Which is more stressful: med-surg or SCU?

1. I've been doing med-surg for almost a year and although I like it they've been making changes to our floor staffing to where I regularly have 10 pts with an LPN and sometimes an aide if I get lucky.The LPN's just pass po meds, do chart checks, and sometimes dressings. Some are better at helping out with other stuff but most just flat out refuse to do assessments and split the patients in half so trying to keep on top of 10 pt's assessments, labs, IV's, new orders,charting, etc is almost impossible! I rarely sit down for the entire shift while the LPN's and aides make sure they get their breaks regularly. There is very little teamwork on our floor. I'm getting frustrated and burnt-out! I was thinking of making a change to a step-down ICU position that's open. However, critical care scares me! Is this just because I haven't been trained in this area yet? The thought of codes and people so ill really makes me nervous and I don't want to trade one type of stress for something worse! Please let me know what you think!

   Last edit by Nurse ABC on Apr 26, '13

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2. 12 Comments

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3. 
   Apr 26, '13

   Sounds like it's time to leave your unit. I work ER, not ICU, but when I bring a pt to the unit, I'm met by the primary RN and at least 2 of her friends. Teamwork can make or break you. Get out of there.
4. 
   Apr 26, '13

   I'd switch. What are the ratios on the Stepdown floor at your facility? My Stepdown unit is still a 1:8.
5. 
   Apr 26, '13

   The previous poster is right. Teamwork makes or breaks the unit. There was more teamwork in the ICU than in the med surg units. Not all med surg units are bad for teamwork. I have seen some great teamwork in the tele unit at the hospital where I work now. I think that assignments tend to be more balanced in the ICU so your co workers can help out more.
6. 
   Apr 26, '13

   Quote from eatmysoxRN

   I'd switch. What are the ratios on the Stepdown floor at your facility? My Stepdown unit is still a 1:8.

   1:8 on stepdown? That sounds awfully high.
7. 
   Apr 26, '13

   It's 1:4 on our SCU.
8. 
   Apr 26, '13

   Quote from Nurse ABC

   It's 1:4 on our SCU.

   That is a very reasonable ratio. Why don't you apply for the position. If offered you don't have to say yes, and it will give you an opportunity to shadow another unit and see how they function
9. 
   Apr 26, '13

   Quote from nrsang97

   1:8 on stepdown? That sounds awfully high.

   8 patients on a step down? I agree with the above post. That is really high! : /
10. 
    Apr 26, '13

    I work in a CV-ICU, and honestly i was scared out of my mind when i started. Everything was so scary. So many tubes, lines, drips and the patients were SO SICK. Our CV-ICu is a little different in that we see them ALL the way through, beigning to end. So we get some "not so sick" patients too. We run our butts off. We really try to staff for acuity (keyword, TRY). we if we have a fresh surgicial we are not going to get another fresh surgical. When they are fresh fresh fresh (literally right out of the OR) we staff 1:1 with them. things can turn bad REAL quickly. If not 1:1 then you'll get a stable patient, several days post op and the fresh. Anyway...what im getting at it is going to be busy anywhere you go. You go to ICU, you are going to be busy. The patients in ICU are usually 1:1 or 2:1 and they are that way for a reason. When i have drips going im in the room constantly, i don't leave. I could be titrating every 15 minutes-1hr until i get them where i need them. (i.e. lasix drips, nitro etc.). Its a different kind of busy, but its busy. There are times where i am dying to go to lunch.I need to pee, im thirsty, my stomach is growling, im feeling dizzy and my patient isn't stable for me to leave him/her. The other nurses are busy and don't have time to be running my CRRT or my drips.
    So...don't think by going to ICU that you won't be busy or things will change for the better. Im not trying o discourage you from going to ICU, i would never do that. I jsut want people to go to ICU for the right reasons. Not beause "it's less busy." ts not.
    There are instances where every one of our nurses are maxed out at 2 patients and another patient on another unit codes and they need to be brought to CV-ICU or ICU. But SOMEONE needs to take him...who will that be?? Someone is going to have to suck it up and take an extra patient, more than they can probably handle. That patient needs a nurse and can't stay on the floor.
    
    Floor nurses have the luxury of having another unit to send their patient to. We do not...we are it (other than OR but they always come back). Just go to ICU for the right rasons. Don't let the drips, tubes, lines, sickness, acuity scare you out of it. You will get it. It will come with orientation and experience. Just please do it for the right reasons. I'm a bit of an adrenaline junky and love a good/difficult patient that gives me a challange. I like being busy, and i like being with 1 or 2 patients....not 500 patients in one day. YIKES! admission,discharge, admission, discharge, admission, discharge all day long. Can't handle that. But a patient coding?? I can handle that...
11. 
    Apr 26, '13

    Keep in mind i work at a large large hospital and our staffing tends to be a little different than most. Yes, we staff 1:1 or 2:1, but it is necessary with the patients we have.
    We staff based on acuity (each patient is assigned a number. I've never been charge so i don't really understand completely how it works but i know it's based off acuity). You could have 1 patient, you could have 6 (Rare, but it happens).
12. 
    Apr 26, '13

    I like being busy and working hard. Been considering CC to increase my skills and feel more challenged anyway. I can even handle the admissions and discharges if everyone is pulling their weight but that's not been happening lately. Thanks for all the advice!
13. 
    Apr 26, '13

    Which is more stressful? It really depends on your own particular job, every hospital environment seems to be different in respect to what services they provide, etc. I worked for several years in a very high acuity step-down; we never got to sit down, eat or pee. It was tremendously busy. Right now I work on my first med-surg, and it is the easiest job I have ever had. Personally, I would say "go for it." Once the culture of a unit/floor has been set, it rarely changes. If you have a problem with some of the LPNs not pulling their fair share of the load, this probably won't change, no matter how much complaining you do about it. My step-down was 1:4.
14. 
    Apr 27, '13

    I think they are both stressful, just in different ways. I'd prefer the challenge of acuity over the challenge of a bad working/colleage environment.

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