I’ve working in the ICU for 6 months and I feel miserable

[brandnewicu]

I know we are in the middle of a pandemic. It seems everyone thinks this is the new normal. Maybe it is. But I am looking for guidance in the midst of this. I started a residency program in August, went through orientation and started working officially by myself in trauma/neuro/ MICU. It was okay at first. Stressful but okay. A lot of days were really frustrating and I felt less than worthy to work there and didn’t really know when I would get over the hill, but it was okay. Although always felt like a big workload. We bathe all the patients ourselves, flow sheet hourly Ofcourse , documenting every 4 hours, take temperatures, q1 neuro checks sometimes in multiple patients,  print and interpret ECG strips, give meds, blood glucose , draw all patient labs (peripheral stick or other wise), change all 24 hour disposables  in all patient rooms. When I list it all out it doesn’t sound like a lot but let’s just say I feel like I’m chasing my tail all night. And then sometimes they put me down for rapid response or code blue when no one has even taken the time to say hey let’s go together. But how can I blame them. No one has time. 
 

Now in the last month I can expect to get 3 patients almost every night. If something goes wrong with one patient it’s like the entire night is a train wreck. It is a 40 bed ICU and we are supposed to have at least 19 nurses and on night shift we have consistently had 10 nurses for I don’t know how many shifts. I either have 3 to begin with, and then maybe I’ll transfer one, get another 3rd one. Or have 2, get an admission. One day I had 3 patients, palliatively extubated 1 patient who had been an admission that same night and got another in hemorrhagic shock within 15 minutes without time to process what even just happened. And I had to take a patient to CT and wait for someone to come help me. It's a challenge to get in contact with some doctors too during the night and just feels like more effort than it should be. 
On top of everything, I made the mistake of signing the overtime bonus contract when I first started in which I worked 6 days of overtime in 5 weeks. I regret that because I got burnt out so bad. And then after that ended, our short staffing has been insane. I don’t even see them trying to hire travelers anymore. Even the travelers say they cry at this hospital and that they’ve been working for years and not all ICU’s are like this. 
 

The worst part of it all is I’m in a 2 year contract agreement and it’s 10,000 dollars worth. I feel miserable, depressed, like I have no life even when I don’t work overtime—which is hard to say no to because they are always asking and begging . I haven’t even continued school for my BSN since I started working here. I am literally scared before I go in for a shift every time I have anxiety. 
 

I just interviewed today for another hospital and I was transparent with them and told them my worries and they said they are having difficulty having a 2:1 ratio as well but they are trying their best and they are having a career fair the following day. The pros of this hospital is they are 10 minutes from me compared to the 40 minute commute to the other hospital and they are offering me day shift instead of night shift. They are a small community hospital, not a trauma center, so I think the acuity of the patient population is less. They haven’t told me the salary yet because the director told me Human Resources will contact me with that information....but again they want a 2 year contract. I don’t know if I should switch or if I wait till something better comes along. Sometimes it feels like I don’t have much choices with only having 6 month experience and only an associates degree. I’d like to stay in ICU in case I’d like to do nurse anesthesia, but maybe the stress isn’t worth it. I don’t know anymore. 
 

either way, I just want to know if this feeling is normal, If this hospital environment is normal, or what is going on. Am I being dramatic or am I just not cut out for nursing? I honestly have not been this stressed/sad in my life. I’m doubting my career choice and I come from a long line of nurses (mom, dad, sister)...and don’t know where else to turn. I would love some words of advice or comfort....thank you. Hope you all are staying safe (and sane) 

[marienm, RN, CCRN]

Not all ICUs are like that, especially not every night. I will point out that undoubtedly some of this is harder because you are new and things do get easier with practice. Your skills (like blood draws), but also your intuition and knowledge of the building/medical practices do get better with time. But when you have 3 to 4 patients per shift you have no time for "practice" and you are basically praying that everything goes right the first time, which isn't reasonable.  Patients are hard sticks, feeding tubes come out right before med passes, patients go into A-fib, etc. It also sounds like everyone is so busy that no one can even try to help each other...can you propose being someone's buddy so you commit to helping each other turn and bathe rather than looking for help each time?

At 6 months in you are probably *barely* getting to the point where you can kind of look at a patient situation and know what's coming. (So your patient has new abdominal distention, emesis of tube feed, no stool x3 days, fever, white count, increased RR, etc...drain their belly and you're probably going to CT so you should look for a stretcher now rather than scrambling.)  But to me it seems unreasonable to make a nurse with 6 total months of experience respond to RRTs. 

I don't blame you for looking elsewhere but I (personally) would be hesitant to get stuck in another 2-year contract. I'm actually still working at the hospital that hired me as a new grad but I wouldn't have been able to promise that when I was hired.  Can your current hospital move you to another unit without breaking your contract? They should be invested in you...at least a little bit...and try to keep you if they can. (On the other hand, they won't and can't care more about your welfare than you do, so you have to be your own advocate in this regard.)  Or, even though you don't want to pay back the $10K, *can* you pay it back? I hate to sound blase but $10K is not much compared to your mental health. 

Good luck with your decision. I don't think this means you aren't cut out to be a nurse...but getting out of this situation before it completely saps your *desire* to be a nurse might be a choice you have to make.

[JBMmom, MSN, NP]

There are definitely many factors all in play right now. First you're a new nurse in probably the worst year ever to be a new nurse, especially in critical care. What you're going through probably wouldn't be as bad if you had an extra year of experience under your belt before being tripled with difficult assignments. That being sad, your assignments sound like a bit much for anyone.

Many ICUs are facing chronic short staffing and there's no insurance that the new place will be better. But you obviously have a first impression based on your interview, so if you decide to follow your gut and go for the job change, that's your decision. However, you are pretty early in your career for burning bridges. If the hospital you're at is part of a larger health system you are likely to face a "do not rehire" on your record with with them if you don't stick out the two years. So, the $10K is one consideration, but another is your future career prospects. Your mental health is important, though, so if you can afford the switch and it feels like a better move, it might be worth it.

[OcalaICU-TraumaCoordinator]

Hi, 

Not all ICUs are like that. I work in a great ICU and we have opening!.

Ocala Regional Medical Center 

New ICU- RN Openings 

10k Sign On Bonus

Demographics: 40 Bed Surgical- Trauma ICU

Location: Ocala, Florida 

PM with any questions: 

RN’s are you considering a job change? Join our great team! Ocala Regional Medical Center was awarded the ANCC’s pathway to Excellence designation in 2020. 

Why is this designation important for RN’s? The Pathway to Excellence Program® – is the premier designation for healthy work environments – recognizes health care organizations that demonstrate a commitment to establishing the foundation of a healthy workplace for staff by providing a healthy work environment where nurses are engaged and thrive, where professional growth opportunities exist and where the leadership team is accessible and present. We value each nurse  team member’s ideas and opinions. 

Ocala Regional Medical Center is now offering a 10,000 Sign On Bonus for RN’s with a minimum of 1 year acute care experience.

 

Your benefits would include:

401k 

Paid Time Off

Medical, dental, flex spending, life, disability benefits

Tuition reimbursement 

Employee discount program

Employee stock purchase program 

Student loan repayment

Ocala Regional Medical Center is a 256-bed trauma hospital located in the heart of Ocala. New openings in the Surgical ICU, Trauma ICU & Intermediate Care Unit with a 10k sign on bonus.

PM me for any questions. If you have one years experience in an acute care unit , you can apply for one of the below ICU positions: 

Link:

https://careers.hcahealthcare.com/jobs/6326932-registered-nurse-ICU.

 

Link: 

https://careers.hcahealthcare.com/jobs/6274446-registered-nurse-ICU

 

IMCU Link:

https://careers.hcahealthcare.com/jobs/6274517-registered-nurse-intermediate-care

[JustAnotherNursemaybe, BSN, MSN]

Not all icus are like that, for sure. I've been in ICU for almost a year now, so I totally understand the whole starting during a pandemic thing. However, my hospital has gone above and beyond to try and keep everything safe. I've never had more than 2 patients at a time and at one point they were paying travelers $8k a week to come here. We have a designated stat nurse that goes to rapids and codes, as well as the charge. Floor nurses never do. We also have a designated hospitalist that's always on the floor (unless they are assessing someone to come to ICU). Last night I had 3 doctors in my room trying to keep my patient alive, all I had to do was poke my head out the door and yell "hey!" 

I know just based on reading about other people's experiences that I apperently have it extremely cushy. But if you are willing to relocate, I wouldn't hesitate. Your mental health and growth as a nurse is important. There are a lot of ICUs out there