As I interviewed for ICU positions, I explained one of my goals as an ICU nurse was to build relationships with patients and families so I could do teaching and cater to their emotional needs in addition to their glaring physical demands. I was open about this being a passion of mine. I ended up getting offers from two ICU's in different hospitals and went with one that was a very well known and very prestigious hospital. I knew it would be hard but I knew even if it was bad all I needed was a year and I could do as I pleased (even though I really thought this was the unit for me and it would be more than a job and actually a long-term career). Now that I am out of it I am able to best reflect on it:
-My preceptor was mean. Call it an ICU thing, call it whatever you want but my preceptor (and most of the nurses) were very short, not extremely interested in getting to know me and were not patient. If I made an error or asked for a repeat explanation about a procedure (mind you with no negative patient outcomes) it was not uncommon to get scolded/yelled at/reprimanded by a preceptor. Admittedly though one time my patient was becoming hypotensive and I titrated the levo up too quickly. Again, no negative outcomes.
-Hours were unrealistic. Shifts were not 12 or 12.5 hours, I found myself there 13-14 hours and I was on top of my charting and not really behind but the expectation was to wait for rounding MD's in the AM and if they were late or pushed back rounds, guess who was staying?
-No time with patients. This seems obvious in a true ICU but something I guess I needed to be in to realize. Patients are so critical and unstable that there is no bonding, there is no teaching, there is no sitting down and holding hands. There is stabilizing then getting them to the floor.
I could go on but I'd like to contrast this with hospice nursing. I have only ever done ICU and hospice nursing. I did briefly do case management but in terms of floor nursing these have been my only two. I am so happy now. I feel like such a weight has been lifted. I don't dread work or have as many countdowns. I have FRIENDS. Oh and the doctors are amazing. The ICU docs I worked with (there were 6 who circulated) were terrible. Great and smart doctors who I'd trust with my life but it was normal and accepted to cry at some point/frequently as a right of passage with them. This is something I wasn't okay with. No rights of passage in hospice.
There are a lot of expectations and the positions I applied for wanted experience and I see why. There is a lot of independence in hospice nursing and a lot of clinical judgement to make on your own and doctors trusting your eyes on the patient since they are not there with you. I love it and have never looked back. Also the pay is incredible! If you are on the fence, make the move!