need advice moving on from PCU tele

[tuxedopenguino]

Hello all,

I've been working on a PCU-tele floor for the past 8-9 months and it has been a very challenging and rewarding experience. I'm an impatient woman, so I can't help but look ahead at what I want to go for next. While I'm learning a lot and still very much have a lot more to learn, I know I'm not going to stay on this unit more than 2 years. I do like it, when we are not so short staffed and end up with 1 or no techs and up to 6 patients. Since it's cardiac, we also get a lot of heavy, old, complete care patients.

I think I'd like to try critical care. I'd like to learn more and only focus on 2-3 patients versus up to 6. I know you do a lot more for them and frankly I'm scared to care for the sickest of patients but the experience will make me more 'marketable'. I love the amount of learning you get in the hospital setting but not sure if I can handle this amount of stress and responsibility for my whole career. I like my 'walky-talkies' and being able to educate them on their illness (when I get it right and they actually care to listen, even though I'm 'just the nurse'...). I do like the adrenaline rush when I respond to an emergent situation appropriately and the feeling of awesome after, but I'm not sure it outweighs all the times I feel like utter crap and I ache all over.

There was a research nurse position at a University I saw a while back...it seems interesting! But it requires CCU experience, CCRN certification...does anyone think CCU will be much better than what I'm doing now? I figured the amount of strain in my back will probably be the same since they're all sedated and will have to be turned and cleaned. Do you have to communicate more with families than on the floor? Do I really have to do 2 yrs before I move on to Critical care? What makes a strong critical care nurse?

Are there any grad degrees for nursing that are worth it for non bedside nursing positions? I'd like to go to grad school b/c I like school but only if it will increase my salary potential b/c money sure doesn't grow on trees and I've been through a lot of school as nursing is a second degree for me.

[HouTx, BSN, MSN, EdD]

There is no magical criteria for a successful transition to critical care. In some cases, new grads begin their career working there. I did, and it just 'clicked' for me right away. The biggest challenges in Critical Care is the barrage of information you have to deal with on a continuous basis & the level of responsibility that goes with the job. CC nurses often have to interpret information and act immediately with no time for a validation or second opinion. They have to have the confidence to initiate communication with physician(s) regarding patient care issues & act as a patient advocate at all times.

As far as family communications go - - the communication is of a different sort than you're used to. Unfortunately, there is much higher level of emotion to deal with. Conflict management is key - the ability to distinguish "intent" from "content". For instance, being able to recognize that a demanding (semi-hysterical) family member may actually be acting from a sense of guilt - will enable you to respond effectively to the real issue. CC nurses must have a strong sense of boundaries & the ability to compartmentalize their emotions so that they can remain effective in the face of some overwhelmingly sad and tragic situations.

So, if you are a pretty assertive person who is also a natural multi-tasker able to make quick decisions..... it will be a great place to work.

[tuxedopenguino]

I'm revisting this topic..as it is now several months later and I am still on same PCU-tele floor, unsure of what to do...

I recently got an interview for a CCU day shift position, and I am very nervous. I am unsure if I am ready to make the jump, but I am getting increasing pressure from my husband to switch to day shift, and I figured if I have to switch to day shift, may as well try the ICU...

but I'm having a lot of doubts. The hospital has been having a lot of trouble with staffing, including the ICU. I heard not so good things about constant managerial changes there. Also, I feel like I'm just starting to feel more comfortable with my coworkers. I am not the extroverted, easy to get to know type of person, so this means a lot. I'd also feel bad leaving when our staffing is already so bad.

At the same time, I'm not so happy working on my unit. The patients and family can be so so demanding, and it can be frustrating to deal with when you are running short staffed and you have 5-6 sick patients. I am also not managing night shift very well, and feel like my quality of life is not so great. Also many things annoy me like all the tasks I have to do but have to wait until a certain time because patients have to sleep (if they do sleep in the first place). Day shift doesn't get that and it's frustrating. They just seem to think we have all the time in the world and do nothing. Sure, I would love to update all 4-5 of my IVs but I'm not waking a patient up at 3am so I can get it all done. The patients that don't sleep are up driving me crazy for pain management, constant toileting, and delirium related issues. Or about to be an RRT type situation.

I feel stuck, and not sure what I should do. Should I just stick it out another full year until I at least have 2 years under my belt, focus on improving my skills and confidence, and then apply to another hospital entirely? Or should I make the switch to CCU day shift now? Has anyone been in my position? Should I just try and be happy with where I am, wait until I'm really comfortable and ready to leave?

While I would love to switch to days and sleep at night, I just don't know if it's best for me right now. As bad as night can be on my floor, Day shift sounds like a nightmare. I can't seem to figure myself out, and the pressure from my husband is not helping...I know he means the best for me, since I complain too much about being tired all the time, being depressed, etc., but it's not easy making this kind of decision.

Maybe bedside is not for me at all. To be honest, I'm really not that great in it. Constantly seeing patients teetering on the edge of really sick may need to go to ICU/possibly dying soon gives me anxiety. I'm constantly worrying about what I should do, not thinking things through carefully enough, juggling all my responsibilities.

But the non-bedside positions I am interested in require a certain kind of hospital experience. The ones that don't require those years of ICU experience and CCRN certification don't sound all that appealing. I even contemplate leaving nursing together entirely...but of course that's not an easy task. I just don't know what to do with my life!

Maybe I'm just asking for too much....

thanks for your patience and any advice you have...