PCU Nurse Feels "Second Rate"

[PacoUSA]

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.

[murseman24, MSN, CRNA]

You sound like an ideal candidate for an ICU hire IMO. The fact you are excited to learn about new drugs and monitoring modalities is fantastic. PCU is where we preferentially hired our non-ICU nurses. I guess it's the area you live in. I'm sorry, that's unfortunate. It sounds like the ICU is missing out on a great nurse.

[0.9%NormalSarah, BSN, RN]

Have you considered moving to a different hospital as a Tele and/or PCU nurse, then applying to ICU internally after a few months or a year? You might get more consideration as an internal applicant over experienced ICU nurses if you do well in your first year there.

[bananas1]

? Can I just say, don't put ICU nurses on a higher pedestal.. just a different one!!! While they may be able to care for sicker patients, they may struggle to deal with the caseload a PCU nurse may do.

But I totally get that you want to learn about how to care for the sickest of the sick, that's admirable and definitely something to aim for. I honestly would just apply, it doesn't matter that you don't have the experience, the worst that can happen is you don't get the job. You have PCU experience and that is so close, you will be able to transfer so many skills from there!

[Workitinurfava, BSN, RN]

Would you consider working in a ER and then later maybe you could transition to the ICU or just stay in the ER ? Personally I feel like if you work in the ER you can work anywhere. The ER is where the patients are first recieved. Having telemetry experience should help you get your foot in the door. I am not sure how many patients ER nurses have but from what I know they stabilize a patient and move on to the next one.

[gonzo1, ASN, RN]

I went from med/surg to ER and then to ICU.

[winniewoman9060ret]

Get your ACLS, BLS, PALS certifitions. I sat for the med surgery test. The more each education, certifications you can get opens up doors. PACU is another route to go too. Our ICU would hire you easily.

[PeakRN]

10 hours ago, Workitinurfava said:

Would you consider working in a ER and then later maybe you could transition to the ICU or just stay in the ER ? Personally I feel like if you work in the ER you can work anywhere. The ER is where the patients are first recieved. Having telemetry experience should help you get your foot in the door. I am not sure how many patients ER nurses have but from what I know they stabilize a patient and move on to the next one.

While the ED will teach critical thinking there are many significant differences between ED and inpatient critical care.

ED is all about the now. Triage, stabilization, and disposition. There is certainly some crossover between the ED and inpatient critical care, but I certainly wouldn't say the ED is a great preparatory job for other sports, of all things the ED way can oftentimes conflict the the ICU way.

ED assignment depends on acuity, but in an average medical pod 4:1 is pretty common. I've had as many as 8 patients at a time in the ED, although there are systems that have even more than this. For especially high risk patients there may be several nurses to one patient.

[Workitinurfava, BSN, RN]

...

[Workitinurfava, BSN, RN]

2 hours ago, PeakRN said:

While the ED will teach critical thinking there are many significant differences between ED and inpatient critical care.

ED is all about the now. Triage, stabilization, and disposition. There is certainly some crossover between the ED and inpatient critical care, but I certainly wouldn't say the ED is a great preparatory job for other sports, of all things the ED way can oftentimes conflict the the ICU way.

ED assignment depends on acuity, but in an average medical pod 4:1 is pretty common. I've had as many as 8 patients at a time in the ED, although there are systems that have even more than this. For especially high risk patients there may be several nurses to one patient.

If she did get an ER position. I can't think that an ICU would not consider her if she later tried to transfer. She may even find that she likes the ER.

She already has some skills that have prepared her to work in the ICU.