What specialty is next?

mmc51264, BSN, MSN, RN · Oct 28, 2016

Both ED and ICU are not extensions of Med-Surg If ICU is your goal, a PCU unit might be an option. I have been on an orthopedic floor that gets a lot of off-service for 4 years. A year is not necessarily a long time...

Meriwhen, ASN, BSN, MSN, RN · Oct 29, 2016

Even with a year of M/S under your belt, going into ICU is still like jumping into the deep end. I agree with you that going into stepdown/PCU unit first is a good idea. This will help you gain experience dealing with more medically unstable patients. Even better, see if your facility offers a training program for nurses looking to transition to ICU (mine does) and apply for that. That will give you the extra support and education you'll need.

nutella, MSN, RN · Oct 29, 2016

My opinion is that PCU is not necessarily easier or a step to take on the way to ICU. In PCUs staff still has several patients who are too well to be in the ICU, which means yelling, not cooperative (because they are older age, confused, delirium and so on and forth), stressed relatives, constant checking this and that. But they are not good enough to go to the floor. So you are basically stuck in the middle - which I think is a lot like middle management (here insert your interpretation).

If your hospital is a major teaching hospital, you have patient in med/surg tele that would be in the ICU in smaller hospitals or community hospitals and very sick patients in a PCU.

If you feel you can handle a challenge and want critical care I would directly apply for ICU. If you work in a community hospital or small hospital no need to loose time on a PCU - in those places you can be glad if you have an intubated patient in the ICU...

ICU is organized, you have more resources, people respect you and you have a lot of leeway as long as you know what you are doing.Personally, I found teaching hospital critical care units /ICU less stressful as opposed to tele med/surg or step-down. I went straight to ICU as a new grad but I had paramedic experience and a long clinical in the ICU.

ED is chaotic, fast paced ... on the other hand -- if you have somebody who is giving you a hard time you know they will be gone at some point soon - unlike the patient who gets their own zip code on the 100. day on the med/surg floor....

KnightRN22 · Oct 29, 2016

I am more structured and organized and I have heard that work personalities such as that work better in ICU instead of the ED. I have heard, and like you said, ED is chaotic because you can get a patient with a simple abscess or cardiac arrest. The cards are kind of up in the air. What I like about ED is that I would be the first person to assess the patient and get the story or background of why they came to the hospital in the first place. ICU is also intriguing because the patient is usually established but they have multiple comorbidities at once. I did a shadow day in pediatric ED when I was in school as well as adult ICU. I liked each speciality, but again, both are completely different. My hospital does offer a transition program. The options are either transferring to PCU or ICU. So technically, I could transition form med-surg to PCU or med-surg to ICU with the program. I just want to make sure that I do not overwhelm my self and that I do not put a patient at risk. I do not have heart monitors on my unit and I am currently not EKG trained. The PCU units at my hospital normally have a 4:1 ratio and ICU is 2:1 or 1:1 depending on if the patient is in a fully rotating bed.