I want to clarify what bad means, I work with some very dedicated RNs who bust their butts and we give excellent care. It is not my co-workers or the pt population, both of which I love, but the overall work culture which is made not-so-much fun by a few nurses who are part of the power structure of the unit, who have been here for 20 + years and the management which it seems just wants warm bodies. Most of the good RNs are leaving and this is the problem.

Now this is a CTICU in a very big and somewhat prestigious teaching hospital. We are 20 + beds and they are going to open more. We just moved from our old building into a brand new shiny one. We don't have the nursing staff for the beds we have open now and moral is bad and getting worse. We are losing a bunch of people in the next few months and that is when management wants to open the new beds. Recipe for a not fun working environment, as most of the people leaving are experienced ICU RNs.

I came to this unit from CT-step down because I wanted the challenge and I wanted to put in my dues and get to the place where I could take care of for instance, the ECMO pts and fresh post-op on RVAD and IABP with rocket fuel, the sickest of the sick. But now that things have taken a turn for the worse and there is a mass exodus started, I am, to be honest, scared to go to work. I am soon to be one of the more "experienced" RNs as an older more experienced co-worker joked the other day and I have about 9 months of ICU experience!

So my question is how long should I stay? I don't want it to look like I was job hopping but if we lose all our really experienced staff this is going to be a scary place to work. I will have a year in january, should I look for another job then? I want to get to where I would be able to take care of the really sick patients, but that will take at least two + years as I will only just then be getting comfortable in the unit and with the patient population devices gtts ect. I hate going to work now as I am worried about getting an unsafe double, no one to help out ect and it is looking to get worse. I want to get into a unit where I can put in my time and get really good at my job, but this unit is sucking out my soul.

Thoughts?

I feel your pain. Significant changes in organizational structure or practice usually cause some staff to leave. Unfortunately, it's usually the top-notch staff (who know they have many options) that bail first. At the bottom end of the spectrum, Mediocre or marginal staff will hang on till the bitter end, because they are unsure of their job prospects elsewhere. The middle-of-the-road folks usually bear the brunt of it; the most responsibility for maintaining quality & safety while trying to prop up their weaker colleagues. Unfortunately, this is not an unusual situation. Your department is also going to experience chaos as it increases in bed size without adequate staff to even maintain current size.

From your message, it sounds as though your skills are sound and your expertise is definitely growing. You will be in a position to advance rapidly if you want to - since you will be asked to fill the holes left by the experienced staff that have left. I would advise you to take advantage of this situation - but there are some important caveats:

First of all, make sure you are absolutely clear on all organizational policies and procedures, including any standing orders/protocols. Do NOT deviate from these or allow anyone else to do so. If you have intensivists on staff, get to know them very well. Take advantage of any specialty training that is offered to you. Take a very firm stand and do not accept any assignment/responsibility for which you have not yet been trained. Open up a line of communication with your manager/supervisor so that you can inform her/him of your concerns. Get to know your unit educator(s) so that you can support them in training new staff.

This could very well be a turning point in your career. One of those times when you have to decide whether you want to be part of the solution or join the exodus and become part of the problem (lack of experienced staff). There's no "right" choice, only the one that is right for you.

Thank you for that input, I have some decisions to make and it helps to look at it not as a problem but as an opportunity. Its hard as the moral on my unit right now is pretty dismal and its easy to become negative and get tunnel vision. Thanks for another perspective.