PCU Nurse Feels "Second Rate"

[PacoUSA, BSN, RN]

So I may be criticized or flamed for some of what I am about to post, but it is just something that I have been feeling and thought I'd put it out there for some feedback and perhaps help my outlook.

I currently work in a PCU and bored to tears because I am no longer learning anything new. In fact, I am working on a unit that does not allow us to do certain things that in prior facilities as either a traveler or staff I have been able to do independently (for instance, PICC dressing changes at my facility are only done by IV team and not floor nurses). Also, my unit does not allow titration of drips like cardizem, whereas in other places I have done this with no issues.

But specifically, because I feel tapped out on PCU, I am yearning to learn to work with more critical patients as those in the ICU. I would love to transition to the ICU but all the ICUs near me only want nurses with ICU experience. It is frustrating because I ask then, well HOW do I get the experience if you wont take me? I have tried to look for critical care courses to take to make myself more marketable. I have even looked into taking an ECCO course, but these are not available to people who do not work in ICU currently. I am a member of AACN as well which I think is important for my goals.

I seem to perceive ICU nurses as more prestigious and important in the hospital setting, and I know that is wrong to say but that is how I feel. When I have to call a rapid response on my patient and an ICU nurse comes to the bedside, I feel inferior because his/her presence makes me feel "inadequate" as if the nurse is here to say "you are not capable of taking care of this patient on your own anymore, you need to step aside and let me with more superior skills take over." So, I ask myself, why can't I be that kind of nurse too? I am tired of feeling deficient, I want to be that kind of nurse that takes care of patients when they get sicker and doesnt need that higher level nurse to come save the day.

I am even having issue with certification. I am clearly qualified to sit for the PCCN but I have this fear that earning that certification will peghole me as a PCU nurse forever which is something I do not want. I would much prefer to have CCRN behind my name. I perceive nurses with CCRN to be higher regarded and I am inclined to not progress further in my career until I achieve CCRN. There are varied schools of thought as to who can sit for a CCRN. Some say the rules are vague and that I in fact can sit for that certification exam. But others say it must be ICU experience. Granted, I have never touched a vent long enough to understand its settings but believe me I want to. I want to learn about A-lines and vents and transducers and all that critical care stuff, and I want to learn to work with medications that are not part of my world. I hear names like esmolol and norepinephrine and I get excited to learn about them and want to work with them. I am also tired of remembering details on more than 2 patients. I much rather know well 2 patients than remember details on 4.

For the past 7 years, all I know is tele and PCU and I feel like I need a nursing change but life is not allowing me to ... despite it all, I love nursing and proud of being one!

At this point I am probably babbling, but I gave enough information to start dialogue I guess.

[ruby_jane, BSN, RN]

So....with the telemetry skills you've gotten some ICU-like care under your belt, no? Investigate whether telemetry is considered under the CCRN "umbrella" as to whether you can test.

I'll be honest, in the ICU I rarely messed with the vents (hospital policy was that the RN knew enough to know which alarms were critical, we could suction) but they preferred the RRTs do all that. And the RRTs were extremely proprietary.

It's tough when you live in an area without a real nursing shortage (they only want trained-up ICU nurses = no nursing shortage). Can you move? If you're bored, move on. You have seven years of experience! You're golden!!! Good luck.

[Night__Owl, BSN, RN]

I haven't taken the CCRN, but I did do some studying on it before I decided to leave ICU. I'll be honest, I think it would be very hard to pass the test with only a written knowledge of vents. Not impossible, but highly difficult. There were also some other gadgets I was worried about being tested on, because at my hospital we rarely dealt with balloon pumps, Swann-Ganz, etc.

I think ruby_Jane has it right. If your current hospital isn't open to cross training or transferring you, and the othe area hospitals won't take you, your only options are to stay in PCU, try a third specialty, wait and hope, or search outside your area.

[brownbook]

What about applying at the ICU in the hospital where you are currently working?

I feel inadequate to a med/surg floor nurse ....I could absolutely not care for 4 - 6 - 8 patients on one shift! ICU sounds prestigious but it can become pretty routine after a few years.

And what is a PCU nurse anyway? I don't feel like leaving this post and Googling PCU nurse.

[Night__Owl, BSN, RN]

PCU stands for Progressive Care Unit. It's usually an intermediate unit, for patients recently out of ICU, or those who are too high acuity for Med surg, while also not requiring ICU care either.

[PeakRN]

Have you actually applied? We want candidates to have experience in critical care, but that often isn't possible.

I wouldn't test for CCRN without actual critical care experience, it can give a bad impression to nurses who worked for years in critical care before they tested.

[PacoUSA, BSN, RN]

24 minutes ago, PeakRN said:

Have you actually applied? We want candidates to have experience in critical care, but that often isn't possible.

I wouldn't test for CCRN without actual critical care experience, it can give a bad impression to nurses who worked for years in critical care before they tested.

I have applied to ICU positions, and nurses with ICU experience always get the interviews before I do ... I am seeking some sort of transition program for nurses that want to learn a new specialty. I believe one occurs in my present hospital system (I am fairly new here) but I dont think it occurs too frequently.

I do have a question tho. I am interested in eventually moving on to a university hospital, it is where I would like to spend the rest of my career. I am not interested in staying in a community hospital setting as this is where I landed a job currently and just took it. I used to work at big university hospitals and loved it and I wish to go back. My question is: were I to get ICU experience in a community hospital (300 beds or so) is that decent experience for me to go on to a university hospital ICU?

[brownbook]

IMHO it would count. I think working in a Progressive Care Unit would also qualify you to work ICU, so what do I know?

[2Ask]

Study hard and take the CCRN exam. I think the credential will make you a more attractive hire.

I got a PCCN certification then applied for ICU jobs and got one. When I took the ECCO testing to plan my orientation, I passed all of it and did not need to complete any ECCO modules.

A few months later after only 6 months in the ICU I took the CCRN then added the CME (CME is a cardiac medicine add on). I bought the online classes from AACN and studied hard. I don't think I had ever had a vented patient before I tested, nor had I done art lines. My ICU/PCU got all the DKA's on insulin drips and non-intubated drug and alcohol withdrawals out of their heads and in restraints with frequent CIWA and COWS medications.

Now I'm PCU- we get vents, LVAD's, art lines, and titrate heparin. You might consider taking a night job in an ICU to get your foot in the door or looking for a different PCU in a different specialty to expand your knowledge (neuro, ortho, cardiac, transplant, etc).

[Nurse SMS, MSN, RN]

12 hours ago, PacoUSA said:

I have applied to ICU positions, and nurses with ICU experience always get the interviews before I do ... I am seeking some sort of transition program for nurses that want to learn a new specialty. I believe one occurs in my present hospital system (I am fairly new here) but I dont think it occurs too frequently.

I do have a question tho. I am interested in eventually moving on to a university hospital, it is where I would like to spend the rest of my career. I am not interested in staying in a community hospital setting as this is where I landed a job currently and just took it. I used to work at big university hospitals and loved it and I wish to go back. My question is: were I to get ICU experience in a community hospital (300 beds or so) is that decent experience for me to go on to a university hospital ICU?

Take a look at Parkland in Dallas. They have fellowship programs and residencies for experienced nurses who wish to switch specialties. One of them is critical care. Its super competitive, but worth a try.

[Cowboyardee]

If you're willing to move, there are always ICU jobs open somewhere.

If you're not willing to move, consider (politely) pestering some of the local ICUs. I just oriented a nurse to our ICU who applied from a med-surg position, sending in a new resume and letter of interest every couple months for a year and a half before he got the position.

[Nurse SMS, MSN, RN]

It is true, small community hospitals with small ICUs often need nurses.