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Transition out of critical care?

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by emmjayy emmjayy, ASN, RN (Member) Member Nurse

emmjayy is a ASN, RN and specializes in ICU, CCRN.

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Hi, all - 

I posted about feeling really burned out on critical care back in February or so in the MICU/SICU subforum. Things improved for a bit with switching to straight nights rather than going back and forth between nights and days, but I'm back to feeling horrible all the time again. I think part of it is the night shift, but I can't handle the thought of going back to days because of the stress level on days as well as the pay cut. I realized that watching people die practically every day is just wearing me out. Additionally, the personality games that have to be played to get along with management and midlevel providers are exhausting and as I've gotten to know the unit more, I've come to realize that there is a lot of unhealthy back-biting and gossip as well. I do feel that I've come to learn a lot and have a good amount of confidence in handling emergency situations/stabilizing sick patients, which is the upside of this experience, but the downsides are huge for me. My husband sat me down the other week and told me he thinks I need to leave this unit for my own sanity and I realized I have been crying every day I work, stressed to the max, and pouring everything into my job with nothing left when I come home to my family. I feel depressed. The other day, I had to get up and go back to work and I just laid in bed wishing I could sleep forever and that I would never have to go back to that job. If I've learned one thing in the past year and some change, it's that life is too short to take for granted and it's too short to spend at a job where I'm miserable. 

That said.... I went to ICU as a new grad. There is zero part of me that wants to work on a med-surg floor. I am considering NICU because the physical demands of that job are less and the positive outcomes are more frequent. I'm also considering endoscopy, interventional radiology, and outpatient surgery centers. I'm also sort of thinking about home care as well. Thoughts? Experiences on transitioning? I do still want to use my specialized skills if possible, such as administering moderate sedation. I would also like to maintain my independence, continue having 1:1 or 2:1 ratio, and having close teamwork and camaraderie with nurses and providers alike. It would really help my soul to experience good outcomes for my patients on a more regular basis, as well. Are there any other specialties that provide any or all of these things that I haven't thought of yet? 

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adventure_rn is a BSN and specializes in NICU, PICU.

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Tangentially related: I contribute fairly often to the NICU forums, and your scenario sounds almost exactly like one we had a few months ago (a burned out adult ICU nurse considering NICU--at first I thought maybe you were the same poster. If you're seriously considering NICU, you may find the forum helpful: 

In addition to the specialties you've listed, have you considered PACU? My current unit (Peds Cardiac ICU) is having a mass exodus, and a ton of our nurses have gone to hospital-based PACUs (both peds and adult). Many of them seem to love it. They work reasonable day shift hours and have 1:1 ratios. It's possible that the patients would be higher acuity than the outpatient endo/outpatient surg centers that you discussed (although I'm no expert). In addition, you mention moderate sedation in outpatient settings: I wonder if nurses are even administering sedation, or if it's providers/CRNAs?

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emmjayy is a ASN, RN and specializes in ICU, CCRN.

496 Posts; 7,566 Profile Views

18 hours ago, adventure_rn said:

Tangentially related: I contribute fairly often to the NICU forums, and your scenario sounds almost exactly like one we had a few months ago (a burned out adult ICU nurse considering NICU--at first I thought maybe you were the same poster. If you're seriously considering NICU, you may find the forum helpful: 

In addition to the specialties you've listed, have you considered PACU? My current unit (Peds Cardiac ICU) is having a mass exodus, and a ton of our nurses have gone to hospital-based PACUs (both peds and adult). Many of them seem to love it. They work reasonable day shift hours and have 1:1 ratios. It's possible that the patients would be higher acuity than the outpatient endo/outpatient surg centers that you discussed (although I'm no expert). In addition, you mention moderate sedation in outpatient settings: I wonder if nurses are even administering sedation, or if it's providers/CRNAs?

Thanks for sharing this! I did not really consider PACU because at my hospital, the general consensus is that you should have at least 3-5 years of ICU experience before trying to go to PACU. I will look into it, though, as I believe they have some open positions right now and I have heard that it is a different pace and flow compared to the ICU. 

I am considering NICU (already have an application that I am working on for it right now), but am just hesitating because I don't want to jump out of the frying pan and into the fire emotionally, so I will review that thread per your suggestion :) 

In the outpatient centers, the job description says that the nurse is responsible for administering and monitoring the patient under moderate sedation. Obviously, my job in the ICU involves much more than that (initiating, monitoring the effects of, and titrating many different kinds of drips), but I doubt there will be much mixing of norepinephrine drips in the general outpatient world, whereas I know moderate sedation is very common. I just don't want to lose the skills I worked so hard to get! 

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