How critical is your ICU?

Published

Specializes in ICU.

Hi guys, I just got my first job in a MICU. I knew I wanted a MICU more than anything after I did my preceptorship in nursing school in one that had crazy sick patients. My last patient of the rotation was insane - ARDS/MI/AKI/sepsis and many other diagnoses I have since forgotten, hooked up to more than 12 drips, an oscillator, CRRT, an EEG monitor because he was paralyzed, a Bair because he couldn't maintain his body temp, etc. I thrived on taking care of him and I thought I'd be able to find a place with that kind of acuity again.

Fast forward a couple of months and here I am, in my shiny new MICU job, excited to be taking care of some crazy sick patients, and... I signed my two year contract before ever being on the floor. I was in critical care classes prior to then. Now that I'm having shifts on the floor, more than half of the patients in the unit can look up and wave at me when I'm walking by. I'm honestly confused. In the ICU I did my preceptorship in, it was a pretty common saying that once they woke up and could recognize there were other people around, they weren't ICU material anymore. Now I'm working somewhere with a ton of walkie-talkies who are somehow ICU material. This isn't a tiny hospital so I'm really surprised at the low acuity of the ICU patients. Where are my sick people? I am frustrated with the unit and with myself because I moved several states away for this job, thinking it was my dream job, and so far it has not been what I wanted. I got offered a med-surg position in my former state, and now I'm thinking I should have just taken it if this is the "ICU" experience I'm going to get where I am. I'm pretty sure I had sicker patients in some of my med-surg clinicals than I have now. I wish I'd shadowed here beforehand, but it's obviously too late at this point. I don't have the money to break this contract so I'm stuck.

I'm just wondering how common all of this is. TL;DR - how sick are your ICU patients? Are they typically crazy ill with a million drips, or are they just glorified med-surg that have no business really being in an ICU? These patients aren't overflow, by the way... they really are "ICU" patients.

Up Vote Up Vote ×
Specializes in Med-Surg Nursing.

I work in a small community hospital now. My typical pt's would be on a med-surg floor if they were in the bigger hospitals down the street. I.E.-chest pain r/o MI's on heparin/ntg gtts, Afib/RVR on cardizem, Bowel resections, GI bleeds, Fem-pop bypasses, OD's are our typical patients. This week's diagnosis du jour was seizures...I think they both left AMA. I spent 6 months in a similar ICU then left there to work in a Level II trauma center ICU for almost 4 years.

I prefer the pace of the ICU I now work in even if I'm also the respiratory therapist on night shift. We also don't have Aides or unit secretaries either. Our census calls for them with 3 patients or more(we have 6 beds) but there's only 1 aide in the entire hospital on nights. I did crazy busy for almost 4 years. It was good experience when I needed it but I couldn't do that pace for 20 or more years.

Up Vote Up Vote ×
Specializes in ICU.

It's summer! Relax, it'll pick up. I work in a MSICU and we've got the same problem, but it's normal. Our census is low, patients aren't that critical, but it'll pick. First cold spell and you'll get some critical patients. :)

Up Vote Up Vote ×
Specializes in ICU.

Actually just to emphasize my point, I haven't had a patient with a Swan or even art line in a month. I've had mostly stable vents just sick enough they couldn't go to LTAC. We haven't had many hearts this summer either. Just the way it is.

Up Vote Up Vote ×
Specializes in Surgery, Trauma, Medicine, Neuro ICU.

We're pretty ridiculous. Level I trauma center. 36 beds. Mixed medical/surgical/trauma/neuro/CV unit. We do pretty much everything but transplant recipients. Our acuity is VERY high. It's nothing for 2+ CRRT, a balloon pump or two and a handful of crashing patients to be on the unit at once with a level 1 trauma landing on the helipad. We cracked a chest on the unit today AND did some bedside surgery. It's rare that we have two tele patients per assignment and then they both get moved out and you get two admits!! Best job in the world. For reals.

Up Vote Up Vote ×
Specializes in ICU.

I'm glad to hear that, vera4130, but I think my ICU's a lot more like the first poster's. There was a day this week that we only had one patient on a vent. I really hope the cold weather proves me wrong.

ICUPrincessNurse - SO JEALOUS! :)

Up Vote Up Vote ×
Specializes in MICU - CCRN, IR, Vascular Surgery.

My hospital doesn't have a medical PCU (but we do have a cardiac and a surgical PCU) so sometimes we get stuck with those who are walkie talkies or almost walkie talkies. Lately acuity has been higher and it's been great!

Up Vote Up Vote ×
Specializes in Med-Surg Nursing.
We're pretty ridiculous. Level I trauma center. 36 beds. Mixed medical/surgical/trauma/neuro/CV unit. We do pretty much everything but transplant recipients. Our acuity is VERY high. It's nothing for 2+ CRRT, a balloon pump or two and a handful of crashing patients to be on the unit at once with a level 1 trauma landing on the helipad. We cracked a chest on the unit today AND did some bedside surgery. It's rare that we have two tele patients per assignment and then they both get moved out and you get two admits!! Best job in the world. For reals.

Been there, done that. Over it.

Glad you still love it. I couldn't handle that kind of stress EVERY SINGLE DAY!! I had THREE patients like that...one balloon pump, one fresh MI and a new trauma pt! YIKES!! NO thank you! I worked too hard for my license to put it on the line every day!

Up Vote Up Vote ×
Specializes in critical care.

Yup, it's summer. Our census and acuity are way down... been getting furloughed left and right. We actually had a couple real sickies the other week and it felt good to get back into that flow.

Up Vote Up Vote ×
Specializes in ICU.

Ouch. Ok we aren't THAT slow! I'd say at least half of ours are vented on any given night, and we usually have at least two or three CRRTs/IABPs up.

I was complaining to my supervisor recently about the lack of critical patients and he made a really good point that yes, some of our patients shouldn't be ICU patients, BUT if we kicked out the people who didn't really need to be there, we'd be cancelling more nurses than we already are.

This summer has been very non-stop or nothing. EVERYTHING comes in at once. We're either having multiple codes, emergent intubations, etc. or nothing.

Up Vote Up Vote ×

It depends for us. I work in a large MICU - level 1 trauma, tertiary care center. Generally during the summer we have a lower acuity, while the trauma ICU has higher acuity. Then it switches during the fall/winter. Right now we have 4 CVVHD patients. It's been 2.5 weeks since I've had a 2 patient assignment because I've been taking the 1:1s. The other day I had 2 patients - 1 had a bicarb, neo/levo/vaso, fent, versed and amio drip. Both intubated. The other had fent, versed, precedex and propofol and levo. FREAKING OUT. With all that sedation she was a whackado. Haha. Earlier this summer all the hospitals in the entire city were kind of low census. It was kind of strange.

Up Vote Up Vote ×

I must first say I work in a cardiac surgery only icu but we constantly have sick ones on balloon pumps crrt and ecmo. And to the nurse saying they had 2 patients with one being a balloon pump, what?!!!!!!!! If our patients are intubated they are kept one to one lol. Which I know from working at other hospitals that that is extreme but that is just how it is here and I sure ain't complaining!:cheeky:

Up Vote Up Vote ×
+ Join the Discussion