Floor nursing vs ICU nursing - page 6

Do you think ICU nursing is as STRESSFUL (crazy, hectic, etc) as med/surg floor nursing? I realize ICU nursing takes a great deal of knowledge and the patients are more critical, . . . .I need an... Read More

  1. by   luvicu
    Oh i love ICU regarless of how stressful it might seem. It's far better than having six patients that i i might even find difficult remebering all their names and which is which when the docs come in..lol
  2. by   RNforLongTime
    I'll take my 3 ICU patients ANY day over 8-12 floor pt's at night! At my hospital there is no respiratory therapist in the building so I have to draw my own ABG's, do my own vent checks q 2 hrs, administer nebulizer tx through the vent and to the pt's not on a vent but still needing q 4 hr Duoneb treatments. We also have NO housekeeping on night shift so if I gotta move a pt out to get another one in,I gotta clean the room myself! No unit secretary in my ICU at ALL!
    Night shift is the only shift in my ICU that has a unit secretary/nurses aide, although she is pretty slow at entering orders, I can do it SO much faster so I usually do it myself! We need a unit sec/NA for days and evening shifts but they won't hire us one! Even so, I'd much rather work in my ICU than out on the med-surg floor.

    And I would definitely take the med-surg unit over the detox unit patients. I got pulled there at the beginning of the month and those patients are just MEAN, rude and nasty!!! Look, I didn't shoot you up with coke, or make you drink a gallon of vodka a day...YOU DID! SO don't treat me like I'm your personal slave telling me what you do and don't want. It's a voluntary unit so if you don't like it you can leave now..let me show you the way out!!
  3. by   ICURN7
    Whoop!..lol....that sure sounds busyyyie. You are basically multitasked. Doing both tech, resp, and nursing jobs...I prefer ICU but not this type.... have not seen it that way b/4...lol
  4. by   10ACGIRL
    What I mean is, there is 8 patients in the ICU Unit. each tech has 4 patients. That means that there are 1 RN per every two patients. If I have 4 patients, that means that I have 2 RN's for the shift and the other tech has 4 patients with 2 RN's as well. Oh.....did I mention that this is a night shift 730 pm-8am?
  5. by   Hoozdo
    Quote from nurse-lou
    I'll take my 3 ICU patients ANY day over 8-12 floor pt's at night! At my hospital there is no respiratory therapist in the building so I have to draw my own ABG's, do my own vent checks q 2 hrs, administer nebulizer tx through the vent and to the pt's not on a vent but still needing q 4 hr Duoneb treatments. We also have NO housekeeping on night shift so if I gotta move a pt out to get another one in,I gotta clean the room myself! No unit secretary in my ICU at ALL!
    Night shift is the only shift in my ICU that has a unit secretary/nurses aide, although she is pretty slow at entering orders, I can do it SO much faster so I usually do it myself! We need a unit sec/NA for days and evening shifts but they won't hire us one! Even so, I'd much rather work in my ICU than out on the med-surg floor.
    Geez Nurse-Lou, that is horrible. The next thing you know, they will make you
    insert central lines and intubate (JK).

    I can count on one hand the number of times I have had to take 3 ICU patients
    this year. It really is an exceptional circumstance in my part of the country,
    (southwest), for ratios to be 1:3. I always have at least ONE RT for a 20 bed
    unit.

    Is it standard for your hospital to routinely do 1:3 staffing? Your post made me
    tired just thinking of all you have to do.
  6. by   10ACGIRL
    The problem today is, there are not enough male nurses whether it be CNA,LPN,or RN. bcuz of when you have patients on your floor that are 190+ in weight and it feels like dead weight to a CNA that is only 121 lbs. herself. It dowes not matter if its a MED/SURG floor, Ortho, or a stroke patient. I hold VERY HIGH praise for male nurses!
  7. by   aCRNAhopeful
    I can't imagine what goes through the mind of med surg nurses that enjoy their job. This is not meant as a disrespect in any way I just don't see anything enjoyable about it whatsoever. The days where I have 3 not so sick patients on their call light every 5 minutes while trying to get all the other tasks, meds, labs, and assessments done on time makes me want to smash my head into a wall. I always volunteer for the super sick IABP or the fresh open heart. I love using my mind to think about "how I'm going to get this cardic output up?" or "how should I proceed with the vent weaning?" or "What does this change in VS mean and what am I gonna do about it?". When I'm scrambling between several not sick patients I leave work feeling VERY unsatisfied. I am amazed about the job floor nurses do and I'm glad we have people out there who thrive off that kind of stress.
  8. by   General E. Speaking, RN
    I have only been in ICU for two months. I used to work MedSurg and Tele. There were days on Tele that were just aweful. My worst day that I can remember went something like this:
    5 patients.
    #1 pt has hemaglobin of 7- needs 2 units PRBCs. Pt is confused and cannot sign conset requiring me to dig through chart, call, get phone consent for blood.
    #2 pt has K+ of 2.9 needing K riders. Frequent PVCs on monitor. IV immediately starts burning after infusion starts (despite having called pharmacy to mix K+ w/ Lidocaine in 500ml -per policy). They have no central line and of, course, NO veins.
    #3 pt has fractured her hip and is confused. She is waiting for ORIF and is in Bucks traction and is incontinent- no foley ordered despite begging. Keeps asking for water every 5 minutes because she cannot remember anything. Told her (nicely, of course) about 75 times "you are in the hospital because you broke your hip"
    #4 pt is sickle cell crisis and pain is not controlled despite mega amounts of narcotics
    #5 pt is s/p TURP and is clogging up because of clots. I unclog the clots w/ aggressive irrigation. Running the CBI as fast as I can but hospital only has 2,000ml foley bags in stock so by the time I can get back into the room, the foley bag looks like a big fat cherry that is about to explode because it needs to be emptied.

    Busiest days in ICU so far went somthing like this:
    Overdose 30 yo pt on a vent w/ Levophed, Propofol, Bicarb, NS boluses, con't Protonix, K runs, multiple antibiotics, Albumin. Troponins elevated- cocaine induced MI? Thinking sepsis now though w/ rhabdo... no urine output X 8 hrs, sky hi WBCs. Doc put in a central line, Quinton and started CVP monitoring.


    Had a patient on 7 IVs. Rocuronium, ativan, fentanyl, NS x 2, Vasopressin, Levophed. She also had an art line, was vented (of course) and had chest tubes, feeding tube, tesseo for HD.... We started the Rocuronium gtt on my shift so I got to practice the Train of Four with the (what I call) the tazer. I switched out the flush bag for the art line. We changed all the tubings and hooked up a manifold for the infusions. This poor patient had the most subcutaneous emphysema I have ever seen. It seemed to grow as I watched. Her neck and face were huge. Issues w/ her trach and air escape plus chest tubes leaking. Got to practice lots of blood draws from her art line. Lots of practice titrating the pressors because her bp dropped a lot during HD. Lots of tips from RT about vent setting changes related to current ABGs.

    Both busy, just different kinds of busy.
    Last edit by General E. Speaking, RN on Jul 30, '10 : Reason: spelling
  9. by   aCRNAhopeful
    Different kinds of busy yes indeed. But at least with the latter, you were able to optimize the care of a critically sick patient where as with the former, you ran back and forth hoping to god that none of the patients got hurt because you weren't able to be in the room to help them. My hats off to you though, because I would certainly not have been able to juggle that patient load on the tele floor.
  10. by   RedhairedNurse
    Are there lots of deaths to deal with in ICU, that seems it would be the hardest part. I would love to work ICU, I feel like I need more of a challenge and want
    to learn more than average medsurg kind of stuff. I worry about the dying part....I work in county hospital and I know there are lots of ICU pts that just don't pull thru. How do you handle it?
  11. by   General E. Speaking, RN
    Quote from RedhairedNurse
    Are there lots of deaths to deal with in ICU, that seems it would be the hardest part. I would love to work ICU, I feel like I need more of a challenge and want
    to learn more than average medsurg kind of stuff. I worry about the dying part....I work in county hospital and I know there are lots of ICU pts that just don't pull thru. How do you handle it?
    Personally, I guess like every other nurse. You sorta have to have a detached attachment. I mean, you are focused on what you can do to keep your patient alive and the needs of the family. You think of the patient as a whole person and try to address all their needs. But there is an invisible barrier there that allows you to think rationally instead of totally emotionally. You give the best care possible but realize that sometimes the body wears out. I still feel sad and sometimes even cry but try to realize that I have done my best job as their nurse: treated them with dignity and respect, advocated for what's best for them, controlled their pain, and kept them as clean and as comfortable as possible.

    Every now and then, tho, that "detached attachment" mentality goes out the window and you cannot help but form a strong emotional bond. Those few still haunt me.
  12. by   Shanlee79
    Just read through this thread and I found it very valuable. I have to make a practicum placement choice for school this fall. I just met with my instructor about this same topic, as I have been having difficulty trying to find an area I think I might enjoy.

    What tends to bother me so far on the floor is trying to get the important things done, while juggling patients of varied critical status, with varied requests. I had one critical patient this week and two others who were stable but constantly calling me for blankets or icecream cups or simply a chit chat. I would love to have the time to do these things but we don't and not only that, but I find myself more comfortable and enjoy devoting my time and energy with the more critical pt. I like to be in the know how and I find on the floor, no matter how on-top I am with orders, I am always still two-steps behind and when you really need a doc, good luck.

    My instructor suggested the ICU/PICU, she joked by calling me her 'l'il control freak'. I never considered this area before but now I am re-thinking it. I wouldn't say I am a control freak, as I can roll with the punches too, but I guess I do enjoy knowing as much as I can about a situation and staying ontop of things.
  13. by   BellaInBlueScrubsRN
    Shanlee79: Before I graduated, I did an internship program. I did ICU as well as general med surg. Both completely different and challenging in the different ways. I work ICU now. It's challenging because there is so much to know. But you have to know it for 2 patients. Medsurg is hard because you have to know it for 5 patients. And the doctors expect you to know EVERYTHING about all those pts still. Its hard!
    ICU for a practicum you could get a taste while you are still in school. Learn a lot of patho! But maybe I'm just biased

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