New grad - PCU or ED?

Specialties Emergency

Published

Hello!

So I just got accepted into a new grad residency program, and I was hired for a PCU floor. My eventual goal is to work NICU, but I obviously know I need some serious training/experience before working with that population. The program also has some openings in the ED for new grads. I feel like I will be able to get some really fantastic skills from PCU that will definitely transition over to a NICU setting, but I'm wondering if ED would be a better place to start. I could ask my recruiter about switching to the ED track. Opinions? My facility doesn't have any peds, but the ED obviously sees a certain amount of pediatric patients.

If you don't like adult inpatient care, you will hate PCU. However, remember you've been exposed as a student. You might feel differently with a bit more autonomy. I know I did, and I was going to be the best CNM the world had ever seen. :) I'm a PCU nurse, now.

I'm really hoping I will enjoy it, and I realize my nursing school experience wasn't the same thing as being the actual nurse. I'm doing my best to keep an open mind. I just love working with kids and babies so much. What is your favorite thing about working in PCU?

Is there any particular reason why you can't start in NICU? I did as a new grad as part of a residency program. My only experience was 8 months in pediatric home care.

I would have loved to start in a NICU! I applied, but didn't get any interviews. The NICUs in the area all had requirements for experience, which I didn't have as a new grad. I actually had to relocate to a different part of the state to start this residency program, I didn't get a single interview for my hometown. I got accepted into a new grad residency program, was interviewed for a PCU unit, and took it. I had graduated 2 months prior and needed a job, so that's where I am now.

Specializes in critical care.
I'm really hoping I will enjoy it, and I realize my nursing school experience wasn't the same thing as being the actual nurse. I'm doing my best to keep an open mind. I just love working with kids and babies so much. What is your favorite thing about working in PCU?

The variety. It's a small hospital, so we get every type of organ dysfunction.

The chaos, though many days I'd prefer a little less. You have stable patients, you have unstable patients.

Night shifts. Because they taught me how to KNOW stable from unstable. It's not like we have a half dozen doctors readily available to come to my floor to determine that for me.

Also, relating to night shifts, even those with the least cohesive personalities become a team in a code. Or, heck, an almost code. The almost codes are some of the more triumphant times because when it's your patient, you take the lead. You learn to delegate. You learn when the code is needed, and when it's not. Your team will see it if you don't. It's the almost code (even the one that becomes an actual code) when you learn you've become strong.

PCU is land of almost codes in my hospital. Day shift you call the code more readily because a ton of staff is available for it. Night shift, we don't have abundant resources. That's not to say we'd skip calling it any time it is needed. We just have only one MD on the floors, total. So, if it is something nursing can think through and get a quick order or two for, we take care of it. You'll hear codes on the other floors, for which we'll shuffle patients to make space for the code on our floor since we are the non-ICU highest level of care (unless the code is ICU-worthy, which is rare on the other floors). Us? We try our best to not sent patients to ICU. We see problems before they happen. We try to prevent them from getting worse.

NOW BEFORE THE OTHER SPECIALTIES JUMP ME :)

That's not to say that other floors lack this focus. They definitely don't. The difference is that we get the actively unstable ones. The difference is that in my hospital (and I emphasize that it is my hospital only, in my own experience) I have seen codes called on other floors for the strangest things, sometimes filling a PCU bed that was needed for something actually PCU-necessary. We are the last gate before the ICU doors, and so our beds need to be counted carefully.

You said you'd like to only stay 6 months. Please consider a year. In six months, for me personally, I was still learning how to be a nurse. I was nervous. I was unsure of everything. I didn't know what was okay, yet. I was still having many moments of victory during which I learned some new nurse insight that was VITAL to my professional growth. You've only begun to taste nursing at 6 months, and you've learned so little that if you are put on a "fast track" orientation for experienced nurses wherever you transfer, you will struggle. Eventually, yes, you'll get it and be just fine. But when you're still afraid you'll mess up on your own, and when you're still overwhelmed by how much you don't know, it's a terrible time to transfer.

PCU is a hard floor. Our PCU has terrible turnover and what I have heard is that is typical at other facilities. But if you can do it, I really do believe you can do anything. If you're one for a challenge, you are about to meet your match and I think you should go for it. For me, I am beyond grateful for my first years as a nurse being on PCU. I've lately given thought to moving on to another area - ED or ICU maybe. But I will never regret my experience thus far, and only want a change because I feel I'm ready to learn and grow more, not because of dislike for PCU in general.

I hope this helps!

The variety. It's a small hospital, so we get every type of organ dysfunction.

The chaos, though many days I'd prefer a little less. You have stable patients, you have unstable patients.

Night shifts. Because they taught me how to KNOW stable from unstable. It's not like we have a half dozen doctors readily available to come to my floor to determine that for me.

Also, relating to night shifts, even those with the least cohesive personalities become a team in a code. Or, heck, an almost code. The almost codes are some of the more triumphant times because when it's your patient, you take the lead. You learn to delegate. You learn when the code is needed, and when it's not. Your team will see it if you don't. It's the almost code (even the one that becomes an actual code) when you learn you've become strong.

PCU is land of almost codes in my hospital. Day shift you call the code more readily because a ton of staff is available for it. Night shift, we don't have abundant resources. That's not to say we'd skip calling it any time it is needed. We just have only one MD on the floors, total. So, if it is something nursing can think through and get a quick order or two for, we take care of it. You'll hear codes on the other floors, for which we'll shuffle patients to make space for the code on our floor since we are the non-ICU highest level of care (unless the code is ICU-worthy, which is rare on the other floors). Us? We try our best to not sent patients to ICU. We see problems before they happen. We try to prevent them from getting worse.

NOW BEFORE THE OTHER SPECIALTIES JUMP ME :)

That's not to say that other floors lack this focus. They definitely don't. The difference is that we get the actively unstable ones. The difference is that in my hospital (and I emphasize that it is my hospital only, in my own experience) I have seen codes called on other floors for the strangest things, sometimes filling a PCU bed that was needed for something actually PCU-necessary. We are the last gate before the ICU doors, and so our beds need to be counted carefully.

You said you'd like to only stay 6 months. Please consider a year. In six months, for me personally, I was still learning how to be a nurse. I was nervous. I was unsure of everything. I didn't know what was okay, yet. I was still having many moments of victory during which I learned some new nurse insight that was VITAL to my professional growth. You've only begun to taste nursing at 6 months, and you've learned so little that if you are put on a "fast track" orientation for experienced nurses wherever you transfer, you will struggle. Eventually, yes, you'll get it and be just fine. But when you're still afraid you'll mess up on your own, and when you're still overwhelmed by how much you don't know, it's a terrible time to transfer.

PCU is a hard floor. Our PCU has terrible turnover and what I have heard is that is typical at other facilities. But if you can do it, I really do believe you can do anything. If you're one for a challenge, you are about to meet your match and I think you should go for it. For me, I am beyond grateful for my first years as a nurse being on PCU. I've lately given thought to moving on to another area - ED or ICU maybe. But I will never regret my experience thus far, and only want a change because I feel I'm ready to learn and grow more, not because of dislike for PCU in general.

I hope this helps!

Wow, thank you so much for that! I have been having a lot of second thoughts and worries about PCU and reading that was really, really reassuring. I think I was/am just getting cold feet. I will definitely take your advice and stay, preferably for the duration of my contract (2 years) so I can leave on good terms.

I have some questions, if you don't mind answering. I tried searching online but nothing came up, and my unit gave me a tour but the topic of patient care didn't come up a whole lot and I forgot to ask (super nervous lol). Can you tell me about the kind of total body care that you do as a PCU nurse? Like assisting with eating, bathing, toileting, bed sheets, etc? The floor has techs but at the end of the day, I know it is my responsibility to make sure certain things are done and I just want to be prepared to know what the level of abilities the patients usually are. Do the patients get out of bed and ambulate to the bathroom alone? I apologize if this is a dumb question, I honestly just don't know what to expect. I don't mind if there is a lot/little, I'm mostly curious to how it compares to med-surg and ICU (which is where I did clinical at). I'm only 4'9" and not the strongest person, so I found I struggled with moving even small adult patients. Obviously I should ask for help with that stuff, but I know sometimes it is busy and you don't always get all the help you want/need. I'll also be on night shift.

My orientation is going really fantastic, we are doing classroom training for 6 weeks including ACLS and some really amazing simulation stuff (haven't gotten to that yet). I'm learning so much already.

Specializes in CAPA RN, ED RN.

It is so fun to hear you consider the possibilities as a new nurse. Remember that whoever hires you now will be investing considerably in money, time and love to get you ready for their unit.

Even with an intensive residency ED nursing takes a year or more to get comfortable so I wouldn't see it as a stepping stone. I would choose a place that will give you time to develop a philosophy of how you practice as an RN. I can't imagine it would take less than a year to do so and the PCU experience will be valuable.

The other thought I have is to research how to make yourself more attractive as a NICU hire. Think about who you need to know, what classes and certifications will be helpful, what volunteer opportunities are available, etc. Experience and thought will get you what you want.

Specializes in Critical Care; Recovery.

To answer the OP, the PCU I worked for had many ambulatory patients that could take care of their own hygiene for the most part. Some of them were pretty sick as they had recently undergone heart surgery or were awaiting a heart cath. If your PCU gets all the heart cath patients the many of the can ambulate after 4-6 hours femoral, or immediately if it was a radial heart cath. We occasionally got some overflow from other floors. At least you have a tech, but don't abuse that. She/he is only one person, and they have things to do also. Sometimes you are going to have to clean some poop, empty vomit or sputum. That's just the nature of nursing, and you're not always going to have a tech around to do it.

Specializes in critical care.
Wow, thank you so much for that! I have been having a lot of second thoughts and worries about PCU and reading that was really, really reassuring. I think I was/am just getting cold feet. I will definitely take your advice and stay, preferably for the duration of my contract (2 years) so I can leave on good terms.

I have some questions, if you don't mind answering. I tried searching online but nothing came up, and my unit gave me a tour but the topic of patient care didn't come up a whole lot and I forgot to ask (super nervous lol). Can you tell me about the kind of total body care that you do as a PCU nurse? Like assisting with eating, bathing, toileting, bed sheets, etc? The floor has techs but at the end of the day, I know it is my responsibility to make sure certain things are done and I just want to be prepared to know what the level of abilities the patients usually are. Do the patients get out of bed and ambulate to the bathroom alone? I apologize if this is a dumb question, I honestly just don't know what to expect. I don't mind if there is a lot/little, I'm mostly curious to how it compares to med-surg and ICU (which is where I did clinical at). I'm only 4'9" and not the strongest person, so I found I struggled with moving even small adult patients. Obviously I should ask for help with that stuff, but I know sometimes it is busy and you don't always get all the help you want/need. I'll also be on night shift.

My orientation is going really fantastic, we are doing classroom training for 6 weeks including ACLS and some really amazing simulation stuff (haven't gotten to that yet). I'm learning so much already.

This is not at all a dumb set of questions. You'll have the whole range - complete care, assisted care, and fully independent. You will have techs to delegate this to, but you will also participate in the activities. When I'm on nights, I actually like to get in during baths to help. Your bed-ridden patients will require clustered care and you wont get a better shot at a complete assessment.

You will not need to do these things alone. Don't get in the habit of it, tempting as it may be when it seems easier to do it rather than wait for someone to help. You will quickly gain full body strength, but you will not have to go solo.

Only one nurse on my unit is shorter than me. She is skinny and also 4'9". She does awesome, as we shorties always do. :) I had this 450 lb guy I was in a code on and only two of us could get effective compressions on him: a thicker strong guy, and me. His ribs never did break and for some reason no one else just got it. Felt like a rock star over that! You will have days when you feel your size betrays you, but you'll have a team there with you. You wont be alone.

Make sure they give you a thorough tele course and a good bit of practice on tele strips before ACLS. Your ACLS rhythms should be obvious when you're tested, but it's easier to know them going in so you can stress instead on the other stuff.

If your goal is inpatient, stay inpatient. Even though PCU is with adults, it will still give you the foundation for switching to a pediatric inpatient population. The ED is a completely different animal. Even though we do work with people of all ages, the work flows are very different. Also, some recruiters don't consider ED nursing to be "bedside" nursing, and will pigeon-hole applicants with ED experience as not having "bedside" experience when considering applicants for hire in the inpatient unit.

It is so fun to hear you consider the possibilities as a new nurse. Remember that whoever hires you now will be investing considerably in money, time and love to get you ready for their unit.

Even with an intensive residency ED nursing takes a year or more to get comfortable so I wouldn't see it as a stepping stone. I would choose a place that will give you time to develop a philosophy of how you practice as an RN. I can't imagine it would take less than a year to do so and the PCU experience will be valuable.

The other thought I have is to research how to make yourself more attractive as a NICU hire. Think about who you need to know, what classes and certifications will be helpful, what volunteer opportunities are available, etc. Experience and thought will get you what you want.

Thank you, that is great advice. I am thinking after I get some RN experience under my belt, to look at some home health opportunities with pediatric patients. Does that seem like a decent idea?

To answer the OP, the PCU I worked for had many ambulatory patients that could take care of their own hygiene for the most part. Some of them were pretty sick as they had recently undergone heart surgery or were awaiting a heart cath. If your PCU gets all the heart cath patients the many of the can ambulate after 4-6 hours femoral, or immediately if it was a radial heart cath. We occasionally got some overflow from other floors. At least you have a tech, but don't abuse that. She/he is only one person, and they have things to do also. Sometimes you are going to have to clean some poop, empty vomit or sputum. That's just the nature of nursing, and you're not always going to have a tech around to do it.

Thank you, I really appreciate your input. I don't mind the bodily fluids (except suctioning patients/oral secretions, that for some reason triggers my gag reflex? lol but I'm sure I'll get over it eventually).

This is not at all a dumb set of questions. You'll have the whole range - complete care, assisted care, and fully independent. You will have techs to delegate this to, but you will also participate in the activities. When I'm on nights, I actually like to get in during baths to help. Your bed-ridden patients will require clustered care and you wont get a better shot at a complete assessment.

You will not need to do these things alone. Don't get in the habit of it, tempting as it may be when it seems easier to do it rather than wait for someone to help. You will quickly gain full body strength, but you will not have to go solo.

Only one nurse on my unit is shorter than me. She is skinny and also 4'9". She does awesome, as we shorties always do. :) I had this 450 lb guy I was in a code on and only two of us could get effective compressions on him: a thicker strong guy, and me. His ribs never did break and for some reason no one else just got it. Felt like a rock star over that! You will have days when you feel your size betrays you, but you'll have a team there with you. You wont be alone.

Make sure they give you a thorough tele course and a good bit of practice on tele strips before ACLS. Your ACLS rhythms should be obvious when you're tested, but it's easier to know them going in so you can stress instead on the other stuff.

We had an EKG class the first week, and ACLS today and tomorrow. The EKG teachers were so amazing. Wish I had them back in nursing school.

I'm happy to know there are lots of short nurses thriving and doing amazing in PCU.

If your goal is inpatient, stay inpatient. Even though PCU is with adults, it will still give you the foundation for switching to a pediatric inpatient population. The ED is a completely different animal. Even though we do work with people of all ages, the work flows are very different. Also, some recruiters don't consider ED nursing to be "bedside" nursing, and will pigeon-hole applicants with ED experience as not having "bedside" experience when considering applicants for hire in the inpatient unit.

Wow, thank you so much for that. That makes me feel a lot better about my PCU position. Obviously I enjoy all kinds of nursing and don't "dislike" adult nursing, my heart is with kids, especially babies!

Another question that I mentioned in the post above but I'm sure it is buried in text (I hate the time wait on posts for this site!), would getting some kind of home health position with pediatric patients after I get a year or so experience under my belt be a good decision to help me make that transition to pediatrics? I am already NRP certified (I thought that would help me in the hiring process), but that will be expired before my 2 year contract is up at the PCU so I'll have to redo that, in addition to PALS and whatever other ones are relevant. I was thinking I could do something per diem but I don't know how that works with home health. I am doubtful that I'd be able to find a per diem position in a NICU or peds floor at another facility without some extensive training, so I am trying to think outside of the box and get some pediatric experience elsewhere while I stay in PCU.

Specializes in critical care.
Another question that I mentioned in the post above but I'm sure it is buried in text (I hate the time wait on posts for this site!), would getting some kind of home health position with pediatric patients after I get a year or so experience under my belt be a good decision to help me make that transition to pediatrics? I am already NRP certified (I thought that would help me in the hiring process), but that will be expired before my 2 year contract is up at the PCU so I'll have to redo that, in addition to PALS and whatever other ones are relevant. I was thinking I could do something per diem but I don't know how that works with home health. I am doubtful that I'd be able to find a per diem position in a NICU or peds floor at another facility without some extensive training, so I am trying to think outside of the box and get some pediatric experience elsewhere while I stay in PCU.

The certifications you have that will expire without you getting hours in for them can be maintained with a per diem position. Again, I recommend waiting until you're more comfortable as a nurse, but otherwise, if in year two you get a per diem spot, if a 12- or 8-hour shift a week or month will fill your hours requirement, you've done well!

As for telemetry classes, my school instructors also lacked. When I had someone connect the lines on the paper to the action of the chambers, I was hooked. Never thought I'd fall in love with cardiology!

Hi! I'm in the exact same boat as you were. I'm a new grad with no experience stuck between pcu or ED. I want to end up in NICU or L&D. Can you give me an update on where your at? Do you feel like you made the best decision starting in pcu? Did you like it? Are you a NICU nurse now and was it hard to transition out

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