A CAREER IN CRITICALCARE NURSING
BY MICHELE WOLFF, MSN, CCRN, RN
At a recent NSNA convention,hundreds of students visitedthe American Association ofCritical-Care Nurses (AACN)
exhibit where they shared their reasonsfor considering a career in critical carenursing. Many said that they love thepace and excitement critical care offers.Others said that they like the idea ofworking one-on-one with patients andfeeling that they are making a differ-ence. One student who works as a nurs-ing assistant in the ICU, said that shelearned how to cry, laugh, pray, andrejoice.
Are you considering a job in criticalcare? Did you know that more andmore hospitals are developing newgraduate internship and orientationprograms? Just a few years ago, it wasnearly impossible for new graduatenurses to get a job in critical care. Now,opportunities for new graduates towork with critically ill patients aregreater than ever.
I began my nursing career in a criti-cal care unit, and have never lookedback. My background in critical carehas helped me in countless ways as Imove through various phases of mycareer. I chose critical care for many ofthe same reasons students today aredrawn to critical care: for the challenge,excitement, and adrenaline rush of theICU environment. I loved constantlylearning new things, working withcomplex equipment, and keeping upwith the latest technology. The lowpatient-to-nurse ratio allowed me toassess and provide more individualizedcare for my patients. I admired andrespected the experienced ICU nurses
who artfully balanced the efficiency ofcompetent care with genuine compassionand caring for their patients and families.
My first job as a new graduate wason a pediatric-cardiac care step-downICU. Like many new graduates, I hadbeen advised to work in an adult med-ical/surgical area for at least a yearbefore specializing. When I was offeredthe pediatric job, I decided to give it atry. I found my first year very challeng-ing, and even discouraging at times. Ithought I had learned a lot in school,but there was so much I did not know!One of my greatest survival strategieswas to not let myself get overwhelmed.I learned to concentrate on the mostimportant information and revisit a sub-ject repeatedly until I understood thebig picture. Throughout my career, Ihave used this technique and I stilllearn new things every day. This con-tinual growth and learning is what hashelped me to achieve many of mycareer goals.
After working in the Step-Downunit for several years, I was ready for anew challenge. Although I was a bitintimidated by the activity and noise ofthe busy pediatric ICU (PICU) envi-ronment, I took a job as a staff nurseworking the night shift. The more timeI spent taking care of critically ill chil-dren and their families, the more Iloved it. I particularly liked the chal-lenge of using my assessment skills andknowledge of physiology to help medetermine my patients needs. I was for-ever moved by the times I providedcompassionate care to families facingthe death of their precious children.My greatest rewards were the visits,
cards, and photos of the PICU graduates. I often found myself filledwith emotion when I marveled at howmy frail little patients had grown up tobe so healthy, strong and full of life.
After a few years of working in theICU, I challenged myself by volunteer-ing to teach in a hospital continuing-education program. I was terrified atfirst, but once I got over my stage-fright, I was hooked! After several yearsof teaching classes whenever I could, Ibecame the PICU educator. I was excit-ed about applying my knowledge ofpatient care and teaching in a wholenew way. I loved the opportunity tohelp both new graduate and experi-enced nurses.
With encouragement from mycoworkers and manager, I went back toschool for my MSN. Soon after I grad-uated, I became the clinical nurse spe-cialist for the PICU, where I had manyopportunities to pursue activities relat-ed to pediatric critical care. I taught atregional and national conferences; act-ed as regional faculty for the PediatricAdvanced Life Support program; servedon regional and national AmericanHeart Association committees; wrotechapters in pediatric textbooks; actedas research coordinator for multicenterstudies; acted as legal consultant inmedical malpractice cases; and madepediatric home health visits. One of mygreatest challenges was deciding whichactivities I could fit into my busyschedule!
A few years ago, I decided to makeanother change when I began workingas a clinical practice specialist for theAmerican Association of Critical-Care
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Nurses. I found that my critical careknowledge base helped me meet thechallenge of developing products andservices for critical care nurses. Ienjoyed learning about many newaspects of intensive care nursing forchildren and adults. I soon realized thatcritical care extends beyond the doorsof the traditional ICU, to anywherecritically ill patients need the special-ized skills of ICU nurses. This may bein the cardiac cath lab; emergencydepartment; post anesthesia recovery;telemetry unit; neonatal ICU; pediatricICU; and even medical/surgical unit orhome health.
When I was a nursing student, Idreamed about someday being a profes-sor of nursing. After 15 years of work-ing in many exciting and rewardingjobs, I recently accepted a position as afulltime faculty member at Saddleback,a community college. I am excitedabout the opportunity to work closelywith nursing students by helping themshape their nursing practice and makeinformed career decisions.
As I reflect on my career, I realizethat my decision to enter critical carenursing provided me with many won-derful and exciting opportunities. Ibelieve that my love for learning andmy willingness to take risks and try newthings have helped me keep my nursingcareer exciting. Connecting withstrong, visionary, supportive mentorsprovided me with positive reinforce-ment and the courage to say, yes, I cando it, even when I lacked self-confi-dence. I now know that my futurecareer choices will continually challengeme with new and exciting ventures.
My advice to student nurses justbeginning their careers is to follow yourhearts and let go of your fears. Trustthat you will make the best decisionwhen the time is right. As you thinkabout your future, consider the follow-ing questions:
Do you love to continually grow and learn?
Do you enjoy the challenge of correcting problems?
Are you fascinated with the latest technology?
Would you like to work with families dealing with major life crises?
Do you see yourself trying a variety of different jobs in your nursing career?
These are all excellent reasons toconsider critical care. Keep in mind thatyou can work in a variety of settingsand get critical care experience. Try notto limit yourself when you are lookingat available job openings. Look at themall and consider the ones that feel rightfor you.
Before taking that first job, thinkabout the following suggestions:
Take the time to reflect on yourindividual strengths and weaknesses.Choose the area that truly appeals toyou. Dont follow the advice of otherssimply to please family and friends.
Look for hospitals that structuredorientation programs designed to meetthe unique learning needs of new gradu-ates. Dont sell yourself short seekinstitutions willing to invest in you bypreparing you thoroughly to care forpatients on you own.
Orientation programs are excellentfor networking, providing the opportu-nity to meet other new nurses; thebonds you form during orientation willlast your entire nursing career, and thispeer network can provide you with thesupport you need as you deal with thechallenges of transitioning from studentto practicing nurse.
Consider joining a professional orga-nization in your nursing specialty. Nurs-ing organizations provide you with thelatest resources you can use in yourpractice, and are a great addition toyour resume. Attending local meetingsis a great way to meet other motivatedand proactive individuals (ConsiderNSNA Sustaining Membership afteryou graduate a great way to stay connected).
Finally, look for a mentor or a rolemodel. Having someone who can helpencourage, guide and advocate for youhelps you to grow and learn in yourcareer. There are many experiencednurses who would be honored to beasked to serve as such an important partof a young nurses career. Many times,the greatest hurdle is finding thecourage to ask!
Wherever you do decide to take ajob, enjoy it. Try to learn somethingnew every day. Never let yourselfbecome victim to negativity burnout,and complacency. Dont ever forgetwhat special gifts you have to offer yourpatients, families and yourself!
The author is on the nursing faculty, Saddleback College, Mission Viejo, CA.
RESOURCESANA Nursing Career Information
AJN Career Centerwww.nursingcenter.com/CAREER
Career Development Serviceswww.travcorps.com
Career Choice Assistance www.jobhuntersbible.com
Healthcare Career Help www.monsterhealthcare.com
Health Career Informationwww.healthcareers.com
Healthcare Career Site www.healthcaresource.com
Wall Street Journal Career Information http://www.careers.wsj.com
ADDITIONAL READINGBridges, W. Job Shift: How to Prosper in
a Workplace Without Jobs. New York,Addison-Wesley Publishing Company,1994.
Case, B. Career Planning for Nurses.New York, Delmar Publishers/NationalStudent Nurses Association, 1997.
Federwisch, A. Career shaping:Turning your job into the one you want.Nurseweek 12:7: 1,9, August 23, 1999.
Hobbs, B. H. Taking charge of yourcareer. AJN 98:1:36-40, Jan. 1998.
Newell, M., and Pinardo, M. Reinventing Your Nursing Career: A Handbookfor Success in the Age of Managed Care.Gaithersburg, MD, Aspen Publishers,1998.