Critical care as an NQN: The pros and the cons.

Nine months ago I nervously but excitedly went to work or the first time in my new job as a newly qualified staff nurse in critical care. Whilst a student weighing up my options for my first job, I was frequently offered conflicting advice from already qualified nurses; some saying to get more experience on the wards first to consolidate your learning before heading to a specialist environment, others saying to go straight into critical care if that is what you’re passionate about. I clearly followed the advice of the latter and now I’ve got the best part of a year as an NQN behind me, I’ve decided to take some time to reflect on the pros and cons I’ve experienced from starting my career as a critical care nurse. 

I suspect there are many more pros and cons than what I discuss in this blog, but to keep things simple I’ve decided to pick three of each based on my own experiences which have had the biggest impact on me personally over the past nine months since starting in my role, and here’s what I came up with:

Pro #1 – The supernumerary time

I had about six weeks supernumerary time before going into the numbers (I know this will vary from trust to trust – I have heard of some critical care areas offering up to twelve weeks), much more than I know many of my colleagues have received in other clinical areas. This gave me a good amount of time to become familiar with my surroundings, the equipment, the staff, and to develop my own routines before taking patients on my own. I certainly found this time invaluable and was a huge factor in helping me feel confident in stepping into my NQN role.

Con #1 – Information overload

Wherever you go as an NQN, there is going to be a huge amount of new information to take in unique to that area; new colleagues, new skills to learn, new pathologies, new medications, new IT systems, and the list goes on, and critical care is certainly no exception to this rule. One example is we have ventilators which require an enormous amount of learning to operate and maintain safely, another is the medications which aren’t used in ward areas, such as inotropes which can have severe consequences if administered incorrectly. I personally found this not only hard to take in because of the volume of information, but also because of the responsibility that comes with it and the consequences of getting such crucial things wrong.

Pro #2 – The staff support

Nurse-patient ratios in critical care are generally 1:1, or 1:2 depending on patient acuity. This means there are a lot of staff around you all of the time which, personally, I think has been amazing as there is always someone around who I can ask questions to when I am unsure about something (which is pretty much all of the time!). At the end of the day, they were once in my position and had to learn from scratch as well.

Con #2 – It’s a niche environment

The main reason I was often told to get ward experience prior to going to critical care was to consolidate my learning as a student in a much more general nursing role. Reflecting on this, I have to concede they made have a good point, at least to an extent. A lot of what happens in critical care is unique to that environment, and there are certainly some skills I have not done since I was a student. Perhaps six months or a year on the ward may have enabled me to find my feet faster. However, at its core, I have found the fundamentals of holistic patient care are still exactly the same in critical care as they are in any other nursing setting, it’s just the practical skills that are different, and, in many ways, I actually found I am much better able to deliver care up to standard that I am happy with as we have all day with one patient, something I know many of my colleagues struggle with in areas where they are caring for many patients.

Pro #3 – The learning opportunities 

As I have already alluded to, there is a lot of things to learn when starting in critical care. As a result, or at least where I currently work, this means I have had a number of educational sessions to help get my head around all this information. Additionally, we are also a melting pot of patient groups; one day I may be caring for a patient with acute pancreatitis, the next I’m looking after a polytrauma patient. As a result of this, every day is very much a school day, and nine months in I’m still learning more each day.

Con #3 – Lack of patient consistency can make it hard to find your feet

Having just in my last point praised how having lots of patient groups is great for leaning, it can also have a negative side: you are constantly reminded of how much you don’t know. In other areas where you may end up looking after patients with similar conditions and you become familiar with many of the needs of these patient groups. In critical care I have found, especially in my first six months or so, it very difficult to get into a rhythm as every day I need to understand something that I have never seen before and that is something that can only come with time and experience.

So there you have it, my own top three pros and cons from being an NQN in critical care, there are of course many others, and please do add your own to the list! I guess the question I have to ask myself now is: If I could speak to my student nurse self, would I encourage younger me to go straight into critical care for a first nursing role? Definitely… maybe. Do I feel I could have benefited from working in a more general role first? Probably. But, do I love what I do and, now that I’m starting to find my feet, do I feel confident as a critical care nurse? Absolutely. Each person is different with different strengths and experiences and it’s up to them to decide what NQN role is the best option for them.

Michael http://www.twitter.com/DrMLJCarter

Published by RCN Newly Qualified Nurses

The voice of newly qualified nurses within the Royal College of Nursing. Providing support from six months pre-registration throughout preceptorship.

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