How is life in the ICU? I am in a LTACH

[Beautiful_Beginnings, ASN, RN]

I was a home health nurse for 1 year. I have been a LTACH nurse for 1 year. My LTACH has a ratio 1-5. 

 At my LTACH,  there are tons of tasks per 5 patients like wound care, mobility x2( out of bed), q2hour turns, record breakfast,lunch Dinner, incontinence care, obtain vital (no vital machine in room, must search), administer TONS of medications, take pt to procedures ( this does not happen often). Some patient have peg, NGT, vents or awake talking asking for items. Also I am interrupted by aides all day for help needing to move patients into a chair. We have tons of medications for  5 patients all over the place. Each patient have meds due at 10am BUT most have meds due all over from 7-1900.

The charting is overwhelming for me with 5 patients. I love the tasks, but with 5 patients charting anything including assessment is overwhelming for me.  I wanted to go into  the ICU. How is the charting? I was told by someone in the not in the ICU that charting is worse. I was told you maybe be charting every 15-30mins.

Any insight on the day in the life of a ICU nurse, charting in the ICU, life as an ICU nurse(is it better ?), are there aids? How much charting is involved ?, do you have time to research patients chart in the AM?,  I can only drink water in the lunch room. We have no nurse station for nurse staff. It is only for charge and secretary. All have WOWs in the  hall. No nursing station for nurses, is that normal ? can anyone in any nursing unit able to have lunch? ?

[Hoosier_RN, MSN]

Beautiful_Beginnings said:

I was a home health nurse for 1 year. I have been a LTACH nurse for 1 year. My LTACH has a ratio 1-5. 

 At my LTACH,  there are tons of tasks per 5 patients like wound care, mobility x2( out of bed), q2hour turns, record breakfast,lunch Dinner, incontinence care, obtain vital (no vital machine in room, must search), administer TONS of medications, take pt to procedures ( this does not happen often). Some patient have peg, NGT, vents or awake talking asking for items. Also I am interrupted by aides all day for help needing to move patients into a chair. We have tons of medications for  5 patients all over the place. Each patient have meds due at 10am BUT most have meds due all over from 7-1900.

The charting is overwhelming for me with 5 patients. I love the tasks, but with 5 patients charting anything including assessment is overwhelming for me.  I wanted to go into  the ICU. How is the charting? I was told by someone in the not in the ICU that charting is worse. I was told you maybe be charting every 15-30mins.

any insight on the day in the life of a ICU nurse, charting in the ICU, life as an ICU nurse(is it better ?),are there aids? How much charting is involved ?, do you have time to research patients chart in the AM?,  I can only drink water in the lunch room. We have no nurse station for nurse staff. It is only for charge and secretary. All have WOWs in the  hall. No nursing station for nurses, is that normal ? can anyone in any nursing unit able to have lunch? ?

Nursing is overwhelming everywhere, regardless of specialty, due to understaffing. The less patients in ICU is their acuity is much higher, and yes, need for more charting. It's definitely a trade off. As far as nursing stations, break rooms, etc, every facility is set up differently, so there's not a one size fits all answer

[marienm, RN, CCRN]

Charting: everything we do at my facility needs to be charted.  How difficult this is depends on the EMR and the complexity of the patient, but at minimum for an ICU patient I chart:

*full assessment q shift

* focused assessment with changes or as ordered (like CSM checks every 2 hours, or full neuro exam for a neuro patient hourly),

*fall risk scale (q shift and also with any change),

*vital signs at least hourly, sometimes every 15 minutes (titrating pressors) or every 2-3 minutes (bedside procedures, intubations),

*intake and output from all sources hourly,

*all positioning/mobility/cares at least q 2

* any new lines or lines removed (placed an IV, removed a foley). 

*special stuff like CVVH or paralysis assessments or bladder pressures as needed...definitely depends on the type of ICU 

We're also expected to chart things like patient education and a plan of care.  And I write a note if something happens "BP 70/40 at 2000, 1L NS ordered by MD Smith, BP 65/43 at 2030, levophed infusion initiated, blood cultures drawn, CVC placed by MD Jones, pt transported to CT scan...."  Ideally in my ICU we have a 1:2 ratio but this doesn't always happen because we get a lot of stepdown/progressive care patients in 1:3 ratios.

We almost never have an aide.  PT helps mobilize patients during the day but not at night.  (Getting patients in and out of chairs is a great time to assess them, so maybe there's some improvement you could make with your aides so this helps your flow instead of interrupting it?). Our facility tries to standardize med times but that only goes so far...we can ask the pharmacy to make adjustments but between antibiotics, insulin, cardiac meds, electrolyte replacements, etc some meds can't be combined. We sometimes have time to look up our patients at the beginning of the shift and sometimes not. We usually take lunch breaks, but we're not allowed to eat or drink on the floor (though there are often cups at the desk but there aren't supposed to be...this is a department of health thing and not the facility).

I still think you'll find the ICU easier in a way, but it doesn't mean you won't have a lot to learn as you would at any new facility and new practice area.