3 years ER experience 4 weeks of CC training. is this enough?

[apaol17]

Hey guys -

 

Ive been doing ER for 3 years where i am the sole PA on the overnight shift. its a 1 doc/ 1 pa show. we cover both main ER and fast track. I was just offered a position as an ICU PA for overnights. its a 24 total bed floor with a mix of SICU/MICU/CCU. they are offering to train me for 4 weeks on days but if i don't feel comfortable they will offer me more training. in your experience as an ICU PA on the overnight, do you think this is enough? I will be the sole provider there with an intensivist on call who can be reached by phone and can drive in if need be. apparently, as of right now its a nurse run floor only. they are used to not having anyone covering the night shift. 

[charlottew]

Wow, 24 ICU patients overnight with no one around to write orders? I guess there are no admissions overnight?

 

I work ICU overnights, one of the units is solo coverage - 9 bed SICU, with a very experienced nursing staff. The bulk of the work is admissions; the rest of it varies depending on how stable everyone is. 

 

I would say that if you are comfortable with vent management, managing hemodynamic instabiity/sepsis, ABG/acid-base, fluid management, can place central and arterial lines, plus have an experienced nursing staff and someone you can call, it should be fine.

 

If they were managing alright with no-one there to write orders overnight, then having someone around should only make things better. Right?

 

ps. you don't mention your past experience aside from the 3 yrs in the ED. Is this your first job out of school?

[apaol17]

statistically there are no more than 3 admissions on the overnight according to the Doctor offering me the job.

 

my ER job was my first job out of school.

[charlottew]

OK, I don't know you or anything about you really, but it seems like a reasonable task. Learning ICU care will be a bit of work, 4 weeks seems a little short but you haven't related in any detail how acute the patients are or how unstable (and perhaps you don't know).

 

I recommend Marino's ICU book, as well as an UpToDate subscription. With those two in hand plus experienced nurses plus someone to call, you should be alright. 

 

I presume you're interested in ICU work? The mentality is fairly different from the ED outlook.

[polarbebe]

I agree with charlottew posts above and add that in 4 weeks you can become proficient with procedural part (and basic understanding of vents, vent troubleshooting, ABG interpretation, etc.) but that does not make a critical care PA.  It is the learning of the management (many complex multi-factorial reasons for shock and multi-organ failure and how one organ system affects another) and the depth of knowledge (really understanding the pathophysiology will help you problem solve these complex patients) that takes years to learn (an experienced SICU PA that the chief residents often ran things by had said it took him 10 years to fully understand critical care).

 

If you are the type of person who wants a significant professional challenge, can read up on their own time, attend conferences, be pro-active then 1 month (or if you have significant experience in the main ED handling respiratory failure with invasive or non-invasive, running codes, handling acute strokes, massive GIB, etc.) then the 1 month may be "ok" but not ideal; you will have a very steep learning curve, you will feel like a fish out of water but... your experience and the knowledge you will learn will be invaluable and make you an extremely skilled and desirable PA wherever your work.

 

I have close to 5 years of full-time critical care experience and 4 years of emergency medicine experience part-time.  Both specialties have significant overlap and really expands your career options.