Newbie - ICU vs PACU

[ThanksForAllTheFish!]

Hi!

I am a new grad nurse who started a ICU internship this past Sept '08. I just finished my first few days (actually nights) on my own. There are many things a like about ICU, but for awhile I've been thinking that this might not be the place for me. I know this is a common feeling for new grads, especially starting in a critical care area. My previous career (pre-nursing) was in research, so I've considered going into clinical research (I have never planned on doing bedside nursing forever).

I've spent the last few days seriously thinking about PACU. It has the critical care aspects to it and from an outsider's perspective seems to have more structure and organization than the ICU (of course, patient conditions are always an uncontrollable variable). I haven't had a real opportunity to spend time directly in the PACU or talk with many PACU nurses. However, I did spend a month at the end of my nursing program in the OR and OR management.

What I am asking is: For those of you that have done both ICU and PACU, did you find PACU as being a more structured setting?

I am considering talking to my education coordinator about moving out of the ICU. I hate quitting something, but I think I would rather feel like a failure and move on to something that works better for me than be a nervous wreck feeling completely out of place.

[Southern Fried RN]

What I am asking is: For those of you that have done both ICU and PACU, did you find PACU as being a more structured setting?

/quote]

No. On any given day you could be recovering a bunch of kids getting tubes or T&As, the next lap choles and total joints, then another some vent pt on propofol and vasopressors. Some of that could be all in one shift! It is really just what's on the OR schedule and how the patient does during the surgery. Everyone responds differently to anesthesia. Just like in ICU, you have a wide variety of patients.

However, in PACU the patients typically aren't held as long so you're not usually dealing with some of the issues of ICU patients. Like starting tube feeding, dressing changes, visitors, multiple MD consultants.

You don't say WHY specifically you don't feel ICU is the right place for you. Do you feel overwhelmed, having issues interacting with co-workers or physicians, a lack of support from ancillary staff? Do you feel like you are grasping pt disease conditions, interventions, medications, procedure, etc for ICU patients? It sounds like you are still on orientation and have only been there about 4 months. I would say give it more time to at least complete the orientation and work on your own for a time before you know for sure. Maybe study a little at home on meds and diseases. However, if there is an issue with a toxic work environment that's a different story.

I don't understand what you mean by structure/organization in PACU is greater than ICU. When I worked ICU, it was much more routine. 7am report, 8am assessment and turn, 9 am meds, 10am turn and chart, 11am physician rounds, 12pm assessment, meds, turn, chart. Etc, etc.

I think most PACUs require 1 year of experience in ICU anyways.

[ineedcoffee]

Hi! I worked in critical care for many years and at a few different hospitals. I am now working PACU and love it. I will not go back. But would I recommend you leaving ICU right now? No. Although I am glad I am not in ICU anymore, I am glad I have the years of experience under my belt. Stick it out for another year or so. Get at least 1-2 years of critical care experience and then see what you want to do.

As for PACU being structured? Not really, like the above post says. But it's nice having patients in and out quickly rather than for 12 hours straight, day after day. But not as hectic as the ER in my opinion where people off the street roll in for random things.

[ThanksForAllTheFish!]

Thanks for your advice and experience stories. I think I've decided that bedside nursing isn't for me. I am planning to leave the bedside as soon as I can find another job. I hope to go into research nursing. That way I can combine nursing and my previous career as a research assistant. Right now I'm just not happy at all in my work. take care!