Quote from RN-icu
So here is the list so far. I'm sure I could add to it, but it's getting late and this is all I can think of now.
Titrating pressors. Actually I like doing it, but I do not feel educated enough. It's not all the time that I have the opportunity to do them so I always have to look them up. I can never remember how to mix them, which ones are mcg/kg/hr vs mcg/hr, or the titration ranges. In codes or when my patient is crashing and I need them quick it stresses me out.
NT suction: I hate doing it. It's torture and it's gross
Placing ng/dht: same thing, I hate doing it.
Cleaning up poop: I did that as an CNA and thought I won't have to do this once I'm the nurse with a college degree. I still do it all the time.
Feeling overwhelmed. This happens a lot especially when I have a 3-4patient team. A recent team I had, but pretty indicative of how they make assignments all the time. I had 2 separate gi bleed patients, both getting blood and needing cleaned up a lot. and a dementia patient that kept taking the bipap off. Until he really couldn't anymore and we intubated him. I just felt like I needed to be in all 3 rooms constantly, but that's not possible so I spent my day running from one to the other.
The charting: gosh! if I didn't have to chart so darn much I could actual spend more time in those rooms. (This is everywhere. I know it won't escape it)
Psych patients: gosh! Half the time I feel like we should just rename ourselves psych-icu. I am not a psych nurse for a reason. Hate it!
Codes/crashing patients: I don't really enjoy this. It stresses me out. I think most true icu nurses get a small thrill form this. Not me!
Feeling like im not smart enough: I know I am my own worst critique, but I hate when a patient or a family member asks me a questions and i do not know the answer. I have to say I honestly I do not know, but I will figure it out. I'm sure they don't feel good hearing that from their icu nurse.
Or doctor for that matter. It's worse when you tell them you don't know something or ask them to explain something. Some really do not like that and make it known.
When I feel appreciated
When I can sit down with patient/family and educate them
one extreme or the other. I like on the vent, calm, and sedated. Or I like the walkie talkies. I do not like the in between and that whats I get most of the time.
Hanging blood products
DKA patients. That is my favorite diagnosis to take care of. I think because you can actually see your work paying off by watching the bs go down every hour and the ketones slowly clear. I know, very random!
Your staffing ratios reflect step-down unit more than ICU. I suspect that if you were in a specialty ICU, you'd learn the drugs (including the pressors) and the most common questions patients and family ask. Perhaps you would feel more confident then. At the very least, with 1-2 patients instead of 3-4, you'd have more time to concentrate on each patient. You're still going to have poop though. An ambulatory setting is probably the only place you'll be able to avoid poop, and even then it's not 100%. (I was in the ambulatory surgery waiting room, waiting for my procedure a few years ago, and the patient before me pooped all over the procedure room.)
NGs are probably more or less unavoidable except, perhaps in CCU. NT suctioning can be delegated to the RT, but you'll probably still have to help the patient through it.
If you really dislike codes and crashing patients, ICU is not the place for you. You're not going to ever completely escape the possibility of codes (even if you work in the cafeteria!) but you can minimize it by working in an ambulatory setting.
There are always going to be too many psych patients (or visitors) and too few appreciative ones.
Looking at your list, though, I'd suggest aiming for an ambulatory setting. Good luck.