I need some advice

[TexanTough]

I was an ER nurse for several years and recently moved into an intensive care setting. I did this to make me a more desirable candidate to become a flight nurse. As much as I am learning in the ICU, I am clearly unlike the rest of my peers. My brain does not work the same way as my coworkers. I find myself hating the attention placed on ridiculous details. For instance, you bathe a patient (which I don't mind doing) and get them all squared away. The doc wants a gas at change of shift. You pull blood from an art line and get a tiny spot on the sheet. In this ICU, a full sheet change must happen if this occurs.

My question is this: It's been a few months and I find myself enjoying much of the complex pathophys and trending labs etc... But the menial tasks are already wearing on me. Technically my obligation is roughly 2 years to the ICU and I'm afraid I can't see myself hanging on for that long.

Do I run back to the ER (where I belong!)?

Do I stick it out and suck it up?

Any thoughts would be greatly appreciated.

[TraumaSurfer]

Not every day is a scene flight or bloody trauma. I realize those comprise a small % of actual transports. However, my practice is patient centered and to maintain a homeostasis of sorts. I enjoy many aspects of the ICU and have gained valuable exposure to the long term management of the critically ill. In many ways my post is a 'vent' of sorts and isn't meant to demean critical care nurses or 'whine.' The assertion that I cannot acclimate is false. Clearly, the heart of emergency nursing and the mastery of it is acclimation/adaptability. I have acclimated to the environment I'm in, but it is mentally draining to have a group of peers who prioritize differently.

The comment about having an ICU doctor holding my hand. I currently do not partake in hand holding nor will I ever. I am considered 'brash' by some because I am so forward and impatient with twiddling of thumbs by residents. I will have all appropriate labs ordered, gtts in hand, and say "these are our parameters, unless you vehemently oppose, want to put those(orders) in?"

In closing, I get your point. I know that not every task is fun or mentally stimulating. I'm simply reaching out to see if others have had the same experience.

You haven't crushed my career goals. I think I will stick it out and suck it up for now. (With the knowledge that my heart will always be in emergency nursing.)

Being brash and being knowledgeable are not the same. You don't even have 2 years in an ICU and you want to drop it. The ED is not the same. You might be able to strut it in the ED which is obviously your comfort zone but how are you going to do with a crashing critical patient without a resident to boss around? It will be you and probably a Paramedic. In the field you will also be prioritizing differently and it won't always be like it is done in your ER because you won't have residents, ER attendings and many other RNs. If you think you are getting scrutiny from the other RNs now you haven't seen anything until you arrive on scene with a bunch of FF/Paramedics who will watch everything you do and will be even quicker to point out the littlest thing.

Suck it up and do what you are supposed to do where ever you are if you want to succeed in even getting an interview for Flight. You also need to think about a year in Pedi ICU or Neo and you will definitely be in for an eye opening experience there.

[Ruby Vee, BSN]

There is such a thing as being too brash, or over confident. After less than two years in the ICU, you haven't learned all there is to learn about ICU nursing; not even close. Unless the nurses you work with are less on the ball than the ICU nurses i've worked with the past three decades on both coasts and in the midwest, they're not JUST fixated on clean sheets when they get a pale grey patient with a MAP of 40 and a heart rate of 140. They're checking him over head to toe as they're "getting him situated." Roll side to side to get the dirty linen out from under them and you can quickly scan their skin to see if there are any bleeding exit wounds or enormous decubs that might be causing sepsis. In the process of "getting situated", you can check their extremities to make sure they're approximately the same color as the rest of the patient, not icy cold and cyanotic. You can slap defib pads on their back and make sure there isn't a 60 cc syringe lying underneath them.

As far as changing sheets for "a drop of blood", if you know you're messy getting blood gases, why don't you have something underneath your arterial line to catch the drips you miss?

[burnrn85]

What exactly do you think safety means and what it involves? Ever hear of things flying into the rotor? What about leaving things behind either at the scene or the station? What about cleanliness for infection control?

It is not sheets it will be other covering. Equipment and whatever is used in patient care will still be need to be cleaned. Do your really want to keep whatever the other patient and the patient before that had hanging out in the ambulance or aircraft? We do not have housekeeping to do all those menial tasks and the aircraft does not clean itself. We also check and double check things which others might find menial and very, very repetitive. If you don't like paying attention to the little things, then you won't like flight or ICU. A sheet might seem like a little thing but in an ICU, depending on the amount, no one wants to look at blood or wonder where it came from. Also, the tricks to learning how not to make a mess should have been mastered. In the closed space of a helicopter making a mess is not so forgiving and you could easily trash equipment which is nearby.

You don't seem to understand the difference between dirty linens and flight safety. Leaving things behind at the scene, securing equipment, and decontamination are entirely different beasts from a dirty sheet that's in use on a patient because they are bloody. Changing the sheet in between patient transports and during a patient transport are two different things silly! If you want to be a bed changer, stick with ICU! Pre-hospital is a dirty job and some people just aren't cut out for it.