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.
Well, I certainly don't work ICU, currently doing LTAC, but 1:1 because of intubation? That sounds like a dream! Obviously drips make a difference but I would love to manage one patient! We have 5-6 patients a night and usually everyone gets 3 vents. Sometimes they're all ok, sometimes all your vents are still ETT's and on complete A/C support. YELP! I guess you could say they aren't as "acutely" ill as perhaps when they first landed in the ICU, but these people are still sick. I wish I was working 1:1 in the ICU right about now LOL
I used to work at an ICU in a small town in NM. Needless to say, most of our "ICU" patients are very low acuity, if we even get patients. There would be days where we would have no patients at all for a week. Sitting down for 12 hours watching rhythm strips and waiting for the rapid response beeper to ring(we do telemetries and rapid response as well) can get extremely boring. When we do get patients, most, if not all of them are SAC patients. Our patient:nurse ratio is 2:1, it's like having 2 SAC patients in a very controlled environment. Anything higher acuity goes flown out to bigger hospitals.
I certainly don't miss that XXXX. Two stacks of pumps on each side of the bed, pt mottled head to toe, pupils fixed and dilated, everything that has an alarm is alarming, ECMO running with the perfusionist yelling at you to "do something!", calling the thoracic surgeon every 30 minutes all night long and getting the response "You're doing great! Keep going! Give the family some time." NP walks into the unit at 0600, comes straight into the room, takes one look around, says nothing ... just rolls her eyes.
Summer is slow for ya'all? Yikes. I work in Burn ICU and we're hopping. I think with the hot weather, people prefer to make their meth indoors -- not a good combination!
I love haveing one patient even if they are not very sick. We had a long term lvad waiting status 1a for a heart that was usually singled by default. Lots of hours sitting in the sun, hair makeup and nail sessions 6 walks a day on non dialysis days massages and just really becoming part of her little family. Yeah it gets boring and not mentally stimulating and I love my supersick patients as well as the next icu nurse but some of my proudest "I'm glad I'm a nurse" moments came from doing the little things like giving a back massage and hearing ur patient sigh with pleasure. I rarely leave work fealing like I didn't have enough time to give great patient care.
I recently worked at a hospital, consider a "sister" hospital to the University, tertiary level hospital literally down the street. My hospital was triaged for the run of the mill UTI's, pneumonia, basic sepsis, etc. Our ICU was brand new and pretty, but the acuity level was pretty low: no Swan's, basic post-ops (all post-op spines went there overnight????? crazy).
Case-in-point: An ED note from the University says "dx sepsis, admit to IMC." So they admit to our ICU. lol.
AngelRN27
157 Posts
Well, I certainly don't work ICU, currently doing LTAC, but 1:1 because of intubation? That sounds like a dream! Obviously drips make a difference but I would love to manage one patient! We have 5-6 patients a night and usually everyone gets 3 vents. Sometimes they're all ok, sometimes all your vents are still ETT's and on complete A/C support. YELP! I guess you could say they aren't as "acutely" ill as perhaps when they first landed in the ICU, but these people are still sick. I wish I was working 1:1 in the ICU right about now LOL