Hi everybody--I'm an ICU nurse who has always worked at really large (900+ bed) level 1 hospitals. I've been a SICU nurse for 3 years and am on my second travel assignment. I decided to expand my horizons a bit and took an assignment at a 230 bed hospital (no trauma designation) to work in their MSICU. I'm REALLY struggling with adjusting to the way they do things. I should've known better but took a night shift position and am totally overwhelmed with not having the ability to discuss patients with residents/attendings at any time. I feel so helpless and frustrated when I have patients who I see getting sicker and the intensivists on call don't seem to care. I don't even know when it's appropriate for me to call the intensivist on call. Obviously, if there is an emergency. But I see so many patients I feel like I am watching getting sicker and nothing is done--even when I do call! Or having patients that could really benefit from certain interventions and delaying these interventions (sometimes just odds and ends type things that are often missed during the day) could prolong their recovery time. Some nurses feel fine putting in orders under doctor's names but as a traveler I don't feel comfortable doing this. I guess I'm just used to being a lot more proactive with patient care and feel almost disabled working at this facility. I'm feeling so depressed about the situation and am wondering if any others have struggled with adjusting to facilities like these and how they ended up adapting. Please help!!Thanks!