My Nurse Specialty

Ep 6: When Every Second Counts: A Nurse’s Life in Critical Care with Jaclyn McPheeters

• Rebecca Emery, RN / Jaclyn McPheeters • Episode 6

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In this episode of My Nurse Specialty, I talk with Jaclyn McPheeters about her path into critical care nursing and what it really means to care for patients in the ICU. She shares how a powerful early experience as a CNA led her into this specialty and why critical care requires both technical skill and emotional resilience.

We also talk about what ICU nursing looks like day to day, the level of critical thinking it demands, the importance of teamwork, and why this specialty can be both deeply rewarding and incredibly intense. Jaclyn also shares advice for nurses considering this path, including shadowing, onboarding, certifications, and the many ways critical care experience can open doors later in your career.


In This Episode, You’ll Learn

  • What critical care nursing really looks like beyond the patient ratio.
  • Why emotional resilience and teamwork matter so much in the ICU.
  • How ICU experience can lead to growth in leadership, advanced practice, and beyond.


About My Guest: Jaclyn McPheeters, MSN, APRN, FNP-C, is a board-certified Family Nurse Practitioner with experience in critical care, internal medicine, urgent care, skilled nursing, and nursing education. She brings more than a decade of high-acuity critical care experience to her work and is known for her patient-centered, compassionate approach. Jaclyn is also a former Assistant Professor of Nursing and the founder of Nurse Education & Empowerment LLC, where she supports nurses and nurse practitioners through education, coaching, and professional development. She is active in nursing leadership, healthcare quality improvement, and community engagement.

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SPEAKER_01

Welcome to Minor Specialty, a podcast for nurses who want a clearer view of what's possible in this profession. I'm Rebecca, a registered nurse, nurse career strategist, and someone who has spent decades working across different nursing roles. Nursing School teaches us how to pass boards, but when it comes to careers, most of us are introduced to only a handful of specialties. It just depends on who you talk to after you get out of school or while you're in school. And then we're expected to figure out the rest on our own. That lack of awareness is where confusion and misalignment begin. This podcast exists to expand that awareness. Throughout this podcast, you'll explore nursing specialties, some you've likely heard of, and some you may not even know exist, along with the insight to help you understand what's best for your career at any stage. This is Minor Specialty. Real nursing, real stories, and real possibilities. Hi everyone, and welcome to Minor Specialty Podcast. I'm your host, Rebecca Emery, and today I am joined with a nurse that we'll be talking with about what her specialty is. So if you wouldn't mind, if you can introduce yourself and talk about what is your specialty.

SPEAKER_00

Hi, so my name is Jaclyn McFeeders. So I'm in critical care nursing. I am currently a board-certified family nurse practitioner. I have over 15 years of experience just spanning across critical care setting. And then currently I am working in a skilled nursing facility as a family nurse practitioner. I do have a background in internal medicine. I've done primary care with that in the uh I've done skilled facility. I've taught previously in med surge nursing, and then with a focus in critical care and then capstone for BSN students. But um, yeah, critical care background I know is what we're kind of focusing in on today. So yeah.

SPEAKER_01

The life of a nurse for sure, right? And all the other nurses to do and deciding where to go. And part of this reason for this podcast is to show nurses where you can go with the exposure, because in nursing school, we only get four, maybe five um specialties that we're exposed to. And how are you gonna find out all that's available to you? So that's what this podcast is actually meant to do is to show a nurse all the pathways. So thank you for sharing all of that. So tell me though, for so we're special the ICU, right?

SPEAKER_00

Is that and stands for because I'm gonna put it out there for well, it's intensive care nursing, so critical care nursing. There's different types of critical care areas. So even within critical care in itself, you could actually be super specialized. So I've always worked in what's called medical ICUs, but there's also cardiovascular ICUs, so heart patients, there's also surgical ICUs, so surgical patients, there's neuro ICU. So even within critical care, you could be hyper-specialized even beyond just that. So within a medical ICU, which is where I basically lived before I became a nurse practitioner, I've seen actually a little bit of everything. You dealt with patients with just super complex conditions. So a lot of patients with sepsis, a lot of patients you get like the overflow from like the cardiac area. Like uh, I feel like half the population has uh cardiac issues. So you do deal with like different shock states, like so cardiogenic shock and so forth. So you do see a little bit of everything. I personally worked in three different facilities as a critical care nurse. So I worked in two community type hospitals. And then I actually worked in a tertiary center in medical ICU. So even like the level of acuity of what those facilities will see is very different. Like the job, even within that, is just very different based off the acuity. They're very the people are very, very sick in all facilities if you're in an ICU setting. Because what does that mean? When you're in critical care, you're going to critical care for expert nursing. That's what you're there for. It's usually a one-to-one ratio for a patient, a two to one ratio for a patient. Very seldom is there a three to one ratio. And I think that when people hear that, they might automatically think, ooh, that's easier than maybe like floor nursing, where you're having five, six plus patients, right? But we what you have to understand is the patients that you're being assigned are so medically complex, you're not like leaving the room. Like those patients are are trying to die. So your role is to literally have that like adrenaline rush rush through you as a person, and you are actively titrating drips to different parameters. And this can happen every like three minutes where you're changing a medication, doing medication dosage adjustments on not one drip, but multiple, multiple drips. You have patients that are on ventilators with either endotracheal tubes or tracheostomy tubes, a lot of advanced lines. So it's not just traditional IV lines. You have different types of central line access. Sometimes patients are having central line access plus maybe dialysis access. Maybe they're on continuous dialysis, that you, as the nurse, are also doing continuous, like hourly intake and output and making adjustments on a dialysis machine just to keep the patient at a normal, like fluid balance, whatever their parameters are set for. Just because you have a smaller ratio of patients, it is very intensive, hence intensive care nursing. It's very intensive nursing. So when you're going into a critical care setting, it's because you need that expert nursing care. So there is a lot of technical things that you have to master and learn and be very comfortable with compared to like working in a med surge ward or even a telemetry floor.

SPEAKER_01

Yeah, that sounds like, you know, I'm glad you talked about that with the one-to-one being the ratio, which can be attractive to a lot of nurses. And I do, you know, I coach a lot of nurses, and I'll always start with like where do you want to go? And a lot of them will say, I see you. And I think it's what they're exposed to early on, thinking, okay, I want to do that. So I'm glad that you are talking about that.

SPEAKER_00

Yeah. So when you're working as a nurse in critical care, this is at least how my brain would operate, right? Like it's as you become, you know, going from a novice, which I actually started at an ICU to what I would say expert level, when you go through that novice to being proficient, to being, you know, competent and then becoming like expert, you actually like really in-depth from getting shift report, like you understand your patient in a very deep way. What I mean by that is, gosh, after my first year, like if you could ask me my patients, I could like in essence recite what their CBC says, like verbatim, like their hemoglobin's 8.9 right now, their white blood cell count is thir 13,000. You know, you could actually like from memory go through it because you actually learn your patient very, very deeply to actually know how to take care of them and then anticipate all of the different things of what is maybe gonna go wrong with that patient during that shift. It's it's kind of like playing chess. You have to try to anticipate worst-case scenarios and different things that might happen during the course of the shift. So it's a very dynamic practice, really, and everything can just change on a dime, and it does change on a dime. You know, one hour your patient appears to be stable, the next hour they're coding, the next hour they're fine again, the next hour, like it's just very tenuous.

SPEAKER_01

So it sounds like you have to stay a step ahead, and like what you're talking about anticipating what can happen in a shift.

SPEAKER_00

Yes. So it definitely takes a great deal of critical thinking when you're working in critical care. So it's yeah, you you have to, in order to really take care of these patients, you just have to always be thinking like one step ahead and trying to plan for the worse and wishing for the best kind of thing. How did you get into this? So I actually was a CNA. I worked on a telemetry unit and I was actually pulled to the ICU when I was working the telemetry unit. I actually didn't like the telemetry unit that I was on very much. Um, but I actually had a situation in which there was a 25-year-old male that was a heroin overdose that coded multiple times during that shift. And I was a CNA there, pulled to that unit. And honestly, being part of that experience, which was horrific, it was very emotional. It was horrific, and the patient did expire. But like being part of that team process and seeing how those nurses, I was just so impressed. I'm like, wow, like this is what I want to be. Like, this is what I want to strive for. Their level of teamwork, their level of critical thinking. It was just like like clockwork. Like they they just worked together so insane. And I was just like, I want to be part of this team. So the very next day I actually put in for a transfer. So I went there into ICU as a CNA, which was great exposure just to see, hey, if this is actually what I'd like to do. And I learned a lot of things working as a CNA through nursing school. And I did a nurse externship over the summer where I was worked as a, you know, nurse extern in that ICU that I had also been employed in. And that was great exposure over like the course of the summer. And then essentially when I graduated, I applied for a job in that same ICU and I was hired on as a new graduate. So that's how that came to be. I never think that I don't know that I would have ever necessarily if I didn't have that experience, like chosen to go that route. I didn't even really know that that route existed or what that looked like. But I mean, I I really left it. It's a very hard and taxing job, especially like emotionally. Like I would be lying if I, you know, didn't tell you that I had countless times where I literally would just get into my car after 12, 13 at plus hour shift, and I would just ball my eyes out because you would have 25-year-olds that died during your shift, and it is tragic. And you're supporting that family, and it's it's just incredibly emotional and sad. So that kind of brings me to talking about what I would say is probably the hardest part of the job. And I think that is having that emotional resilience. I as a within the first year or two of nurse, I actually almost quit like several times, like almost every shist. I feel like it was a lot. And I would be lying if I didn't say that I was overwhelmed. I did seek professional help to like process some of the things that I was seeing. And I did, I do think that I actually experienced PTSD during that transition as an R. And I do think that it's a very emotionally hard job. And it's not definitely not for the faint of heart. But I think that if you learn the coping skills that to really survive in that field, I do think that it is a beautiful thing. And I do think it's a very rewarding career, especially if you enjoy really getting to know your patients very, very deeply. And you enjoy like learning like analytical skills because that's very much needed to succeed and to be good at that type of nursing.

SPEAKER_01

Thank you for sharing that. Yeah. Do you know if like hospitals offer those kind of resources for nurses in these specialties?

SPEAKER_00

I think every hospital system I have ever been in, yeah, they have some sort of like employee therapy that they do offer to help nurses with that. I do think that working in a good, healthy ICU environment, there's a lot to be said about having a good nurse leader. I think that that's like paramount to like your happiness is really having a leader that understands what it is like a day in the life and understands that emotional toll. Like I've had great leaders, I've had also not so great leaders through the unit. And the whole way that the unit feels is very different depending on the type of nurse leader that a person has.

SPEAKER_01

Yeah, and you know what's important. I mean, we are human, we do thrive in in areas, but yes, you're gonna have those days that are hard and learning those skills. And yeah, my hope was yes, that hospitals do offer this for nurses. I know a lot happens with as far as debriefing, too. You're saying that yeah, and having that leader that recognizes the need for doing that.

SPEAKER_00

Yes. So I also I know we're not gonna kind of speak very strongly into this necessarily today, but in part of like my ICU role, I was also on the code team and rapid response team. And debriefing is a very big piece of that, especially for you know, floor nurses that they don't get codes necessarily all the time, as you do maybe in an ICU setting. So that is it can really impact them emotionally. So I'm also becoming good at debriefing and doing a check-in to make sure that that the staff is okay is really a big piece of that too.

SPEAKER_01

What is the most rewarding part of being in the ICU in the medical setting?

SPEAKER_00

Gosh. Seeing patients get better. There are a lot of patients that don't make it, but there's also a lot of patients that do. And that's like super rewarding when you work over the course of a week and the patient that you cared for on a Monday by Friday is maybe extubated without like a breathing tube, and maybe has been weaned off all the drips that they're on, and are maybe sitting in a chair and actually like transferring out of the unit. And that's a super rewarding experience because you actually get to to see them do well. So I think that's rewarding, especially like I was I mentioned I was part of medical IC, like that's where I kind of lived. There was a lot of overflow. I would say that being in a community setting, you had like a lot of different mixes in there too. So you'd see like the surgical patients, which oftentimes would do very well. So that was like a rewarding experience. Like they're sick, but it's most of them did get better that you would see, especially for like some of the more complex, like elective, maybe like lung surgeries and stuff like that. So that's very rewarding. And then I actually think like that I really enjoy being part of like healthy team dynamics. Like when you work in a felty ICU environment, you're almost like you feel like you're with a second family, where you're feeling like you're amongst friends. And you do need that teamwork to literally survive and for that unit to thrive. You maybe have literally patients that are crashing, and you have, you know, six nurses in the room, each doing something. Like it's just like complex. And I actually really enjoy that. And I had I've always worked with like honestly the best nurses. I've been like so blessed, like best nurses that you could have ever in all environments, like work with. So I loved that piece of it.

SPEAKER_01

Yeah, that's definitely another part of your nursing experience is who you're working with and knowing that you rely on them, right? Yes. So you started in a pathway where you know you started as an aide and went over there. But if if someone's never been over there, but this podcast, let's say, resonates with them or thinking that's you know the kind of nurse I want to be, what recommendation would you give them?

SPEAKER_00

Yes, I actually always recommend job shadowing. I think that honestly, most unit managers are probably pretty open to that, even if it's for a couple hours during a shift. So even as a student, you might be able to try to reach out to a nurse manager or say, like, hey, I'm super interested in this area and I want to see if this is like the right fit for me. Can I do some, you know, job shadowing of some kind? And I actually think that that's important too for people that are new with the registered nurse license and maybe even work in an area and you're thinking of transitioning out of another area into that. I think that it's good to like job shadow even for a shift before accepting a position. Because with honestly anything, I think that like is across the board, not just ICU, just to see if you think that you would like it and if the culture of the unit feels good, like if you get that like good gut instinct about working at a place, I think that's like super important. I do think that if there's an externship available, I think that's an amazing route too, because you're being paid to have like an extra clinical experience, yeah, under your belt. And um, if anything, if even if you didn't like it at the end of the day, it's a great resume booster. It is a stopping stone.

SPEAKER_01

So right, and avenues to maybe other areas that you may have considered. So okay, but like starting, you started right off the bat as a new grad. I did. But looking back on that, is that something you would do again or great that it worked out that way, or what would you tell a nurse that is brand new?

SPEAKER_00

So uh personally, I think that if that is what you want to do, do it. Get the training. Like most places have a very great onboarding if it's a good, you know, hospital facility. It's usually a longer onboarding because there's so many different things that you do have to learn. So onboarding should be anywhere from like two at minimum to three plus months for a critical care nurse. It is a lot of orientation, and it meant to be that way for patient safety because there's so many different things you have to learn. You do need to know how to be a very comfortable and I would say like competent level for reading EKG strips, which I think for some nurses is seems to be like just more of a challenging skill, especially straight out of school, because they don't necessarily hyperfocus on all the nuances that you do need to know to safely care for patients. You know, taking some sort of advanced telemetry course that would be very beneficial. I know for working in healthcare, you have to be BLS certified. In ICU, you have to be advanced life support certified or a ACLS. So that is actually a great course to take if you're looking to get into this. As you advance in critical care, you can actually also get a certification, which is a another board certification. And that's called a critical critical care nurse, like CCRN. There's actually an association for critical care nursing, which is like, in my opinion, which I'm a little biased, like the best association ever. But you could, as there's different criteria to you can't go from being uh, you know, registered nurse to then studying and taking like a CCR on board. There is a which I don't recollect what the criteria is off the top of usually hours, I know, for like all the board certifications.

SPEAKER_01

You have to have so many hours in that specialty and it translates to years that you know before you sit for that.

SPEAKER_00

Don't quote me on an MIB three. I I don't recollect off the top of my head, but you have to meet criteria. But even studying for that board, you learn so much. So I've taken three boards since I have become a nurse. I was like, you know, my registered nurse, my CCRN, um, which I no longer hold just because I'm not in that environment. Like an alumnus is what it's called, CCRN alumnus, or my uh family nurse practitioner degree. And out of honestly, out of all the boards that I took, I actually think that that was the most difficult that I took.

SPEAKER_01

So wow, yeah, I can see that probably, but I'm glad you brought up the organization. Because that is a good way for nurses to see what you know, the articles that they're putting out that are good articles about the specialty and what's happening and keeping up with, you know, all the changes that happen in healthcare because things get changed on um, you know, how we sometimes treat a patient, that finding out that this is actually better, the data shows. So those are good to be. And I also know that they offer discounts for students. So if there's a student that's on here listening to us today, they usually can get a discount for membership. Is that correct? And in yes.

SPEAKER_00

And just also to students, one thing that I wish is just as a pro wisdom that I wish I maybe was taught from a mentor before. Okay, facilities will pay for some sort of continuing education. Like they want to invest in you. Like a good employer wants to invest in their employees. So let them invest in you. Most places do have some sort of continuing education stipend, even for registered nurses. And even if they don't, I actually think ask anyhow. Ask your nurse invest in you to retain you because honestly, like if they want to be the best in medicine for their patients, like you you best invest in your nurses.

SPEAKER_01

Yeah, no, I I agree. Yeah. Thank you for bringing that up too. Because a lot of nurses don't know that their organization offers it or and they end up paying on their own. And even if you do pay on your own and you found it afterwards, you can get reimbursed. So take advantage of that. But it's better if you ask ahead of time. And then you're right. If they don't know and they take a course and they can take it to their employer and say, hey, this is for here, my growth as a nurse here in this unit. Please can I put this for reimbursement to get paid? Yes, definitely asking about that for sure. Okay, great. All great information. Thank you. And so anything else you want to add? I I do want to talk about growth. We talked a little, we kind of touched on it a little bit, but lateral growth from going from MICU to growth that you can grow in from being in this specialty.

SPEAKER_00

Yeah. So um I think that it's kind of a mixed bag. I don't know, like statistics or what, like if you were to, you know, Google Data says nursing. So in critical care nursing, the reality is, and I just I think it does go back to the emotional impact that it definitely can take a toll. You see different things. Okay. So I it does have a high rate of turnover, meaning like maybe people will do it for a year or two, but they get burnt out too quickly. I do think that it has maybe like a uh, if I I'm not mistaken, again, I don't know what the actual stat is. Probably a quarter of people maybe work there a year or two and then burn it, um, where they need to switch just because it is too intensive to sustain them and their work life balance and what they're kind of bringing home emotional baggage and and so forth. There is a lot of opportunity. I think for growth, there is you could be like a charge nurse, which is treated differently depending on the organization. So it's type of like a manager position, more or less. So you can you can go into management, you can be a clinical nurse leader over that type of area. So I think like definitely moving up in that way. I think that the level of autonomy and the confidence and the skill set that you gain from uh being a critical care nurse, I think that it makes for great like organizational leaders where they can really um analyze and critically think through very complex problems and organizational needs. So, like I think like leadership opportunities, even beyond the walls of like an IC, I think that they make fabulous leaders uh because of that. I think a lot of nurses in critical care, they have this like, you know, quench for wanting to know and learn. I think that's on for advanced degrees, whether that be in a nurse practitioner role or maybe like a nurse seesiology type of role, just because you are dealing with a lot of advanced airways, you're dealing with a lot of ventilators and drips and sedation titrations and so forth. So it's, I don't want to use the word, but like a transition point where some people might a leadway. Yes, it's where like they have that experience and it just feels like natural to grow in that way. So, like for kind of talking through myself, I chose to be a family nurse practitioner because I wanted to be more preventative, help the patients to not end up in an ICU setting. And I want to learn how to best manage chronic conditions and have me catch these things before they end up in this like horrible state, right? So that's why I entered into primary care. And uh currently, like I mentioned, I'm like an in-house NP in a skilled facility. And the facility that I'm in is unique in that I actually manage trach invent patients within the facility that I'm in. They also take non-titratable drips. And I feel like I am very good at it because it just, you know, it just all kind of blends together and it just flows like in that way, like where I've had that exposure. So there's so many different avenues that you can take in in nursing. And that's like the beauty of the profession is you're, you know, you have your degree, but it is nothing is like set in stone, right? Like it is a very, I'm gonna use the word flexible, where you can experience different things and see just what feels right to you and like where you're you're gonna grow with passion and what's gonna make you happy and how you're best gonna serve patients is when you're happy, I feel like. But there's just so many different things. Like I have a lot of nurse colleagues that are maybe in like case management now, or even like kind of be on the bedside type things.

SPEAKER_01

Right. I mean, what we're talking about actually is like feedback. Like every time you take a role and you get the experience, that's feedback for you on what you like and where you're gonna grow. And we know a lot of nurses that want to go even into be an NP. And it's great that you're mentioning that the experience that you had kind of took you more down that road. And so you had a strategy of this is great what I'm doing, but maybe I'd rather be in that prevention part of it. Let me get my NP and do that. And then you took all that experience with you of what you did over in the critical care setting. I have a question for you. Just kind of a fun way to end it and say, my nurse specialty is perfect for the nurse who is has a big heart and is has like a want to learn.

SPEAKER_00

So always looking to learn. That's probably like the biggest thing in critical care. To be successful, you do have to be willing to and wanting to learn just because it's constantly changing. Um, like how you mentioned before, like just the practice of nursing is constantly evolving, constantly changing. And actually it's fun, like that that's what it should be. It's oh, how can I apply this knowledge and really like take best care of the patient and elevate the care for the patient and actually like save the patient because you have applied the nursing process in an elevated way. Right. Yes. It is a difficult environment also, but it's it's a very rewarding environment. Can definitely make a super huge impact for your patients, and you literally can save a life.

SPEAKER_01

Yes, for sure. And then if you choose to grow from there, you've got all that experience that you've had in those years of working in the critical area. So, for nurses listening, I hope this episode gave you a better look into the specialty. We'll put the how to get you in the show notes. Okay, thank you so much. Thank you for having me. Thank you. Thank you for listening to my nurse specialty. I hope what you heard today gave you real insight into this specialty and helped you see what's possible for your nursing path. If you're watching this on YouTube, please subscribe. And if you're listening on audio, follow the show so you don't miss what's next. If you know a nurse or even a student nurse who's learning about their next steps, tell them about the show or send them this episode. And tell me, what specialty should we feature next? If you're a nurse in a unique specialty that you'd love to share, apply to be a guest on my website. I'm Coach Rebecca. Until next time, keep exploring.