Why I Love Being a Nurse in the ICU and How I Got Here
Written by Vanessa | BSN, RN, PCCN
I wanted to be a nurse for as long as I can remember.
It sounded fantastic to work three 12 hour shifts a week.
It is. The schedule allows my hubby and me lots of time to enjoy our little farm (our pups, horses, and chickens). 🐴🐥
It sounded full of opportunity.
I was right; there are endless and diverse opportunities. It's hard to think of a more flexible career.
Along the way, I found that I love one of the most intense and demanding nursing jobs you can work in.
I'm going to tell you why I love the ICU, what it takes to thrive there, and tips I used along the way to prepare for the leap.
I started my career on an intermediate/transplant unit. This position was terrific as a new grad! The patient care was complex and challenging, but it felt manageable. I knew I liked complex cases since nursing school, but I paid attention to how I gravitated to more acute care. When my patients became too sick for my unit to manage, the ICU would always swoop in to save the day. I remember feeling so bummed that I wasn't the one who could help make sure that patient was ok.
About a year into my nursing career, I began feeling a strong tug toward the ICU. I was becoming more confident in my skills, and I wanted to accept that next challenge. But was I ready?
The question of whether I was ready for the ICU tumbled through my head regularly!
Plus, I had a lot going for me already
I was comfortable in my unit.
I had been specialty trained,
I had been a preceptor,
I even stood on committees.
But I needed more; I was itching to grow my knowledge as a nurse.
I wanted to work where the ability to care for patients was at my fingertips. I wanted to be the one that knew how to care for my patients no matter how sick they got.
Maybe you have felt like I felt. I'm in a great spot; I'm comfortable and learning! Why can't I shake this desire to try something that challenges me?
But when you think about it long enough, it is clear that what you want sits outside of your comfort zone.
So I applied to the ICU. I remember the day that pushed me to do it. I had received a patient admitted from another facility who apparently was septic. The patient's blood pressure was dwindling. My fluid boluses and albumin didn't seem to make any difference. The pressures were not doing well; the patient needed dialysis but could not tolerate it (especially with MAPS in the 50s!) I felt like my hands were tied, I could not do vasopressors on my floor, and I could not do CRRT. I wished that I had the equipment and experience to care for this patient in the way they needed. This type of situation and needing to transfer happened frequently on my unit.
When I applied, I was not really sure what my odds were or how soon I would hear back. Well, surprise! I got a call two days later for a "random screening," and shortly after, I got it…. I got an interview.
The interview was intimidating (but what interview isn't)?! The best advice I could give would be to talk to your supervisor, give them a heads up that you are applying. Mine gave me some great pointers and even shared with me what scenario questions might look like. Also, realize that when answering scenario questions, the interviewers want to see how you think. They want to see how your mind works. You won't know every answer, but give details as to why you say what you say and what brought you to think that way. You are a nurse; draw from your experiences!
The next day, I'm at Home Goods; I got the call. I had been offered a full-time ICU position! I was so excited and also terrified.
I thought the ICU would be amazing.
Yep - It's Amazing
The ICU is everything I thought it would be, plus more. There is so much to see, so much to learn.
When you have a complex patient in need of blood pressure support, CRRT, even ECMO,...look no further; you have those resources and trained staff to accomplish these things! You have the honor of caring for the sickest of the sick— the rarest and most complex. Your patient's blood pressure is low - you have vasopressors to use. Their heart is not working as efficiently - you can start dobutamine. A patient needs a balloon pump - we got those too! There is nothing more fulfilling than knowing that if something goes wrong or a patient crashes, they are in the best and safest place for that to happen. There is an ICU provider team, respiratory therapists, and vascular access specialists to support this patient alongside you. ICU seems to be a place that learning never stops. Some nurses have been in the ICU for 30 years who continue to learn and see new things (CRAZY!).
For someone who strives for opportunities for growth, this is the place!
Here are the steps
When I first got the job offer, I felt like I needed a book that was basically like "ICU for dummies" to look dumb in front of my preceptors. If you are looking to transition to the ICU, too, here are my thoughts from my recent transition.
First - DON'T STRESS. Ask Your Questions
I don't even know how many times I was worried about asking a dumb question. But, if you think that your previous nursing experience and some youtube videos could ever prepare you for the ICU, there is no way. Luckily, your new team respects their work enough to understand how hard it is and help you along the way.
ASK THE QUESTIONS. Orientation is a great time to ask questions, but even after, ASK! Consider working in a teaching hospital, where doctors, nurses, PAs, and NPS are used to teaching in their daily rounds. Knowledge is power; asking and learning grow you as a nurse.
You will learn so much more by living through situations and having the ability to ask questions. The reason you have an orientation is to have another nurse with you, to be that resource to ask questions and show you the ropes. You can read about procedures and know policies, but doing them in real-time is so beneficial.
Second - Jump In
The best advice I can give is JUMP IN. When a procedure or task is being done in another room with another patient, watch and learn from other nurses. I remember a liver transplant had just arrived in the ICU from the OR. I remember assisting the nurse and doctors settle the patient. I was watching how all the nurses had tasks to assist with the arrival of the patient. I decided to draw labs since I knew how to do that. As I drew labs, I took note of the other tasks the nurses were helping the primary nurse with. Hours later, this patient started losing a lot of blood. Nurses were hand-pumping blood, and soon they transitioned to MTP. I remember thinking, "better jump on in". I became the runner, so I ran down to the blood bank to gather the many blood and products. While I was verifying the blood with another nurse, I would look around again... This procedure was running like a well-oiled machine! It was only a week later I found myself in a similar situation with a liver transplant. I was sure glad I had been in a situation similar before it was my own patient!
Third - Help Out
HELP OUT! Get some experience by helping a fellow nurse! I learned so much by trying to immerse myself when I could.
Know when to ask for help.
My preceptor once said, "great nurses that are 25 years into their career will continue to learn something every shift." Great nurses aren't the ones that think they know everything. Great nurses are the ones who are open to the new lessons each shift has for them.
Fourth - Remember the ICU is a TEAM
You are a member of a team. When the ICU gets an admit, it's all hands on deck. Things happen rapidly, and it's hard to do them all with only two hands. It builds team morale when everyone helps one another. If you are caught up, make sure you check with your fellow nurses, can I offer any assistance? I would not have made it through my most challenging moments without the proactive help of my team.
Fifth - Show you are Detailed and Diligent.
Be detailed and diligent. The patients are so complex. There can be 100 things going on at once, but be diligent. What is something that can help you be more organized? For me, it was looking at other ICU nurse's report sheets and making one of my own from their ideas. When I first transferred, this helped me focus on tasks by the hour and also assisted me in giving a thorough report. Do what you need for your brain to learn their systems, even if it is double work for a while.
You Got This
Transferring to the ICU has grown my knowledge and confidence as a nurse. I learn something new every day, and I love being challenged.
ICU stole my heart, and I think I found my niche. If you are thinking of a possibility in ICU, I encourage you to try a shadow shift and maybe even apply. You never know until you try; you got this!
If my story resonates with you as a nurse, follow the EARN blog for more from local nurses. EARN has a vision to precisely match RNs and NPs with the positions and organizations that fit your skills and personality. The right fit means everything.
Hi, I’m Vanessa RN BSN PCCN; I am so excited to be a part of building a better way for RNs and NPs to be precisely matched with nursing positions that really fit them. I’m fueled by almond milk lattes ☕️, especially after a good workout at F45💪🏼, and of course wine 🍷