u/Extension_Nothing552

Has anyone gone from PICU to an adult MICU? Lots of adult to peds but having a hard time finding the other way around.

This month marks one year in PICU. I’m in a 27 bed unit that has more step down unit type patients. We have a handful of high acuity patients at a time & since transitioning to nights in March I have gotten more higher acuity patients. I’m struggling a bit with drama on the unit & negative unit culture/toxicity. I think part of the reason is everyone is a 20 something girl (me included!) but it’s just exhausting & very political. I have a friend in an adult MICU that loves it & feels like she is really supported. Furthermore the nurses are all different ages & have different backgrounds. My plan is to shadow there but does anyone have experience going PICU to MICU?

My other concern is my current unit gives little autonomy to nurses. Nurses that have come from other hospitals or adult icus say there is a lot more autonomy elsewhere (one example being managing drips, we do not titrate any drips). I am at least 2-3 years out from applying but trying to master hemodynamics, asking providers as many questions as I can, & trying to stay out of the drama I’m just not sure this unit is setting me up for success in the long run to be a strong applicant. Or am I still so new it just comes with time? Feels like there isn’t enough acuity to go around.

Any advice greatly appreciated

I’m a new grad PICU nurse and have really enjoyed my time in the ICU so far. As I’ve gained experience, though, I’ve started realizing how different my ICU is than other places.

I’ve noticed that many nurses who come from other places are surprised by how little autonomy we seem to have.

There were concerns I brought up during rounds on my most recent shift & the provider just disagreed with me but never came to assess the patient.

To be clear, I don’t expect providers to automatically agree with my recommendations. They’re the ones with the final responsibility for medical decision-making. What frustrates me is when concerns seem to be dismissed without discussion or reassessment. I would actually welcome someone explaining why they disagree because that’s how I learn.

I’ve also noticed what feels like a broader pattern on my unit where provider concerns are often deferred overnight and significant changes wait until day shift. Maybe that’s normal, maybe it isn’t—that’s part of why I’m asking.

For those with more ICU experience, is this common? Is it a PICU thing, a unit culture thing, or just something I’m noticing as a new grad? One of the things that drew me to critical care was the collaborative environment I observed when shadowing in another ICU, and I’m curious whether my expectations were unrealistic.