ICU burnout?

Pediatric Critical Care Columnist · Aug 12, 2015

Staffing seems to be an issue everywhere these days. It's false economy to cut staff to the bone then have readmissions, sentinel events and adverse outcomes but no one is willing to look at the big picture, put the pieces together and advocate for appropriate staffing. So we at the bedside take the heat. It's demoralizing to go to work knowing you're not going to do more than keep your head above water for 12 or 13 or 15 hours and to know that no one really gives a rat's rump about it. None of us went into nursing to provide mediocre care or to just do the essentials, but it's really all we can do. I know none of that really addresses your feelings of burnout, but I do understand your frustration. I keep mine at bay by engaging in my hobbies on my days off so I have pleasant things to occupy my mind, rather than dwell on how much I wish my workplace was more like I want it to be. Once I start dwelling on the negative, everything becomes negative in my mind, even the things that really aren't bad. So maybe you could try to compartmentalize a bit more and find enjoyable pursuits away from work. It won't change anything at work but it might change how you're viewing your world.

goodbadugly · Aug 12, 2015

Dear ICU Burnout!!

There are only 2 states that will treat you right, California and New York. Every place else pretty much sucks. I have worked in ICU for a long time. It takes 10 years to get real good at it and by then it has lost all of it's luster and was never fun. It has it's moments, but generally your job is to keep dead people alive.

There are so many different jobs in the medical field, donot stay in a place where you are unhappy. The greatest thing you need to protect is your mental health. Your sanity will depend on you stepping up and refusing to take unsafe assignments. As they say, you need to grow a 'pair".

Generoh · Aug 19, 2015

Dear ICU Burnout!!
There are only 2 states that will treat you right, California and New York. Every place else pretty much sucks. I have worked in ICU for a long time. It takes 10 years to get real good at it and by then it has lost all of it's luster and was never fun. It has it's moments, but generally your job is to keep dead people alive.
There are so many different jobs in the medical field, donot stay in a place where you are unhappy. The greatest thing you need to protect is your mental health. Your sanity will depend on you stepping up and refusing to take unsafe assignments. As they say, you need to grow a 'pair".

Why do you say NY and CA will treat you right?

StayLost, BSN, RN · Aug 21, 2015

Dear ICU Burnout!!
There are only 2 states that will treat you right, California and New York.

I work in New York City. It's the norm here for ER nurses to oversee 16 or more patients.

calivianya, BSN, RN · Aug 21, 2015

We have been tripled a lot, too, but getting out as late as you are talking about is very uncommon. We are considered leaving "late" if we clock out after 0722/1922, and we have to write in an incremental overtime book to justify our extra pay if we clock out beyond that. It is rare for someone to still be at work past 0800. I have only clocked out after 0800 once in a year of working at my current facility, which is a very large referral center with over 900 beds, so we take very high acuity patients. I have probably clocked out after 0745 less than five times.

I am thinking there is more of a problem with your unit than just acuity/staffing. Are you mostly new grads with no experienced resources? I would suspect you are either all new, or have teamwork problems if you have staff getting out that late. We have had nights with three or four codes on the unit with lots of staff being tripled and everyone is out before 0800. You have a real workflow problem if staying that late to chart is normal for your unit.

MunoRN, RN · Aug 21, 2015

I can't imagine staying over 2 hours to document much less 4. If that's how long it takes to chart when that is all you have left to do, I'd say the charting is a major contributor to why you are feeling overburdened. Even if I haven't done a lick of charting, I can have it done within 45 minutes of handing off my patients, maybe an hour if the EMR is running slow.

infinitynotzero · Aug 22, 2015

I would say about 60% of my job is charting, unfortunately.

MunoRN, RN · Aug 22, 2015

What does your charting consist of?

infinitynotzero · Aug 22, 2015

Well lets see.. 3 physical assessments per patient per shift, event notes, end of shift notes, hourly assessments which consist of drip rates/IV's hanging with their rates, VS, I&O, and anything else you could imagine might be assessed hourly.. like icp etc... any drip titrations. vascular access and turns/activity every two hours and rhythm strips are the bare minimum. Depending on what the pt. has going on, you can add about 8 plus assessments that need to be documented a few or more times during the shift. Have an admission? Add on two more hours of paperwork. Also, we "cater to our doctors" which means we put in all their orders for them (most don't even know how to do this). There's probably quite a bit more that I can't recall off the top of my head.

APRN., DNP, RN, APRN, NP · Aug 22, 2015

Why do you say NY and CA will treat you right?

California has ratio laws. I've worked in ICU for years and years. I've not once, never ever, had more than two patients since the ratios went into effect in the early 2000's.

calivianya, BSN, RN · Aug 22, 2015

Well lets see.. 3 physical assessments per patient per shift, event notes, end of shift notes, hourly assessments which consist of drip rates/IV's hanging with their rates, VS, I&O, and anything else you could imagine might be assessed hourly.. like icp etc... any drip titrations. vascular access and turns/activity every two hours and rhythm strips are the bare minimum. Depending on what the pt. has going on, you can add about 8 plus assessments that need to be documented a few or more times during the shift. Have an admission? Add on two more hours of paperwork. Also, we "cater to our doctors" which means we put in all their orders for them (most don't even know how to do this). There's probably quite a bit more that I can't recall off the top of my head.

That's standard ICU charting - every ICU I have ever worked in charted all of those things, and I have never gotten out as late as you do in any of them. They even took away copy and paste at one of those jobs, so every single assessment had to be manually charted, and we still all got out on time. Granted, I've only worked in four ICUs, but still - this charting is normal.

Do you have a unit shared governance council? I'd put a bug in their ears about figuring out why your charting takes so long, and what can be done to fix it.