Frustrated in the ICU

[firemedic12, BSN, RN, EMT-P]

So over the past few months, I've noticed a trend in my nightly assignments. I don't ever seem to be assigned to sick patients. I have to admit a truly critical patient to actually be assigned to one, but when I come back the next night, the patient that I admitted is assigned to someone else. I've asked my coworkers, charge nurse, and unit manager why this is and none of them have much of an answer for me. I've gone to extra lengths to make myself more valuable. I'm 1 of 2 night shift nurses with PALS and only one with ENPC (on an adult SICU that occasionally admits PICU overflow). I'm trained in ultrasound IV access, and I'm going to a CRRT certification course on my own (since the hospital doesn't want to hold a course of their own). I've been a part of the code team for a while and the team leader where I've had great success and many commendations from physicians and fellow nurses alike. What's the deal here? If I wanted to be an IMC nurse I would have gone to work on an IMC floor. I really do enjoy where I work, but this trend is making me want to start a new job search.

[Tneo8385, BSN, RN]

Where in the world is this hospital located? I know here in the rural area of PA its usually a fight over the truly sick patients that come in. Also where is this CRRT course and do you know of any near PA

[Lunah, MSN, RN]

Firemedic12, is this a change from the past? If so, what changed where you are? New people?

[SunnyCCRN]

It's a little difficult to assess this situation without a little more information. How big is this hospital? Is it rural or urban? Are you a new grad or a seasoned ICU nurse? Did you just transfer from another unit? Is this your first job? How long have you worked there?

What I can offer from my experience: My first critical care job I would not be assigned the truly critical patients because of unit politics. The nurses who had been there 10-20+ years wanted the critical patients, and they got them. They weren't going to let a newbie take the drips and vents and CRRTs while they took the tele overflows. This was at a moderate sized rural hospital, the biggest one for 100 miles. My last job I had to fight to take the most critical patients; it took about a year. What you're doing sounds like what I did: I made myself valuable, and eventually the charge nurses came to respect me and near the end of my time there I was taking the sickest ones that nobody else wanted to touch. This was at a small urban hospital. Due to some other reasons, I left that job and went to work for the large trauma center downtown as a float nurse; I float between 5 ICUs, 2 PCUs, and sometimes take critical care overflows in the ER. The level of acuity I get assigned between these units varies, and a lot of that has to do with the personality of the units and the amount of time I spend there. The units I work more often in have come to get to know me better and assign me more critical patients than the units I work less often in.

I doubt you're not getting the harder assignments because the charge nurses think you're incompetent; if that was the case, you'd probably be in the office all the time or be a victim of bullying. If taking the sicker patients is your goal, my recommendation would be to get a CCRN certification; I got mine and became the one of the only non-supervisors to have it on the unit and it definitely elevated my position in the pecking order.

Also remember too that you don't HAVE to take the sickest patients on the unit to be a valuable ICU nurse. Every patient in the hospital needs your skills, and you have a lot to offer them even if they aren't prone and on CRRT and six drips.

As for getting your assignment changed form night to night, that's probably something you should bring up to your supervisors/director/unit meetings; Continunity of care is important if it can be done; snubbing you on assignments is rude and reeks of unit drama. Unfortunately though ICUs do tend to attract drama, and if your unit is affecting your job satisfaction because of it, and bringing attention to the matter doesn't fix it, then maybe this is a unit so caught up in its drama and politics that quality patient care isn't the priority, and perhaps you would be better off with a different job.

Good luck!

[MYSTICOOKIEBEAR]

More often than not, the Charge RNs will collaborate to see which cases is appropriate for which RN. Im not going to give a 6 month new to ICU RN a less than stable, pressored up ECMO/CVVH patient. I'd give them a fresh heart from the OR or x2 post op day 1 Plan A patients transferring to the floor.

Unfortunately there are some ICUs that play favorites and give the senior staff first dibs on whatever they want EVEN if it disrupts continuity of care and even if the previous RN managed the patient well. It just comes with the territory and I am happy that I do NOT work at a place like that. These are the same ICUs that do NOT have your best interest in mind in terms of your development and growth.

I'd say talk to them and ask, but do it from the standpoint that you want to get better, want to be challenged, and want to grow as a Unit RN. Hopefully you get it all figured out!