From University floor to Community Hospital ICU, advice needed!

[InfoNurse81]

I really would appreciate some advice.

I recently left a job on the east coast in a very large university hospital where I worked on a busy neurology/neurosurgery floor (non-ICU). I am now starting a job on the west coast in a Neuro ICU in a somewhat smaller community hospital.

The thing I can't wrap my head around is, not having residents on-call. At the University hospital I was used to passing a lot on to the residents on call, all throughout the night (critical lab values, subtle neuro changes, etc). Now it is my understanding that at these community hospitals you only have the attendings to call, so....am I really calling them at home at night for these things? While I realize some things can wait until the AM, I think it might be hard for me to determine what can and cannot wait, especially with neuro when even a subtle change may mean a major problem. Also, i am finding out things like the rapid response team for the hospital is made up of the ICU nurses....that amazes me. At the University Hospital i came from, the ICU fellows and residents were involved in the rapid response, as well as the ICU nurses. I find it...scary, to think I have so much responsibility. i mean, I'm sure its do-able...community hospitals have been functioning for years and years without having docs around 24-7. Just the concept of having only a ER doc in house at night makes me a little nervous. It may be that ICU's in community hospitals are not as acute as in University hospitals? I'm not sure....I would love some advice, especially from those who work in non-University settings. I feel I have been a little babied, and I'm now in for a real shocker...am I overreacting?

Thank you so much!!!