Tele RN Pursuing PCU Assignments

[PacoUSA, BSN, RN]

FRUSTRATED!

Sounds to me like I need to leave travel to get the proper experience.

I have almost 6 years of telemetry experience (3+ as a traveler) but on some assignments I have floated to PCU. In fact, I had an entire 16-week contract on a neuro PCU and left with great recommendations (in hindsight, I should have stayed there as I was offered to stay permanently, but that is besides the point) - unfortunately that was now 2 years ago. I am currently applying for PCU assignments because I often take care of patients that are quite high in acuity and are easily true stepdown patients (multiple cardiac drips, variable and frequent VS, etc. tho never vents) but because of bed management and a smaller PCU these patients are placed on larger telemetry units. This experience does not seem to be enough to get a PCU assignment in some hospitals (except for the one time I got on a neuro PCU). My references unfortunately can only attest to the fact that I have been an excellent nurse and that their units are telemetry (ie, they don't seem to acknowledge that they are some stepdown-level patients there or that I have successfully worked with these patients).

I eventually want to return to staff to become an ICU or ER nurse because I am "bored" with traditional stable telemetry patients as I am eager to learn more critical skills. I truly enjoy (for lack of a better word) working with more unstable patients because I feel more productive and interested in what I do. I realize the competition is higher now than it used to be for travel assignments even in the 3 years I have done it. So in theory these PCU assignments should go to nurses that have worked in an official PCU for lengths of time. However, I hate working with more critical patients masked on a lower acuity unit and having my skills washed out based on the unit I am on and not being able to prove this on an interview with a manager (ie, they will say if it was not a PCU you did not work in PCU). My skills checklist for PCU are also consistent with this (except of course with regards to vents).

I am already beginning the process of looking at permanent jobs that will provide me the skills I wish to have, but I doubt I will return to travel nursing after that. I may have to take a tele job and transition internally if that is the easiest way to go.

Anyway, thanks for reading.

[NedRN]

Consider applying at the PCU that offered you a staff position two years ago. I will say that my thoughts that PCU or step down job is much more difficult in many ways than ICU. You could have a patient on a vent, another with a drip, and a third you need to get walking for the first time post op. Your focus in ICU is narrower.

Can't say ED is any easier but it is certainly different! Either the ICU or ED will make you feel like a "real nurse" (I think as an OR nurse I'm allowed to say that without offending anyone) fully utilizing your education and prior experience. In both specialties, you are more likely to really save lives and be a full participant in patient care with direct collaboration with physicians.

I'd suggest shadowing a nurse in ICU and ED. I suspect your choice will depend on your own style. Immediate daily gratification? ED. Dislike continual chaos and changing pt assignments? ICU. Thoughtful planning care for one or two patients? ICU. Fast thinking and great organizational skills? ED.

For anyone reading this in any of the mentioned specialties: please forgive the vast over generalizations I've made here.

[PacoUSA, BSN, RN]

Consider applying at the PCU that offered you a staff position two years ago.

I've tried that, but ironically every time I have looked to see if there are openings there aren't any. And it seems internal candidates at this hospital get priority.

Dislike continual chaos and changing pt assignments? ICU. Thoughtful planning care for one or two patients? ICU.

These two phrases you mentioned ring more true to me than the ones you mentioned about ED. This is why I am leaning more to ICU. In fact, I did try to go perm a year ago in an ED back home, but that failed miserably due to that place being a bad hospital with a bad environment and an even worse preceptor who made me look like a liar to management. So, after 3 months there I left without looking back and back to travel nursing. It did not make me hate the ED, only the hospital which is surprisingly a Magnet hospital too :/ ...

I would love to go straight into an ICU with my current experience, but all the ICU jobs I see want ICU experience (so dammit HOW do I get the experience you want if no one wants to hire without experience???). My best bet I think is to get into a system with my current experience and internally transfer after a year or two.

[NedRN]

I have to believe there are ICU's out there who would love someone with your experience in a shortened internship. There is an association of teaching hospitals. Find them online, and start cold calling. In fact, I'd suggest skipping HR and calling managers instead, possibly directors in a facility with multiple ICUs.

Alternatively, you could continue to travel, work a few weeks to get a good reputation, and beg for ICU days with easier patients. Confidence that is not cocky goes a long way, especially after they know you. That might lead to a staff offer or even an extension at the same facility at least partially ICU. That's a longer road of course. You might also select assignments if they want step down or PCU float - good deal for both of you. More experience for you, and cheaper bill rate for them. Probably have to interview to find if this is possible so you could be wasting your agency and the manager's time. But a good recruiter could submit you with this sort of pre-condition.

[PacoUSA, BSN, RN]

I have to believe there are ICU's out there who would love someone with your experience in a shortened internship. There is an association of teaching hospitals. Find them online, and start cold calling. In fact, I'd suggest skipping HR and calling managers instead, possibly directors in a facility with multiple ICUs.

Alternatively, you could continue to travel, work a few weeks to get a good reputation, and beg for ICU days with easier patients. Confidence that is not cocky goes a long way, especially after they know you. That might lead to a staff offer or even an extension at the same facility at least partially ICU. That's a longer road of course. You might also select assignments if they want step down or PCU float - good deal for both of you. More experience for you, and cheaper bill rate for them. Probably have to interview to find if this is possible so you could be wasting your agency and the manager's time. But a good recruiter could submit you with this sort of pre-condition.

I like your advice, thanks! I just secured a travel position (PCU day shift) starting next month in a city I would not mind settling in for a while, perhaps this is the open door I have been waiting for??

[NedRN]

Congrats!