Should I Transfer to ICU?

[studog12, BSN]

Hey everyone,

I’ll try to keep this as short as I can. So, I’m at a crossroads and I don’t know what to do. To give you some background, I am a PCU male nurse with about 3 1/2 years of experience working in a cardiac/neuro and a multi system PCU. When I first became a nurse, I got a job in a cardiac ICU, and it didn’t go well. I had a terrible experience with my preceptors, and I was so stressed out during those 4 months I was orienting that I literally haven’t been the same since. Needless to say, I ended up resigning. Now I am more sensitive to stress, have less energy, and it just seems I lost part of my vitality, even though I take good care of myself (I.e., eat well and exercise, although I do have an irregular sleep pattern due to currently working nights). Anyway, despite that initial bad experience, I was able to get back on my feet with my career in PCU and that’s where I have been since.

Ever since I left the ICU, though, I have always been curious about what it would be like to go back with some experience under my belt. I have become a good nurse—I am systematic, conscientious, caring, and a good team player. I am also a good critical thinker, have a calm demeanor, and intellectually curious, all of which I think would be a good fit for ICU. However, my main issue is I am more sensitive to stress and do have anxiety (more OCD-like anxiety than generalized), so I wonder if the inherent stress of the ICU would be too much for me. Sometimes I think it would, sometimes I don’t. Even with my mental health issues and the traumatic experience in the past, I am still able to handle the PCU and the stress of hospital work. But it’s just back and forth for me in regard to whether I should give the ICU another try. The unit I would be going to is lower acuity, so it wouldn’t be a big jump in that regard. However, I am also apprehensive about the culture of ICUs in general—they tend to breed strong personalities (understandably so) and unfortunately they aren’t always kind either. Being a sensitive type, I think I would have a hard time being in an environment that’s always tough and where everyone is mostly on edge. One good thing about the ICU I am considering is that even though there are nurses who aren’t as friendly, the manager and ANMs seem to be, which is encouraging. The ANMs and rapid response nurses are actually trying to recruit me to the unit, so even though I have my personal issues, I must be doing something right to be noticed and for them to have confidence in me, especially since one of the ANMs is apparently pretty particular.

Anyway, I’m just stuck. On the one hand, I like the sweet spot of PCU, in between med-surg and ICU. I also have wonderful coworkers who are very nice and I fit in very well in that regard. However, the ICU thing has always been something in the back of my mind, and now that I have some experience and more confidence, I wonder if I should take another crack at it. I did shadow in the ICU I’m looking into last week for “up training” due to COVID-19 in case there is a big surge when the country reopens again, and I did enjoy it and learned a lot. I was nervous and anxious but found my confidence increased each day. However, I still find myself going back and forth. I think my PCU manager would take me back if I transferred and ended up finding out it wasn’t for me or if things didn’t go well. To be sure, I would try to stick it out at least 6 months or even a year ideally, but it would be reassuring to have a backup plan. I suppose it would be more embarrassing than anything to have to transfer back, as the failure to thrive there would be more public and known since I would still be in the same hospital. Most importantly, I want to make a wise and informed decision, whatever it is.

What do you think? Should I try it out? Stay put? I really appreciate all responses and guidance. God bless everyone and thank you for all you do. I hope this message finds you well during this pandemic.

Sincerely,

Ethan

[ljo28, BSN]

What is the patient assignment like in the PCU that you are currently in. Also, what is the patient population like in the ICU that you want to transition to. Since you have more experience now than you had before, is certainly an asset, but it should be all about what you want for yourself, what your future goals are etc. There will always be some hiccups initially. Your decision should not be based on the people who are telling you to make the switch unless you really want to give it a shot.

[Maria Frances, ADN, RN]

Oh Ethan! SO MUCH of your post resonates with me!

First, let me address the mental health issues. I'm 40 years old and I have legit OCD/depression since I was 20. Not the "hee hee I always have to put 3 emojis in every text I send" type of OCD that people joke about, but the kind that made it impossible to lead a normal life. Until I got on medication. And I've bee 90% better since. If you don't already, you should find a good psychiatrist for medication and also a talk therapist that you see once every one or two weeks to help you with stress.

That being said, I had a almost identical experience as yours - I thought all I wanted was to be an ER nurse. I did one year of tele and got a job in and ER, and it was a disaster! I "resigned" in lieu of being fired. My preceptor had the personality of a wet towel, and we just didn't gel. I hated the EMR they used, and the charting was SO different from inpatient. They didn't scan their medications - and their omicell didn't match what was ordered - it included all the meds so it was easy to pull the wrong thing (like rectal tylenol instead of oral). I was humiliated and felt so defeated. It was awful. But I cannot imagine starting off as a new nurse in an ICU. That must have been so stressful! I think it's best to get some experience as a nurse in general before taking that leap.

Important question for you - are your nurses unionized? If you are in a union, there may be a clause about this exact situation.

Anyway, you need to ask yourself the following questions?

1. What made you decide to be a nurse, other than that you get to help people? There are hundreds of ways to help people - why did you choose nursing? I chose nursing because I love medicine.

2. Where do you want to be in 5 years? Do you think you will be happy if you are a PCU nurse in five years? I once worked with a nurse who worked part-time nights and she was completely happy with being a med-surg nurse - she said she could easily do it until she retired. She, however, had more stuff going on outside of work that she was more interested in advancing in. So, ultimately - where do you want to be?

3. Do you have the confidence you need now that you have experience? You don't have to be arrogant LOL, but are you comfortable with your knowledge, while of course being open to learning a whole lot more? If you are still really nervous, then it might not be the right time. For example, when I was in the ER, if I made a mistake, I would totally lose focus and wonder/worry if they were going to fire me, etc, to the point that I made even more mistakes!

You need to ask yourself these questions, but even more importantly , you need to ask your family and close friends who really know you as well. I think in general it is very hard to self-evaluate, and from what you've said I can tell that you will totally downplay your abilities.

You should continue to "shadow" as much as you can - not just for the knowledge but for the opportunity to get to know the ICU staff. You mentioned in your first position that your coworkers weren't very welcoming. So get to know the ones that are there in your current hospital. Find out who precepts and get to know them.

I would also recommend taking a critical care course, even if you have to pay for it yourself. Also, consider joining one of the critical care professional organizations. You might be able to network.

My personal recommendation is that if you make the move, to stay in your current hospital, or go to a small hospital. There's nothing like having to learn the procedures of a 500+ capacity hospital and all the doctors and how to get in touch with them while also trying to learn how to be an ICU nurse. You also already know your hospital's "way" of doing things. Also a big plus.

If you are willing to move, there may be a residency program available that will give extensive training, but with your current experience, your definitely qualified to transition directly.

As for me, after my ER disaster, I ended up doing some work at same day surgery centers, subacutes, urgent care, and have been in med-surg for three years. At this point, I'm totally over the bedside meg-surg environment. I also looked back at my time in the urgent care where I worked and there were a things about it that I didn't like - as a nurse you really didn't do much of an assessment - more of getting history and a med list. The charting was mostly just updating that the patient was comfortable and noting when the MD saw them. When I showed up for my first shift, my preceptor didn't even have a stethoscope, and had no intention of finding one/using one. Huh???

Sooo... I too have been thinking about ICU for the past year. My most recent job has been with an agency on a contract - it was supposed to last 2 months but here I am a year later and finally leaving. Let me tell you - if you want to see how much you really know, take a PCU contract job. You get literally 2 days of orientation, and during those 2 days you are basically just followed by aother nurse - you are expected to take a full assignment and figure out how to do things right away. But anyway, applied for some different positions - LTAC (have you considered that? That's another avenue that you might want to look into), I applied for some behavioral health, and I applied to some ICUs. I said to myself - why not? I should be finishing my BSN in December, so I was looking for either something short term to tide me over until then, or a job that I REALLY want to do that will advance my career. And lo and behold, on Monday I am starting an extensive training program for ICU in a small community hospital. I'm so scared, and so nervous!

My gut tells me that you should go for it. It sounds like you want to advance, and it sounds like ICU is where you pictured yourself when you started nursing school. OK, so it didn't work out the first time - but you were a brand new grad! I can't imagine being a new nurse trying to get an IV on a patient in cardiac arrest! I don't know ANYONE who graduated nursing school and went straight into ICU. No one.

My biggest fear in taking this opportunity is the fear of failing, not only professionally but financially. But should it not work out, there are enough subacutes here in NJ who are desperate for help and would hire me on the spot. I'm sure it's the same wherever you are.

And you don't have to decide tomorrow. But you do have to decide at some point. Give yourself a deadline and say for example, by July I'm going to make a decision. And if it doesn't feel right, or you are just not sure, then give yourself another year in PCU. The ICU isn't going anywhere - take another year if you need to.

But I think now is the time. Not just because it's been in the back of your head, but because of the timing with Covid. ICU nurses are always in demand, but with Covid, the US has learned how vital they are, and that we don't have enough. So there is more of a push to train new people than there has been in the past. Keep that in mind. I know the hospital where I was just at was looking to do something similar with shadowing, so now really is a good time to try.

I'm sorry this is so long but your post just really hit home with me. Whatever you choose, you will end up just fine, but I personally hope you give the ICU a shot! ?

[studog12, BSN]

Thank you both so much for the thoughtful responses. I ended up getting to shadow some of the ICU nurses for a few shifts as part of an "uptraining" program for PCU nurses when the pandemic was hitting us hard in the beginning. The shifts went well, but after revisiting again firsthand what ICU nurses do and actually getting some good hands on experience helping care for critically ill patients, I found I just didn't have the fire in my belly to do it. A part of me thought it was cool and intellectually stimulating, but given my lack of will to deal with the extra stress and to work with other nurses who are just more type A than I am, I decided it was best to stay put. Plus, this particular ICU was very short staffed and didn't have techs to help with patient care, and for me that was a significant concern.

Again, I really appreciate the words of wisdom and support from both of you. I read every word and took it all to heart and thought about it carefully.

God bless and all the best to you both,

Ethan