From the ICU to Primary Care: The Transition From Inpatient to Outpatient

Transitions are hardly ever easy, but sometimes changing it up is the best move.

Inpatient to Outpatient: Transitioning from the ICU to Primary Care

For the first nine years of my nursing career, I worked as in a trauma/surgery intensive care unit nurse, at a Level One trauma hospital. I started there as a baby nurse, fresh out of school and clutching my NCLEX in hand as proof (or reassurance) that I could work in such a place. Needless to say, the ICU far exceeded my expectations. I learned how to take care of intubated, sedated patients with open bellies and extensive wounds. I learned how to manage CRRT on patients with complex comorbidities.

I learned what a productive code looks like and how to avoid a chaotic one. It was a hard, all-encompassing experience at times. And while there were some tears and self-doubt early along the way, I grew to be a proficient nurse in a stressful environment. I grew to love everything about the ICU.

Now I am currently two semesters away from graduating with my masters as a family nurse practitioner. I plan to work in family practice in an office setting, far away from crash carts and codes and people with trachs who cough up phlegm. It’s a stark contrast and it’s reasonable to ask why I made such a big move from ICU to Primary Care. I’ll attempt to answer that questions as well address some of the advantages and challenges to steering my career in an entirely new direction.

So why did I decide to move to outpatient as a family nurse practitioner (FNP) instead of pursuing a career as an acute care nurse practitioner (ACNP) in the ICU? Most of the reasons are very practical and a few are more complicated.

Family

First of all, I have a family and want to work weekday hours with no nights, weekends, or holidays. I am a mother and a nurse and I believe you can do both jobs well, but I hate not getting to see my two year-old daughter on the days that I work at the hospital. I also want a slower pace with less daily stress.

After nine years in the ICU, I’m not ashamed to say that my back and my feet want a change to something less strenuous. And although I won’t be making as much in outpatient as I would in the hospital as a nurse practitioner, I decided that was worth it to me for all the reasons that I just discussed.

New Responsibility

Secondly, I want to take on a new kind of responsibility as a provider but I don’t want those responsibilities to include taking care of thirty critically ill patients (kudos to those of you who are up for that challenge!). I want to try something new and after years of dealing with the most complicated patients in the hospital, I suddenly find the idea of diagnosing coughs and managing diabetes very appealing. I want to round out my skills and family practice provides me with a whole new environment of care.

Emotional Well Being

Lastly, I will admit that I have experienced some degree of emotional fatigue. I am tired of seeing people die everyday, of taking care of the worst-case-scenario patients. Some part of me has started to believe that every car wreck ends up in paralysis and every pneumonia ends up in ARDS. I know it has been taking a toll on my family and me, so now I look forward to managing common complaints, promoting prevention, and developing long-term relationships with my patients. It’s a much-needed change that I think will provide me with a little bit more balance.

Downsides

There are some downsides to completely changing environments. One of those disadvantages is that many of the ICU skills that I’ve spent years honing will essentially go unused. It doesn’t matter anymore than I can get an ABG in one stick or that I can help with an intubation or that I can manage four pressors at once. Much of my expertise is not applicable in a primary care setting. Additionally, I will miss the adrenaline of the ICU. I will never again help run a hospital code or rush STAT to a head CT.

A part of me will grieve the loss of my first love (trauma), my first nursing job, and my coworkers whom I have grown to love with the fierceness of a family. Although I know I will come to make many new friends in the outpatient setting, I will be saying goodbye to a certain type of patient, experiences, places, and most of all, people.

Advantages

I can’t honestly tell you that I know all the advantages yet of going from inpatient to outpatient, from the ICU to primary care. I do know that I enjoy stretching myself in new ways academically, professionally, and emotionally. I love developing solid kinds of relationships with patients and getting to see their progress over time. I enjoy getting to see my daughter in the morning before I leave and getting to have dinner with my family at night when I come home. I enjoy getting to use all my new knowledge in a provider role and advocate for nursing from a new vantage point.

If you’re considering changing practice environments, you need to recognize that it will take adaptability, humility, and a willingness to learn. You may find it more difficult than you thought or better than you could’ve imagined. A big change like this means risk and you will be taking a risk in moving from the familiar to the unknown. So as a confidence booster, I will offer this one piece of encouragement: you know more than you think you do.

No matter where you started or all the places you’ve worked during your journey to an advanced degree, you’ve been working as a nurse and that means you’ve developed your nursing intuition. You know what I’m talking about.

You know when someone has an acute abdomen versus something innocuous just by looking at them. You can pretty much pick out when people are lying about their pain medications or when someone is struggling with a mental illness. You can navigate those difficult patients with ease because of my experience with high-pressure situations.

This skill is more amorphous than being able to get an IV but invaluably useful. It’s a learned skill and we’ve all worked very hard to acquire it no matter what background we came from. You’ve got the gut feeling and it will continue to steer you in the right direction as you go down a new path.

The transition from ICU to primary care has been full of growing pains and I’m sure more are to come as I become an independent provider. There are aspects that I will love and things that I will miss. But in the end, I think it’s a trade-off, some advantages here for some advantages there. At the core of it all, I get to work with people and that’s the reason that I chose healthcare in the first place- to hear, to heal, to comfort, to encourage. And now to prevent, to diagnose, and to treat.

I know that I’m walking into a whole new world that may be challenging at times, full of learning curves and inherent risk, but I believe it will be worth it. I will be a different kind of nurse, but still a nurse all the same.

And I have found that nurses are almost always up for a challenge.

Natalie is an RN who is working towards her masters degree. She is moving from the ICU into Primary Care. Natalie blogs about this move at Nurse Natalie. You can also follow her on Twitter at NurseNatalie15 and Instagram.

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