Is DOU Nursing Right for You?
If you’re interested in seeing a wide array of patient diagnoses, DOU nursing might be the specialty for you. A direct or definitive observation unit (DOU) is similar to a telemetry unit because patients here require close monitoring. As a DOU nurse, you might see patients who have just come from cardiac catheterization, or who are experiencing unstable chest pain.
DOU units are staffed with a multidisciplinary team of nurses, nurse assistants, physicians, advanced practice providers, and more. This is an acute care area, so if you’re a new nurse looking for skill-building opportunities, working on a DOU unit could be a great fit.
The patients here require fewer interventions than critical care, but more monitoring than general med-surg patients. Here are some of the diagnoses and problems you might see in a DOU unit:
- Altered mental status
- Chest pain
- Drug overdose
- Endocarditis
- Patients being ruled out for a myocardial infarction (heart attack)
- Stroke
- Seizures
- Syncope (fainting)
- Transient ischemic attack (TIA or mini stroke)
What Is DOU Nursing?
A DOU nurse works in a specialized observation unit in a hospital. Patients in the DOU typically have conditions that are not immediately life-threatening but require close monitoring and assessment to determine the appropriate course of care. A DOU unit in a hospital is typically close to an ICU so patients can be transferred if their status worsens.
Nurses in this unit are adept at quickly assessing patients and responding to problems. Should a patient develop sudden shortness of breath, chest pain, or something else, a DOU nurse has to know how to respond. Some of the skills you might use during a shift in the DOU include:
- Gathering and interpreting electrocardiogram (ECG) readings.
- Managing continuous cardiac monitoring or telemetry devices.
- Administering medications through oral, intramuscular, intravenous, and other routes.
- Managing specialized intravenous medications, such as Cardizem and heparin.
- Head-to-toe assessments of patients upon admission and throughout their stay.
- Inserting and managing intravenous lines, catheters, and other devices.
- Collaborating with interdisciplinary team members.
- Responding to emergencies using ACLS protocol and others.
- Accurate documentation of assessments, interventions, and outcomes.
Along with these essential clinical skills, working in acute care also requires soft skills. For example, explaining a new plan of care to a patient’s family requires cultural competence and therapeutic communication. Sometimes patients have a hard time following the care plan, and working with them requires empathy and patience. DOU nursing, like other acute care specialties, combines clinical competency and people skills.
Pros and Cons of DOU Nursing
Some of the advantages of working in a DOU setting include:
- Variety in the patient populations and diagnoses you’ll see.
- Collaborating with different interdisciplinary teammates, such as respiratory therapists, physical therapists, and specialty providers.
- Career advancement potential — DOU skills are valuable in many other specialties.
- Schedule flexibility, since many DOU nurses work three 12-hour shifts per week.
At the same time, every specialty has drawbacks. Some potential disadvantages of working in a DOU include:
- Patient acuity that can fluctuate shift to shift.
- Ratios of nurses and patients are higher than other units, so juggling patients can be challenging.
- Physical demands of an acute care setting include lifting, leaning over, and being on your feet much of the time.
DOU Nurse Salary
The average registered nurse salary is $94,480 per year. A nurse’s salary depends on their years of experience, education, extra certifications, the area they work in, and facility type.
Curious about areas where you could make more as an RN? Check out the states where nurses make the highest income:
DOU Nursing FAQs
DOU vs. ICU: What’s the difference?
The DOU is an intermediate care unit, meaning that patients need monitoring and medical interventions, but they’re not unstable enough to require ICU-level care. While DOU nurses use some continuous monitoring equipment, ICUs use more invasive measures, such as arterial lines. DOU nurses typically work with four to six patients at a time, while an ICU nurse may care for up to two patients.
The DOU may also function as a step-down unit from the ICU, so patients who are recovering may come here for monitoring before being discharged. And inversely, DOU patients who become sicker may be transferred to intensive care.
DOU vs. PCU: How do they compare?
PCU stands for progressive care unit, and the two floors are very similar. Both are intermediate units where patients require additional monitoring. ICU patients may come to either unit once they’re stabilized, with the goal of being discharged. On both DOU and PCU units, you’ll likely see patients who are on continuous cardiac monitoring, IV drips, and other protocols.
DOU vs. step-down: Are they the same?
Yes, they can be. Both take patients from the ICU who are moving closer to discharge, but need additional monitoring and treatment. DOU nurses and step-down nurses share many similar skills and can achieve the same certifications.
How to Become a DOU Nurse: 3 Steps
If you’re not an RN yet, gaining the education to be a DOU nurse will take between two and four years. If you already are an RN, working in a DOU could be just a job application away.
Step 1: Nursing School
To become an RN, you have two options for education: a four-year bachelor’s degree in nursing (BSN) at a university, or a two-year associate degree in nursing (ADN) from a community college or technical school. Either will qualify you to take the RN licensure exam, but the BSN is preferred by employers and will open you up to more specialty opportunities. Many nurses start with their ADN and take a bridge program while they work as RNs.
Step 2: Pass the NCLEX-RN
Passing the National Council Licensure Exam for RNs is your next step to become licensed. The exam uses computerized adaptive testing, which means that the amount of questions you must answer is determined by your responses. About 75% of candidates pass nationwide, and you can give yourself the best chance of passing by studying in advance.
Step 3: Gain DOU Experience
Once you pass the NCLEX, you’re able to apply to your state board of nursing to receive an RN license and begin to work in a DOU. Depending on your area, you may be able to enter this specialty after graduating from nursing school. A DOU is similar to progressive care, so search for roles in both areas as you’re applying. You might also gain experience in med-surg, cardiac nursing, or another area before transitioning to a DOU.
Getting certified isn’t necessary for this specialty, but it can deepen your knowledge and make you a more confident clinician. Some of the courses and credentials that could advance your DOU nursing skills include:
- Advanced Cardiac Life Support (ACLS)
- Progressive Care Certified Nurse (PCCN)
- Cardiac Medicine Certification (CMC)
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