My apologies in advance for asking such a ridiculous question...
I will graduate this Dec (2007) with my BSN and have been working at a large hospital this summer in a BSN-student residency/internship/clinical experience. I have been heavily recruited by the CCU/ICU Nurse Manager to apply and work in the unit.
I have had several observational experiences in the adult ICU/CCU and have always felt a certain dread, even before arriving. I find that I do not like the exceptionally sick patients, the vents, the drips, the extra lines, etc.- but have been repeatedly told that it's "normal."
I have no interest in ICU nursing- what was the deciding factor for you CCU/ICU nurses? I realize there is something for everyone, but in being assured and reassured that I would make an "excellent" ICU RN, I have serious doubts about it. I feel that in order to be a good nurse, you should be comfortabl in your setting, as opposed to feeling dread and watching the clock to see when your shift is over...
Any response would be greatly appreciated- thank you.
I thought I would never want to work in critical care, no matter what, up until my last semester of nursing school. I got placed for the entire semester in a medical ICU. I had excellent preceptors and the staff on the unit were wonderful. Nobody ever tried to talk me into critical care - I came to it on my own during that semester.
The first thing that tipped me off that CC might be for me was when I observed/assisted two codes and an emergent intubation within two weeks or so. Something about the way I felt no need to freak out during these times made me think maybe I could be an effective nurse in this area.
By the end of the semester, I would be approached by physicians who had been consulted on our patients and wanted to know the big picture on them before diving into the chart. One day I realized I was effectively communicating - as a nursing student?? - with plastic surgeons, nephrologists, pulmonologists, neurologists, etc... and none of them were looking exasperated and asking to speak to the REAL nurse.
I decided I really liked that feeling of actually knowing what's going on with my patient.... in all systems.... and knowing I couldn't possibly keep up with all that information on the floor. I think that's the biggest thing that led to my decision.
Now that I've been working in a CCU for almost a year, I have different reasons for staying, probably. I just haven't made the effort yet to sort them all out in my head and put them in pretty words!
When I started nursing school, Critical Care terrified me. I had one instructor tell me that the CC course in nursing school would fail me out, keep me from graduating, etc.
Then I ended up in the critical care rotation with the most demanding instructor our school had.
And I thrived.
My rotations were in the medical and neuro ICUs, and I thrived on the level of care involved with those patients.
After graduation, I accepted a position on a Progressive Care Cardiac Unit. Our patients aren't ICU level sick, but all our beds are monitored, we run drips you don't see on most floors, we take the rapid response patients that we don't have an ICU bed available for, etc.
I have heard that in the hospital, the level of care has increased so that the patients you now see in ICU would have previously died. A lot of the patients you see on the floor would have been in an ICU. Nurses I work with that have been employed for 20 years tell me that the majority of my patients would have been in the ICU 5 years ago.
In a lot of ways, I think I have a dream job. My patients demand a high level of care, I have become familiar with a lot of different drips and medications, yet my patients are generally on the road to recovery. I see post op day 1 CABGs and Thoracotomies, and immediate post op VATS, for the most part. I generally work with the same 3 surgeons, the same PAs, I know them, they know me, we all know our patients, and we all have a great amount of respect for each other. I know that when something is going on with a patient and I call the PA in the middle of the night, there is a really good chance that the PA will ask me what I think should be done before he/she writes an order. It is a great environment to be working in!
My patients generally have happy endings.
I think that is why I stay where I am as opposed to moving to the ICU. As much as I think I would enjoy the mental challenge (because I loved it so incredibly much in nursing school) I know that the proportion of happy to sad endings in most ICUs is not nearly as favorable as where I am now.
I am also in an environment where management encourages us to further our education. We have inservices with the surgeons and cardiologists at least monthly which we are encouraged, but not required to attend.
Our patient ration is generally 3 or 4 to one. Far more likely to be 4 than it is 3, but I rarely feel overwhelmed.
When you are considering jobs, there may be something out there that you would find stimulating that may not carry the level of stress you associate with ICU.
I know I feel I lucked out when I found the job I have now.
One question. Why do you think they have told you that you'd make an excellent ICU nurse?
I agree with many of the others - once you get over the fear and the learning curve (and it's pretty steep), you come to appreciate only having two patients and really getting to know them. You get spoiled! And I like the others, I am a control freak and in ICU settings you do primary nursing care - which is the best.
Specializes in CVICU/Trauma ICU ...moving on to SRNA!.
Everyone has great points. I think the point I agree with the most is finding an area you love.
I did not even have a thought about working in an ICU until my last couple semesters in school. I thought I wanted to work in an ER, but after doing a rotation there found out the adrenaline rushes were too few and far between for me. Also thought of psych, but after that roation I thought it was more interesting to read about schitzophrenics than to be face to face with them. Even when I did my ICU rotation I was afraid to kill someone and I did not think I would want to be around such "sad cases" that can be emotionally and physically draining. But after only a few weeks, and an awesome instructor, I knew that the ICU was for me. The adrenaline, the complexity, the need to stay up to date on your education, the teamwork, the need to release your OCD personality traits, the technology. It is awsome!!!
It is not for eveyone though. One of my best friends does hospice nursing and her passion is just as deeep to her specialty. Life's too short to not follow your heart (and mind). Every unit/specialty has it's ups, downs, positives, negatives. My 2 cents if you are unsure of what area you want to work: make a list of things you want out of your job, and then list traits of the units you are interested in (and the types of people on them) and compare for the best fit. Worse come to worse, someone already mentioed this, but you are a nurse and have the great flexibility to change and find you place in the vast number of specialties.
I choose it because the patient is MINE... I know every last bit of their history, I know all their labs, I understand our current treatment... where we're headed and how we need to get there.... I know what to monitor for, what to call for, what to question... what to put on my "laundry" list of things to add to treatment for the doc. I know every time I turn a patient and suction them and give oral care I prevent complications... I spend endless hours educating non medical families on multi-system failure , where we are-what we're doing... what I hope to see over the next 12 hours. I go head to head with any doc fighting for any new order that can improve outcomes... I read at work, at home and I study all the time to take better care of them.
On a floor, I do spot assessments, I know the important history, don't have a clear picture, am torn between many other patients, lack time to teach, rarely know labs, except if on anticoagulation or med therapy. Rarely have time to read through the chart, all the progress notes and the consults to see the true state the patient is in ... and frequently play catch up on labs, meds and tests without a concise knowledge of where were going.. this can't be done with 6-12 patients. If my floor pt. codes, I have to pull out the chart to give the coding doc the info needed.
Not trashing floor nurses in any way, they will always be in awe to me.... for me, I need to know it all, do it all and manage it all with the MD. Can't do this on the floor.
so, I'm a control freak, live and thrive in the ICU and it works best for me, on the floor, floating... I can't do less than I know... it makes for one hell of a night.
Excellent, excellent post!!!
I think sadly, the fear of the unknown many times leaves many nurses on the outside. I've worked a little of everything, and what I really like is Progressive Care/Step Down. Similarly, I can usually know every problem, what to look for, and have many problems solved before they ever start. On a Med-Surg unit when you have 7-14 patients, you can't possibly know ALL of their history, spend time educating every one of them AND their family members. Where I am, I spend time educating each patient and family is need be, because I'm much more readily available caring for 3-4 patients than I would be with 7-14. It allows me to feel as if I've met their needs as well as I could, and in all honesty, makes the job more rewarding.
ICU_floater- add me to the list of nurses who liked your answer. It puts into words the reason I want to switch to critical care. I have an interview next week... mind if I use your words to describe my feelings? Seriously... I want some ownership over my patients and the care I give them. I love when I have the whole picture, not fuzzy poloroids from popping my head through the door to "see" one patient when I'm on my way to the next. I'm always "on my way" to the next.
If the intensive nature doesn't interest you, then definitely find another cup of tea to sip! I didn't think I'd work cardiac ICU in school (on go on to do a board cert in CV), but once I got the feel for it, I did it for half my career. Same for ER. The lovely thing about nursing is the ability to go from one area to another if your tastes change or a window of opportunity arises. I ended up in PACU currently due to the schedule, allowing me to run my business during the day & work PACU 3rd shift. I didn't know I'd be in PACU or running my business 18 years ago, I assure you. just find some area that you really enjoy.
Kerrigan 06
53 Posts
I thought I would never want to work in critical care, no matter what, up until my last semester of nursing school. I got placed for the entire semester in a medical ICU. I had excellent preceptors and the staff on the unit were wonderful. Nobody ever tried to talk me into critical care - I came to it on my own during that semester.
The first thing that tipped me off that CC might be for me was when I observed/assisted two codes and an emergent intubation within two weeks or so. Something about the way I felt no need to freak out during these times made me think maybe I could be an effective nurse in this area.
By the end of the semester, I would be approached by physicians who had been consulted on our patients and wanted to know the big picture on them before diving into the chart. One day I realized I was effectively communicating - as a nursing student?? - with plastic surgeons, nephrologists, pulmonologists, neurologists, etc... and none of them were looking exasperated and asking to speak to the REAL nurse.
I decided I really liked that feeling of actually knowing what's going on with my patient.... in all systems.... and knowing I couldn't possibly keep up with all that information on the floor. I think that's the biggest thing that led to my decision.
Now that I've been working in a CCU for almost a year, I have different reasons for staying, probably. I just haven't made the effort yet to sort them all out in my head and put them in pretty words!