New Cardiothoractic ICU job

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Specializes in ED / CTICU.

I have been an ER nurse for five years and was looking for a change and  knew I wanted to stay in a high acuity area as I mainly worked in critical care/trauma sections of the ED of a level one trauma center and loved caring for ICU and chest trauma patients the most. I also love complex cardiac cases. I've been selected for a staff position that starts January 8th in a Cardiothoractic ICU that has a reputation for only choosing those with a year of ICU experience but the nurse manager believes I am a good fit having ACLS, etc. I came from a critical care ED with ICU level patients but of course not spending as much time with them as I would have liked.  I look forward to having the opportunity to care for these patients outside of the ED, continuing their care in a more controlled and organized environment. I am excited but also a bit worried. Transitioning from ED to ICU will make me feel like a bull inside of a china shop. I have always admired the ICU nurses. I hope to develop the finesse and organization skills that Critical care and ICU nurses have in their practice. I know I have many things to learn about critical care, but also a lot of things to unlearn from the ED.  My orientation is going to be a bit longer than others which is reassuring. I will be enrolled in a critical care core course prior to transitioning to the CTU. Part of my orientation will be rotating through the MICU, neuro ICU, burn unit and SICU to learn the basics prior to orienting the Cardiothoractic ICU. The nurse manager seems very kind and understanding and said that if I am uncomfortable for any reason, my orientation can be extended. If anyone has transitioned from ER to ICU, what was your experience and what advice can you give me to help me succeed?

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Just enthusiastic desire is most of the battle. Not just of few folks in those places just punching the clock or stroking their egos. 

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Specializes in SRNA.

I transitioned to the Cardiac ICU (nonsurgical patients) a year ago from the ED and the learning curve wasn't too bad. You'll transition relatively easy especially if you're coming from a level 1 trauma center. I went from a high acuity community hospital ED to a level 1 trauma CCU and was comfortable after 6 months in the unit. The acuity of my community ED was high enough for me to pass the CCRN while on ICU orientation. The hardest thing I struggled with was the family dynamics, head to toe assessments, keeping up with PIV and central line change dates, the constant wound care, keeping up with a million consults, and digging through the charts regarding progress notes and cleaning up the orders. Code call came easy and approaching the intensivists/APPs with my concerns was also easy. But man oh man, I have enjoyed learning about the new toys I get to play with; a-lines, swans, TVPs, CRRT, IABP, impella, initiating and weaning pressors, vent management, and learning the nity-grity patho-phys, treatment plans, and understanding the bigger picture. I have a new found respect for critical care medicine (ED and ICU). Giving a full report was also a challenge but I had to find what worked for me. Some patients been in the unit/hospital for weeks on end and you have to figure out how to compress your report so you're not talking about every single detail because who wants to be in report for 30-40 mins??? not me; when I take report I want 5 minutes or less (the ED in me) but when I give report; it's 15-20 minutes (the ICU version of me).

When I go back to the ED and get a critical patient, I'm definitely less stressed because I've been stressed way beyond that level while in the ICU LOL - a BP 70/40s don't scare me anymore, I'm more concern if their MAP is <55.

I recommend getting the passCCRN and passCMC book by Nicole Kupchik and read it while on orientation to help put two and two together. I'm surprised your ED didn't make you take the Essentials of Critical Care Orientation course. I had to take it when I started in the ED and was able to skip it when I transitioned to the ICU. PM me if you have any questions.

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Specializes in ED / CTICU.

You just made me so much more excited ! Thank you so much for the book recommendations. I'm going to look into getting them. I have a CCRN book. That is the Ascencia study guide, which I use for the CEN. I have a good feeling as you said because the acuity level was very high in my last emergency department so it makes tackling those practice questions a bit easier! The last emergency department I worked, and I worked in for two years and out of all the ERs I have worked, and it was the only one where I would be setting up for the A-line. I can't wait to see the care continue. I am excited to learn all of the new skills!

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Specializes in SRNA.
Biology2Nursing said:

You just made me so much more excited ! Thank you so much for the book recommendations. I'm going to look into getting them. I have a CCRN book. That is the Ascencia study guide, which I use for the CEN. I have a good feeling as you said because the acuity level was very high in my last emergency department so it makes tackling those practice questions a bit easier! The last emergency department I worked, and I worked in for two years and out of all the ERs I have worked, and it was the only one where I would be setting up for the A-line. I can't wait to see the care continue. I am excited to learn all of the new skills!

I forgot one more person, Pam Bartley, I used her to pass the CEN and also used her to supplement my study material from Nicole Kupchik. If you already have your CEN, you'll definitely transition well because you already have critical thinking down. Not every ED nurse is like that. I'd love to keep in touch because I don't know too many ED nurses who transitioned. Rare breed haha.

PS don't get involved in the unit drama aka ED vs ICU HAHAH because you're definitely going to get offended when your new coworkers start sh*tting on the ED in front of you.

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Specializes in ED / CTICU.

We play on both sides of the fence ! I will be in touch!

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Specializes in Critical Care | CCRN-CMC.

My transition was from medsurge to ICU. Actually, more accurate, during 2020, when my hospital created PCU, I've volunteered to join the staff there and pick up extra bits of wisdom. Then, ICU manager gave me an opportunity to get some cross training into ICU as well. 

I was medsurge and it included (remote tele/vent/psych/geriatrics/infection disease/etc) for number of years... So when I finally got an opportunity to jump into ICU, I already had a smell (not a taste) of critical care ?.

Now, few years in this role and with CCRN (that's another 5year journey in its self) I'm realizing yet again, that I have no idea what I'm doing and re-hitting the books, again. 

I feel, one of the most important aspects of critical care, or any field actually, is to stay humble, remind that there will always be those who will know more and therefore continue learning, continue growing and continue pushing you're self and your colleagues to become better for the benefit of the unit.

Good Luck, enjoy your he new GiG!!

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Specializes in ED / CTICU.

This is by far the hardest thing I've ever had to do in my life and I am feeling like I am drowning, but management says I'm holding it down,

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Specializes in Critical Care | CCRN-CMC.
Biology2Nursing said:

This is by far the hardest thing I've ever had to do in my life and I am feeling like I am drowning, but management says I'm holding it down,

Your expecting MUCH more from you're self, that's why you feel that you're drowning.

Good leaders, like parents, see the potential of their subordinatea and see exactly how that potential is playing out. As we are living in it, we feel that we are drowning but it's our parents who see that we are actually doing well  😀 

Your bosses see what you can't see about yourself, that's why you're holding it down LOL

Keep on chugging and comeback here to case reviews 😂 

 

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Specializes in ED / CTICU.

Thank you so much for the encouragement. I had a very rough start and I am just starting to feel more comfortable now, but they gave me two more weeks until I go on my own. I only experienced two very complicated cases that were labile hemodynamically and had other issues such as IV drug use history and on methadone. His blood pressure would not stay down for the life of me until during rounds I realized that nobody called his methadone program! He was without his dose for 48 hours! I found his clinic and the PA called.  Getting his dose stopped his BP issues.  
They only extended me so I could try to experience more very sick open heart cases with CRRT and cardiac assists, etc. Most of the cases I took care of independently were pretty straightforward CABGs. I got to also have a post op day 1 after a triple valve procedure, something uncommon in my setting. This same patient I also took care of his pre op. He went from having the loudest murmur I have ever heard of my life to normal heart sounds. It was pretty amazing. I was lucky to experience ECMO twice on orientation already as their ECMOs aren't common. They are in the process of expanding their ECMO program.
Their only complaint is about me finishing my documentation on time because I came from the ED where we didn't chart as much as I have to in a critical care area. I am also trying to get a little more social with them prior to coming here. I was an agency and a travel nurse in emergency departments. This was my first staff job in over four years. I missed having the concept of having a work family. I truly miss the stability that comes with being a staff nurse. So basically I transitioned from ER to CVICU transitioned from night shift to dayshift after working six years on nights and transitioned from being agency to staff so the adjustment process has been so rough. This specialty is truly amazing. 

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Specializes in Critical Care | CCRN-CMC.
Biology2Nursing said:

Thank you so much for the encouragement. I had a very rough start and I am just starting to feel more comfortable now, but they gave me two more weeks until I go on my own. I only experienced two very complicated cases that were labile hemodynamically and had other issues such as IV drug use history and on methadone. His blood pressure would not stay down for the life of me until during rounds I realized that nobody called his methadone program! He was without his dose for 48 hours! I found his clinic and the PA called.  Getting his dose stopped his BP issues.  
They only extended me so I could try to experience more very sick open heart cases with CRRT and cardiac assists, etc. Most of the cases I took care of independently were pretty straightforward CABGs. I got to also have a post op day 1 after a triple valve procedure, something uncommon in my setting. This same patient I also took care of his pre op. He went from having the loudest murmur I have ever heard of my life to normal heart sounds. It was pretty amazing. I was lucky to experience ECMO twice on orientation already as their ECMOs aren't common. They are in the process of expanding their ECMO program.
Their only complaint is about me finishing my documentation on time because I came from the ED where we didn't chart as much as I have to in a critical care area. I am also trying to get a little more social with them prior to coming here. I was an agency and a travel nurse in emergency departments. This was my first staff job in over four years. I missed having the concept of having a work family. I truly miss the stability that comes with being a staff nurse. So basically I transitioned from ER to CVICU transitioned from night shift to dayshift after working six years on nights and transitioned from being agency to staff so the adjustment process has been so rough. This specialty is truly amazing. 

WOW THAT IS Amazing!!

Very happy you're kicking *** at this gig. Slow ... Every orientation I had, I've been asking for more and more time 😀 

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