Urban ED Meets Rural ICU

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Hi everyone,

thanks for opening this thread. I appreciate ANY and ALL input, feedback, suggestions, sympathy, sharing of your personal experiences, anything you can give me I'd love to hear it.

I'm a "seasoned" nurse transferring from a high volume extreme acuity ED in an full service acute care medical center in a downtown area to an ICU in a critical access hospital.

I'm on orientation and going a bit stir crazy. The acuity isn't there, most of the patients seem like what we would've seen on tele and the sick patients (the type Im accustomed to as ICU acuity) are transferred. The treatment also seems very conservative.

I just expected more. I was warned that I might be bored. I didn't want to believe that. I thought I could delve in and give more of the personalized care and that it would satisfy me.

I am often made to feel like I am being silly and asking too much and not prioritizing when I ask that very basic diagnostics be performed. My preceptor has a tendency to shut me down with a rationale but I actually don't agree with her rationale. I explain and it doesn't really go anywhere, except maybe she'll give in to my suggestion but I still feel like a bother. She has raised her voice to me several times and rudely interrupted me when conferring with a colleague. She has apologized but minimizing behavior hasn't stopped. Not sure if it's personal or cultural/institutional.

I have a dynamic position and fill several roles besides ICU nurse so I definitely don't want to leave.

How can I stay stimulated, avoid frustration, and make the most of this rural ICU?

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Specializes in Critical Care.

What sort of "basic diagnostics" are you suggesting be done that your preceptor is shutting you down on?

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If you show up to the hospital with your face smashed up with subq air and no clear story of how it happened and are altered with a side of urinary sepsis and xarelto I'd like to at least double check with the attending that he is certain we don't need Cspine and maxillofacial imaging since we are going to radiology for head and chest already... Reasonable?

If its NOT reasonable from an ICU standpoint because it's not a priority I'm totally cool with that. I'm just not convinced.

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Specializes in Critical Care, Emergency, Education, Informatics.

Having been a CNO for one of those hospitals, I'd suggest the following.

First just get through orientation, Second, get to know the providers, make sure you speak their language. Once they get to know you, you mght find that you have more autonomy in the smaller places than you would in the bigger ones. CAH's are more conservative. Remember that most of the providers are going to be Family Practice or Internal Med and not intensivist or ED Docs. The medicine can be a decade behind wh t your used to.

But that being said, if you play your cards right, you can find that you can make a positive impact on both the practice of medicine AND nursing there. Fron experience don't wave the "I came form a real hospital" flag in front of people or you will get shot down.

I started by being a bit passive aggresive. I would print out journal articles and leave them laying around where the doc's could see them as well as the nursing staff.

Those studies are in the perview of the ICU. I do both, I can't tell you how many times Iv'e taken patients who just got to the unit from the ED back for further study. You have the advantage many times of not having a full waiting room pushing at you to get the patient out of the department.

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Specializes in post-cardiothoracic surgery.

I'm 100% in agreement with CraigB-RN. I would just add to that to choose your battles wisely, and be humble. Make sure you have a "willing to learn" attitude, and find what gems you can in what your new colleagues are sharing. Acknowledge them as good nurses and compliment them. I don't mean fake flattery, but if they know you respect them, they are more likely to get past any preconceived notions they may have about you and give you back the respect you deserve. Be very sensitive to the fact that they know you come from the big ED in the big city, and they probably expect you to be a bit cocky. You could also try finessing them like you sometimes have to finesse stuck-in-the-mud doctors--kind of ask questions that lead them around to your point of view.

As far as staying stimulated, it doesn't sound like there's much you can do about the level of care of the patients you get to keep rather than transfer. So maybe join your unit practice council or similar group, maybe look into research opportunities? Do you have an evidence-based practice program that you can be part of? Are you able to be involved in ongoing nurse education (as a clinical coach or similar)? Do you get nursing students at your facility?

Hope this is helpful!

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Specializes in Nephrology, Cardiology, ER, ICU.

What a timely post for me. I'm interviewing in a small, community hospital. I'm coming from a 900 bed level one trauma center to an approx 120 bed hospital.

I'm on the second round of interviews and yes, they do wonder if I will be bored. However, there are students at the hospital, committees, etc..

I also go to school and am active in several volunteer organizations. So....for me, I'm going to try to fit in, get the lay of the land so to speak (if I get offered the job - lol) and keep my mouth shut and my ears open.

I want this job for the flexibility that it will afford as well as the patient base.

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