious which contributes to his symptoms. Doctors comes in and checked the patient then after a few minutes with the doctor, he ask for psych consult for anxiety meds. These are what you normally pick up in LTC/subacute. It's interesting because most of these patients goes either home or to the rehab in which in this case these will be the patients that you would encounter. This is my first impression of the unit thus far. Now it would really depends on how the orientation will be. I'm still anxious on how I will fare because to me it's definitely different types of patients. But, I am hanging in there.

[Arisztel]

Im glad to hear you are enjoying your first day. I will definitely ask my manager if I need more time. Im honestly already anxious thinking about it but nothing will happen unless I try it. Where I’m going is a small hospital so Im not sure if it will be like that too, I hope it will tho. Thank you! 

[Dani_Mila, BSN, RN]

21 minutes ago, Arisztel said:

Im glad to hear you are enjoying your first day. I will definitely ask my manager if I need more time. Im honestly already anxious thinking about it but nothing will happen unless I try it. Where I’m going is a small hospital so Im not sure if it will be like that too, I hope it will tho. Thank you! 

My hospital is very small too. It's a community hospital. I would also maybe try to review things you don't remember.I bought a med surg book that I'm going to try to review since there are a lot of things I have forgotten because I don't use it while I was on acute rehab. I am still anxious because I'm nervous about just making through orientation and meeting their expectations. I've read about people not being able to make it because the unit is just not a good fit or what. Good luck and hope you keep me updated! 

[Arisztel]

Oh God we have the same exact concerns. The LTC I worked at was a new facility and when I started we only had LTC residents. I did a lot of basic nursing cares and only little of assessments. They were all stable. A month after I started that is when we started getting our skilled. I learned a lot then but still rusty on lung sounds LOL. We did basic wound cares nothing too complicated. I think the most we had at one time was a Jackson pratt bulb for wound drainage. Im planning to watch videos online to refresh my memories on some topics and skills. I just keep telling myself if I handled 18LTC and 5+skilled that I will be okay with 5 or 6. My husband is very supportive of me. He told me to just try and if it does not work then no point of torturing myself over it at least at the end of the day I tried. But Then again I don't want to go back to LTC we are always short staff and no one to call for help. Nurses got so burned out they called in all the time. 
Just try your best and take as much as you can learn there. Please keep me posted. Just really nice to have someone to talk to who are going through the same. 

 

[Dani_Mila, BSN, RN]

I know what you mean. I'm rusty too with lung sounds. Heck, I need to learn how to read EKG strips because one my floor everyone is on cardiac monitors. I'm also rusty with head to toe assessments. At the rehab/LTC, we mostly do focused unless you get an admission or transfer, but you pick up things on how to do a head to toe assessments in a different way. For example, if you greet the patient and the patient starts talking and does facial moves, you're already assessing the mental status/ any stroke issues. Patient was able to shift herself, grab things without issues by hand, you already assessed the musculoskeletal. These were the things we do at the acute rehab and I realize that they do this as well at the hospital. I've had slightly more exposure to skilled patients. I've taken care of patients with trach, IVs, Foley, colostomy, urostomy, C-PAP, post-op, skin graft, amputees, cast, wound vacs, JP drains. I've performed bladder scan, suture removals, straight caths and some other things. Despite this, my anxiety is just a mess to the point that I barely slept the day before the orientation. I was so scared because hospitals can be more challenging and that I might not have the nursing skills that I will need, but then when I was on the floor, I realized that these patients are similar to the ones in rehab/LTC. Most of these patients are sent there and can be as sickly as they were in the hospital because hospital are trying to make more room for much sickly patients. My husband is the same. I kept telling him that I am so scared that I might be let go and won't make it through orientation because I might not be a fit. My husband said the same thing. He said "well if you got let go or you decide to quit then that's it. You look for another job. Life goes on. You're a nurse and there's plenty of jobs out there. Hospitals are not all that". He is very supportive as well despite my constant nagging and pessimism like a broken record ??. Ask you're NM what kind of unit it is and what kind of patients they typically see. In this way, you can start reviewing from there.

[Arisztel]

Hello again! Oh wow your skilled exposure is way better. I actually did some of those. some of our LTC resident had Foley so I did those. I also did  bladder scanning and straight cath. Since I work nights I had to do blood draws too. Im successful on some blood draws but not always. We did not have people with trachs, I never inserted IV there although We had skilled that came in with PICC and are on IV abx. I got to those and liked it. Im very proactive at work before if I have opportunity to try and my coworker have time to teach me  I always jump on it. I got really good doing montoux test. In my 1 year there I really learned a lot I just lack confidence now since Im going to be in a new environment and I know my limitations. Im nervous that my new coworker will not be supportive of me and my growth. I had a good support system where I worked and most us were new nurses so we really tried to help each other out as much as we can. Yes I will ask them more details. Thank you! Hope your rocking your orientation. 

[Dani_Mila, BSN, RN]

50 minutes ago, Arisztel said:

Hello again! Oh wow your skilled exposure is way better. I actually did some of those. some of our LTC resident had Foley so I did those. I also did  bladder scanning and straight cath. Since I work nights I had to do blood draws too. Im successful on some blood draws but not always. We did not have people with trachs, I never inserted IV there although We had skilled that came in with PICC and are on IV abx. I got to those and liked it. Im very proactive at work before if I have opportunity to try and my coworker have time to teach me  I always jump on it. I got really good doing montoux test. In my 1 year there I really learned a lot I just lack confidence now since Im going to be in a new environment and I know my limitations. Im nervous that my new coworker will not be supportive of me and my growth. I had a good support system where I worked and most us were new nurses so we really tried to help each other out as much as we can. Yes I will ask them more details. Thank you! Hope your rocking your orientation. 

Oh absolutely! Whatever goes in your mind is the same for me. I am worried as well on if the new coworkers will be helpful or how they will treat newcomers. So far, I've seen most of them asking each other if they need help so that's a start, but then again these people knew each other for years. Like your workplace, my coworkers are also very supportive and they will teach you if you need anything so it was a good floor to start with when I was a new grad. Like you, I needed new change. I want to be more proficient with acute care and improve my critical thinking skills. You're experience with blood draws will definitely come in handy. At my workplace, we have a phlebotomist that draws blood in the AM. I work nightshifts too. So, our experience is quite similar. When do you start? I'm about to start my second week and I think it will be a hands on this time.