what do you guys think of my working conditions?

[BandEmom]

I work in a 20 bed ICU stepdown unit. Typical census is 12-16. Our staffing ratio is usually 3-4 patients. Sometimes we have no nurses aide, sometimes we have no unit secretary. Sometimes we have neither. On some occasions we have a CNA that is also trained to do the desk, and they are responsible for all the orders, phone calls, etc, plus vitals, blood sugars, baths, etc. There is no central monitoring tech, so we have to keep track of our own telemetry wherever we are. We have 24 hour chart checks that take place during night shift. Night shift is frequently complaining and writing up day shift for orders not being taken off correctly, things not being done, etc. Typical day/night stuff. There is a charge nurse who is up and down floors between PCU and ICU all day, and sometimes we don't see them for hours.

I've been feeling burned out at work. I think it might be just that I'm tired of acute care in general (I'm applying for an NP program). But sometimes I wonder what its like in other hospitals too, if its the same wherever you go. This is the only critical care department I've worked in. What is it like in other progressive care units? Are we pretty typical?

[hollyberry678]

Sounds like my unit...except we have a monitor tech, and generally always someone at the desk. And now the MDs order on the computer, so we can check off orders ourselves, though the secretary will do the work on that (ordering whatever and tubing pharm slips). We have aides sometimes, sometimes not (night shift), but if we do, they arent that helpful anyway, and I can do without the attitude, so its nicer not to have them if that's the case.

[qt2168]

We have a 15 bed CCU, usually have a tech and most always have a secretary who does our orders and will help us out. I have been working here 6 months have taken 3 patients one time who slept all night and usually have 1-2 patients. Sounds like your place just kinda sucks.(no offense) Good luck with NP!!

[gilf7243]

I think you may work at my hospital. This all sounds very familiar to me. I feel burned out too. Good for you for going back to school. If we don't work at the same hospital then it must be the same company that owns it. Is your hospital a catholic one that just added a tower called the K tower? That would give me a good indication if we are at the same place. Good luck!

[NEHuskerRN]

If this is a true CCU (critical care unit/intensive care unit) then you are totally working in an unsafe work environment. The CCU/CICU/CVICU/MSICU that I've worked over the years are a 1-2:1 ratio, with only a 3:1 in a crunch. They are totally putting your license in jeopardy with a 3-4:1 pt ration (if this is considered ICU). CYA!!!

[juraviel]

I work in a 20 bed ICU stepdown unit.

That says it all. Its a step down so 3-4 ratio is about right.

[missionary]

I went back to work recently after 16 years and because I was ICU/CCU years ago I elected a step-down telemetry unit in our small town hospital. Like you, we usually have 16-20 beds filled and our staffing ratio is up to 5... usually 4. Days: We always have a monitor tech that also covers ICU, always a US. We always have a nurse tech to do patient care, vital signs, I&O's. It sounds good on paper but I am flying all the time. The patients are coming and going all the time. But I like it, for some strange reason.

Do you have othe local hospitals? Check out their policies.

[medpasser]

I think I feel very sad because I thought my situation was unique. I now realize the fear and frustration I feel at work seems to be almost ubquitous. I am quite defeated right now because I am leaving the unit I oriented into as a new grad because the work load is so heavy and the clients so sick. I made it 14 months and everyone tells me I'm doing great but if this is "doing great" I can't imagine how it feels to be "doing poorly". We are 4:1 in pods with a trach and pegged total care chronic in each pod and from day 1 to day 3's in other rooms I'm slinking away to radiology because I have a miagraine HA very time I finish a stretch and wake up in the night worried. It seems that everything that happens or needs doing for these folks lands right on the nurse. All the other disciplines look pretty relaxed to me but the RN's are killing themselves. We are the final line of defense. I know thats what nurses do but I feel that as sick as these people are the ratio is too high so out I go. I enjoy cardiac and the surgical aspect is interesting too but I'm too beat down to stick and don't feel confident enough to travel. Nothing but respect for you folks who can ride that horse, but take care. Thanks for the validation I thought I was just a loser but what I see here says different.

[BandEmom]

about a week ago I had a pt who presented pretty lucid, although a poor historian on admit assessment. Several hours later he went into DT's or something because he ripped out his IV, ran down the hall, opened the fire escape and proceeded to urinate off the balcony. This happened at exactly 7pm (end of the shift). The sound of the alarm was deafening and there were patients and family members out in the hall pretty freaked out. I was sitting down talking to the new grad that I was precepting when this happened. The oncoming night shift CNA saw the pt go out the door. I didnt witness it but I got up right away to see what was happening. He was covered in urine and feces as was his room. How many people would you suppose got up out of their chairs to help me? This includes the CNA who witnessed it....

the answer is zero.

They didnt even call our charge nurse to tell her something weird was going on. They called engineering to shut the alarm, while they waited in their chairs at the nurses station for night shift to come on so they could give report and get out of there. I called for my preceptee to pull some ativan for me. (btw she didnt get up either until I called for her, she must have figured that I had it all under control too). I gave the ativan, cleaned him up, cleaned his room up, moved his bed to a room in front of the nurses station by myself.

I am so completely done with inpatient work. The worst part here is that we were not even poorly staffed at the time. There were three other RN's, a secretary and a CNA, which is ironic considering my original post. The worst part is that they sat around with the alarm blaring and chose not to get up. they didnt even care that i was the only one running around at change of shift while they were all caught up and just waiting to hear the sound of the elevator opening. Even this event aside, I have witnessed such awful catty, competitive and just mean spirited behavior from so many people in the hospital. Not just here but everywhere I have worked. Attitudes about who is lazy, who is a bad nurse, who is just plain dumb, why I'm teaching someone who has already been taught something about our brand new computer charting system.

I feel sad because I always wanted to care for sick people in the hospital, but this environment is really bothering me. I can handle the work just fine, but the emotional stress is too much.

Readng some of these replies has given me some insight that my workplace is really not very unique, but that I am just in the wrong environment. Thank you for the replies.