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Discussion

New here. Ltc or CCU? Help!

Hello. My name is Ashley. Ive been an RN since July 2015 and worked 11 months on a super busy Medsurg floor. This floor has its reputation in all the nearby hospitals to be the "hell" floor due to the work and the nurse patient ratio. I was managing 6 patients on dayshift and on nightshift Id have 10 patients. One night I was hanging blood on a patient, initiating a cardizem drip on another patient, had another patient whose rectal tube was giving me problems, and another who was having pauses on the monitor..all going on at once. So I can manae a heavy workload but it got way too stressful and felt way to unsafe to carry on in such a crazy environment so I quit and not one 1 nurse on that floor blamed me for quitting. Id literally cry before my shift because I dreaded it so much. Every shift was overloaded, not the typical bad day here or there...it was everyday. So now I have 2 job offers on the table with my limited 11 months of medsurg experience. A nearby long term care/skilled care facility, or a nearby CCU/ICU nurse. Its a big dilemma deciding which is for me. Heres why: I suffer from a pretty severe anxiety disorder and I have a physical condition the doctors haven't figured out yet. The physical condition causes me to have extreme fatigue and tiredness, dizzy spells, spells of nausea, sometimes near synope, and bad headaches. Having anxiety on top of it because of worrying about my physical symptoms makes day to day life a constant worry of how sick I'll feel that day and will I be able to go o work.

Im leaning toward LTC center because of the quieter environment, more of a daily routine, pay is significantly better, and the hours are flexible and I can pick when I want to work. However, Im fearful of losing any skills I gained in Medsurg nursing and not gaining new skills due to lack of acuity/availability in the LTC/skilled facility. In a perfect world Id take the ICU job and make less on the hour but I would be gaining lots of new knowledge and skills. I guess I want everyones opinions here. I shadowed a nurse for 4 hours yesterday in ICU and it was a dead day, very untypical she said. I wanted to really see how the day goes typically but that didnt happen. All the nurses assured me Id do fine. Most said they started as new graduates there. Just the sight of the numerous IVs running along wit ventilators and orogastric tubes was scary. I remember feeling overwhelmed in Medsurg when I had a patient with 3 different IV lines going. I dont know what to do here...pay isnt everything or else Id take the LTC position and make 7 bucks more on the hour and work wayyy better hours than just 7a to 7p and 7p to 7a. Okay Ive rambled enough. I guess my questions are...would I lose skills and not gain many new ones in a small LTC/skilled facility? Am I cut out for CCU since I only have 11 months nursing experience and am so anxious daily? Everyone on the CCU unit yesterday said Im ahead of most of them when they started out just cause they were new grads and also since I managed 10 pts a time at my last Medsurg job it'd be a cakewalk to manage 1, 2, or 3 pts most in CCU they thought. Thanks for reading my novel and sorry for any typos, was in a hurry.

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Forgot to mention that on this ICU floor they have SICU and TICU and something else but I cant remember . I was offered the SICU position and it was never really explaine to me what all that entails other than "heart stuff" that was mentioned during the shadow. "Heart stuff" with (again) only 11 months meg surg experience? Eeks!

I feel like you have already made up your mind with all of the pros you listed with the long term care position. You sound like the thought of the long term care position just feels more like a comfortable fit for you. You didn't mention what the nurse to patient ratio would be in the long term care or the types of patients you would be caring for. I personally would probably take the icu position to further gain experience and have the lower nurse to patient ratio. Could you try to set up another shadow in hopes of be g exposed to a more typical day? Maybe also a job shadow in ltc to see what their typical day is like? Good luck to you with whatever you choose. You need to choose what will be good for your overall well-being and if the long term care position does that for you, you should go for it!

Don't take the ICU position if they are not offering a significant orientation/training period. When I did my critical care new grad residency, we had six months of classroom time and quality time with preceptors in the various disciplines (neuro, CCU, SICU, MICU). We were only gradually released to work solo. Even with all that teaching and nurturing, the first couple of years were very stressful.

Those folks that told you that managing 1, 2, or 3 ICU pts would seem like a cakewalk to you coming from M/S did you a disservice. Juggling names, or rooms? Yes, remembering 2 patient names vs 10 is obviously easier, but that's about the extent of what's easier on a typical day. If you do get a slow day, then it is all easier, but expect those easy days to be rare treats, indeed.

That said, I don't see where you considered your long-term plans? LTC vs ICU lead down somewhat divergent paths over time. How will each job fit any 5 or 10 year goals you may have?

I am just over here trying to figure out where LTC pays more than ICU...

Coming from the floor to the ICU I can tell you that managing 6 patients on the floor doesn't make you a better ICU nurse and being able to manage two critically ill ICU patients doesn't make you a good floor nurse. They are both distinct fields. You will have to let go of the floor mentality. Yes, it does exist and the mentality is to know a general summary of history, disease process, and plan of care. In fact most floor nurses do not round with primary team AND every single consult on every single patient because that would take ALL day!

It is simply impossible for a floor nurse to get super detailed because .... Well hello you're being spread thin between 6 and even WOW 10 patients.

Whereas the ICU you must know everything about your patients. A good history of present illness & reason for admission, past surgical history, past medical history, and labs. Lab trends and vital sign trends. Are they on antibiotics? Is there a infectious disease consult? Why are they on vanc still? Did they do a second round of blood cultures? What is the white count? Do they need to perhaps renal dose the Zosyn? Did you note in the problem list they developed AKI ... Oh but why did that happen? Hypovolemic shock? Oh they bled? Oh it was septic shock? Infection? Where? Oh so that's why they're on ABX and pressors! Ohhhhhh! What about respiratory? Are they still on the vent? What day is this? What day 23???? Do you think maybe they need to bring up long term vs short term airway? Trach? When was the last breathin trial? Are their lungs wet? Do they get dialysis? Maybe they can't get extubated because they are so wet? When was their last dialysis?

This is just an example of a way an ICU nurse thinks ... I could go on about neurology, cardiology, and skin. And you are very involved and active in rounds.

So if you like the sound of being nosey and involved and detailed then the ICU may be for you!!!

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