[NRSKarenRN]

Found at Medscape.com:

Organizational Climate and Intensive Care Unit Nurses' Intention to Leave
Why do nurses leave the ICU? Of those intending to leave, >50% expressed poor working conditions as the reason. Are there steps that can be taken to reduce turnover and help ensure a stable and qualified workforce?
Crit Care Med 34(7) 2006

[PeachPie]

Have management give a crap about acuity.

[FossilRN]

Well, Gee, why would I leave a job that I really do like. Today I left work after a day that wasn't perticularly different. My "good " patient had a low blood sugar (36) 18 Beats of vt, and had to go to IR for a picc line after her Dopamine infiltrated thru a peripheral site that I pointed out to the Cardioligist that it wasn't a good site to begin with but I couldn't find anything better and IV team said it was ok. As I was tied up with her doing dressing changes for an hour my vent paient pulled out her ng and soaked the bed with tube feeds after I had just changed everything? I guess the only thing that made this a different day was that the vent patient weighed 600 lbs. Not only do we not have a lift or any kind of transport or move team, we didn't even have a nurse's aid for 20 beds, etc. I had just assembled a team to turn this poor huge soul, by begging. I had to reinsert the tube, get (2) xrays to confirm placement and then turn her again. The one house orderly took one and a half hours to come, this woman laid in her s**t and tube feed until then and then was changed. This, along with answering other nurse's bells today and working 9 hours and getting paid for 8 makes me think, what intellegent woman wants to do this? Well, catch me on a good day.

[honeyz]

BURN OUT!!! simple as that////

[MarySunshine]

I hear you loud and clear, FossilRN. When everyone else is too busy putting out fires to help you with your own fires it can be maddening. Today I had two critically ill patients and I was just about literally darting back and forth between the two of them like a maniac just trying to keep my head above water (read: keep my patients' stable/alive). My charting was pitiful and the rooms both looked like hurricanes had hit. But the patients were alive when I gave report. I am now sitting here at home (3 hours later) obsessing over everything I did -- what I forgot to do and what I should have done better. Not always a warm, fuzzy, rewarding job. I could have REALLY used some help...

[dukeRN]

why would anyone not want to work in an ICU??

Here's what I told my manager in my annual evaluation: To start, over half of our new hires (read, mostly new graduates) are only interested in working in an ICU to acquire the required 1 year of experience for anesthesia school, and they will tell this to anyone who will listen... repeatedly. So, here comes the experienced staff, precepting someone who will essentially tell us on a daily basis that we are wasting our time: we are investing in their knowledge, future, experience, but yet, they are not investing in the unit/team, etc. Then, you get to listen to all of these same people whine about being assigned "chronic" patients, b/c all that they are interested in taking care of is the fresh post ops. So what happens? they spend all night chatting it up with their neighbors, and the next day, you pick the patient up, and nothing has been done, no bath, no dressings, old lines left in, etc, as the patient has been neglected, often for several shifts in a row. Just yesterday I cared for a man who had a dressing from 7/17: this is to be a daily dressing change, yet six, yes six, different nurses had charted that they had assessed the patient, 3 had allegedly bathed them, and yet no one had performed the required care.

And lets not forget the surgeons: if a patient is not fresh out of the OR and on the recovery course, they are the conductors of the neglect train, as they walk by on daily rounds stating "mr. so and so, nothing new", and keep it moving. God forbid we give an antianxiety to a lung patient who takes tons of xanax or ativan at home, b/c "it might respiratory depress them": translation: we don't want to toy with the (nonexistant) possibility that a lung tx pt who is breathing 50bpm might drop their sats after 1 mg of ativan, and require an extra minute in their precious surgical icu bed. I have watched too many end stage lung cancer patients rot in the icu without ANY pain meds or sedation, getting stuck 2x/day for blood gases b/c the docs are too lazy to stick in an a-line and b/c the docs just want to get them out. ***? Why would anyone want to leave the ICU. Used to be that the ICU was full of experienced, excellent RNs who cared for their pts and took pride in providing the best care, working with the best physicians. Now, half of our staff is fresh out of school, probably 10% have more than 3 years experience. Insane. There have been nights when both of my neighbors have less than 1 year of nursing experience, period.

And what's up with CRNA schools?? I remember it wasn't but a few years ago when only the brightest, most experienced ICU nurses got accepted. Now, it seems as if it's any new grad with a pulse. I'm scared. And, above all else, I am DONE with the ICU.

Whew, it felt good to get that out again.

and, for the record, I got the full raise (big old 4%) even after going off about this!

[soliant12]

The smart ones go on to advanced practice.

[motorcycle mama]

Originally Posted by dukeRN

And what's up with CRNA schools?? I remember it wasn't but a few years ago when only the brightest, most experienced ICU nurses got accepted. Now, it seems as if it's any new grad with a pulse.

If that's the case, maybe I do have a shot at CRNA school after all!

[tonyaRN38821]

I was one of those new nurses straight out of school who went in to the ICU. I went because I wanted to get good skills. I really wanted to go in to labor and delivery, but I hoped going into ICU would give me better skills and I would get to see so much more and do so much more. I have now been a nurse in the ICU/CCU for 2+ years and yes I want out. I have difficulties in getting out because most labor and delivery jobs posted require experience, and most hospitals are short in ICU so here I am still. I am now actually on a travel assignment, and plan to take one more. After that I have vowed to leave ICU, even if I have to go to a doctors office. I love my patients and care so much about them and their care. the problem is alot of nurses don't and the ones that do are so over worked and burnt out from doing their own job and the others too. It is so depressing and scarry, I think ok these people are HUMAN and need us no matter why they are here. I hear nurses say things and treat certain pts differently because of their own bias, and no matter why they are in ICU they deserve the same care as the other pts. Anyway If you are going into ICU think hard about it because it is very challenging, but it can be rewarding also. But be ready to work your tail off!! I just hope you have a heart because that is what the ICU needs more Hearts!! LOL!! thanks tonya

[janfrn]

The sort of working conditions that cause people to leave our ICU include things like a total lack of respect for the frontline staff from any level of management. Respect, which should be a two-way street, is expected to travel in only one direction and that's up. Anyone who questions a manager's decision, makes a suggestion that hadn't occurred to the manager, dares to complain about an assignment, or voices a concern about any aspect of the day-to-day running of the unit is asking for a visit to the office with both the manager on duty and upper management. It isn't only nursing management that is lacking in respect for the nurses doing the work; the physicians are also very guilty of this. Some of them make it plain that anyone without MD after their name is not worthy of their attention.

Chronic short staffing is another frequently mentioned issue. We are usually short-staffed, and when we aren't nine times out of ten the administration pulls the "extra" staff to another area. We are a unionized facility and have a very explicitly worded contracct, but it is violated in a number of wasy every single day. Staff aren't getting their statutory holiday days-off-in-lieu as they're supposed to, vacations aren't being granted, management is deciding how much time a person should require to deal with a personal pressing necessity and we have a huge number of people off on maternity leave, sick leave, short-term and long-term disability whose positions have not been filled temporarily. They rely on casual and part-time staff to fill in the gaps. but then whomever has signed up for the shift may still cancel themselves. Some help. We are often left with no unit clerk or nursing assistant because they've called in sick, or one just wasn't scheduled, so a nurse has to take on those responsibilities. There are never enough bodies to bathe, change, turn and reposition our larger teenaged patients (like our 95 kg 13 year old quad), because as our DON has repeatedly said, all our patients are babies so we should be able to do it all without help.

So in an effort to alleviate some of our staffing woes, they went on a hiring blitz and hired more than two dozen new nurses since January. However, most of the people they've hired are new grads who have yet to develop organizational skills, assessment skills and basic nursing skills. So the result is that the experienced nurse at the next bedside is expected to "watch out for" the new nurse. Our acuity level is always extremely high and thus making safe assignments is very difficult. I've had shifts where I was the only nurse within one half of the unit who had any experience at all, taking responsibility for the patients of four or more other nurses in addition to my own. But then many of these new nurses have already left or have dropped down to casual. So we're back to square one.

We are also part of a teaching hospital so we have a revolving door for second year residents and foreign fellows in every specialty. We often have to tell them what the order should say (it's easier to just write it myself and then have them sign it!), what our usual practice is in given situations, show them where things are, get things for them, clean up after them and do their charting. Every day nurses in our unit save patients from the follies of the medical education system. Our newest foreign fellow, from Brazil, has such poor English that trying to get her to understand what the problem is with a patient, we're having to use sign language some times.

Scheduling is a huge problem for our unit. About half of our staff self-schedule, at least in name. I used to be one of them but found that the schedule I had selected bore no resemblance to the schedule I ended up with. Our master rotation is very unbalanced, both in how the shifts correspond with pay days as well as which days of the week are worked. The master has five Mondays out of six, one Wednesday and one Thursday, and two of the three worked weekends are nights. See staffing problems above! Trading shifts is almost an industry... some people have to print up thier schedules every time they work so they know when their next shift is. The contract's rules about scheduling only apply when management wants to apply them, so a person may not be allowed to make a trade because it would give them too many shifts in a row, but management can then change their schedule so they have the same number of shifts somewhere else, based on "operational requirements"...

Recognition and praise are only ever horizontal. My coworkers will recognize and acknowledge a job well done, a good catch or a special effort, but it seems management expects every nurse to function at the "exceeds expectations" or "outstanding" level at all times. But there's an unwritten managers' rule that no one will ever exceed expectations in writing, as with our annual performance evaluation.

Our nurse practitioner, who has been away from bedside nursing for about fifteen years, keeps coming up with these lovely ideas for improving care, most of which involve filling out some type of documentation every shift. We are still using paper charts, and our daily pile of paper usually runs to some dozen or more pages not counting medication documentation. Of course, in order to cut back on auxilliary staff costs, we are expected to do all the filing of documenation, all the transcribing of information, all the processing of orders and such, order our own blood products and meds, as well as provide total care for our patients. So if I'm filling out yet another form that isnot considered part of the chart just so that she can have some numbers to reprot to justify her salary, when do I have time to do patient care? Another thing she likes to do is devise schedules for things like dressing changes and treaments that will accommodate family timetables, but which totally mess up the nurse's.

I could go on forever, but I won't. These are some of the things that are making me think long and hard about changing jobs. The only roadblock for me is that this is the only PICU in this area. The next closest one is 185 miles away. My local community hospital has some peds beds, but the acuity level is very low and I'd probably find it boring. The management knows that if you're a true PICU nurse, you're going to stay and take whatever they dish out because you have nowhere else to go.