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ICU burnout?

Hi there,

I've been working as a new graduate in an ICU for a year now. I'm completely turned off by my job. I got into nursing wanting to become an ER or flight nurse, but jumped when the ICU position was offered to me. Obviously I'm not a pro in the ICU yet, and I'm okay with that- but my frustration is not solely the complexity of the patients. I feel that I understand the pts. needs and patho/drips/machines etc. fairly well and enjoy that the most about my job. I'm having a hard time understanding if I'm turned off by ICU completely or if it is just my facility... we are constantly short staffed, and get tripled frequently. I feel that the care that even the more experienced nurses can provide in these conditions is lacking. Often many of the staff stay two hours late to document, and on a bad day, four hours late. Is this common for all ICU staff? What are your experiences in ICU or with ICU burnout?

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology.

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.

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".

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

Specializes in CVICU, CCU, Heart Transplant.

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

Specializes in ICU.

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

Specializes in Critical Care.

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.

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

MunoRN, RN

Specializes in Critical Care.

What does your charting consist of?

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.

RN., MSN, RN

Specializes in Perianesthesia.

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

Specializes in ICU.

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.

Yuppers21

Specializes in Med/Surg, ICU.

ICU ratios at my work have been far more kind than what has been represented here. 1-2 patients, on rare occasion a 3rd can be added if no other option presents itself. I almost never see anyone stay later than an hour. I live in Utah, there are no unions or ratio laws. I just happen to work for a system that still allows us to staff appropriately. I can only hope it stays that way as our med/surg floors have not been so lucky. I don't think I would stay in an ICU such as you described.

I second Yuppers, above. I am also in a state with no ratio laws. I have 1-2 patients every shift. I have picked up a third patient only rarely, I would say just once in the past year.

Tradition in my hospital is to give an extensive, detailed report. I don't like it, because having worked other places I know it can be done much faster. But that is how we do it. Because of that, if you are finished on time, you will clock out 7:30-7:45. If you have charting to catch up on, it will probably be 8 to 8:30. No one would blink an eye if you stayed until 8. We are never, ever, questioned about our overtime. We used to have a book to justify clocking out after 7:45. That disappeared about a year ago and no one has mentioned it.

Also, if we leave earlier than 7:30 (handing off to the same RN you got report from, or only one occupied bed at handoff) it's not a problem. No one feels obliged to stay until clock-out time.

Typically when I stay late to chart, something has happened close to the end of the day...a patient has crumped or I've had a very busy new admission. I may make enemies of night shift RNs here, but staying late to chart happens much more often on day shift. The biggest time eater on days is being stuck in rounds. If the attending is a slow rounder or spends a lot of time teaching, we could easily be in rounds for an hour and I may not have access to a computer. (If I do, it's a great time to catch up on charting!)

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.

I would disagree. I think it's excessive - if I'm understanding correctly - charting on vascular access q2h (just an example). Um, hell no. qshift is enough for that. I'm not a fan of charting 3 full assessments, either. Most things are not going to change q4h, even on critical patients.

calivianya, BSN, RN

Specializes in ICU.

I would disagree. I think it's excessive - if I'm understanding correctly - charting on vascular access q2h (just an example). Um, hell no. qshift is enough for that. I'm not a fan of charting 3 full assessments, either. Most things are not going to change q4h, even on critical patients.

I totally agree with you. I want to come work with you if those are your facility standards - seriously. I didn't say any of that made sense, I just said it was normal in my facilities.

My current one wants q4h full and q2h focused assessments on their presenting problem. So, if they have pneumonia, as an example, we do full assessments every 4 and listen to lung sounds/look at temp/talk to them and assess mental status/look at color/etc. every two hours. As if any of us are actually listening to lung sounds q2h. All these kinds of restrictive policies do is successfully promote false documentation, which is rampant on my unit (no surprise there).

hawaiicarl, BSN, RN

Specializes in Critical care.

I give all orientees a copy of this paper. It helps them meet charting requirements, but more importantly it prevents overcharting. This is especially helpful to experienced nurses who may have started with paper charting, and feel a compulsive need to chart more than required. Each hospital will vary slightly, but look through your policies for the minimum charting required.

~ICU CHARTING EXPECTATIONS

Full assessments (including pupils) Q4H – acute system based assessments PRN if changes

Vitals Q1H – more often if Pt labile or titrating pressors

Temp and Pain Q4H – Record result 1 hour post any intervention (analgesic or Tylenol) increase temp to Q2H if pt febrile

I&O Q2H – Increase to 1 hour if results are marginal or actively treating ie Lasix

EKG – post strip and record rhythm Q shift and with any rhythm change

Pt Education - chart when done

Lines, foley care, and drains – chart Q shift, and if inserted/removed

Vent bundle – Q shift on vented Pts

RASS Sedation Scale – Q2H, and with any sedation titration, only used on sedated pts

Rounding sheets – Q shift

CHG bath on pts with central line charted daily

Physician Orders – Review and clean up Q shift, check frequently during shift for new orders

PDP, plan of care, MRSA, palliative care, and immunization screening within 24 hours of admission

Cheers

I give all orientees a copy of this paper. It helps them meet charting requirements, but more importantly it prevents overcharting. This is especially helpful to experienced nurses who may have started with paper charting, and feel a compulsive need to chart more than required. Each hospital will vary slightly, but look through your policies for the minimum charting required.

~ICU CHARTING EXPECTATIONS

Full assessments (including pupils) Q4H – acute system based assessments PRN if changes

Vitals Q1H – more often if Pt labile or titrating pressors

Temp and Pain Q4H – Record result 1 hour post any intervention (analgesic or Tylenol) increase temp to Q2H if pt febrile

I&O Q2H – Increase to 1 hour if results are marginal or actively treating ie Lasix

EKG – post strip and record rhythm Q shift and with any rhythm change

Pt Education - chart when done

Lines, foley care, and drains – chart Q shift, and if inserted/removed

Vent bundle – Q shift on vented Pts

RASS Sedation Scale – Q2H, and with any sedation titration, only used on sedated pts

Rounding sheets – Q shift

CHG bath on pts with central line charted daily

Physician Orders – Review and clean up Q shift, check frequently during shift for new orders

PDP, plan of care, MRSA, palliative care, and immunization screening within 24 hours of admission

Cheers

O Dear. Ridiculous!

weirdscience

Specializes in Critical Care.

I give all orientees a copy of this paper. It helps them meet charting requirements, but more importantly it prevents overcharting. This is especially helpful to experienced nurses who may have started with paper charting, and feel a compulsive need to chart more than required. Each hospital will vary slightly, but look through your policies for the minimum charting required.

~ICU CHARTING EXPECTATIONS

Full assessments (including pupils) Q4H – acute system based assessments PRN if changes

Vitals Q1H – more often if Pt labile or titrating pressors

Temp and Pain Q4H – Record result 1 hour post any intervention (analgesic or Tylenol) increase temp to Q2H if pt febrile

I&O Q2H – Increase to 1 hour if results are marginal or actively treating ie Lasix

EKG – post strip and record rhythm Q shift and with any rhythm change

Pt Education - chart when done

Lines, foley care, and drains – chart Q shift, and if inserted/removed

Vent bundle – Q shift on vented Pts

RASS Sedation Scale – Q2H, and with any sedation titration, only used on sedated pts

Rounding sheets – Q shift

CHG bath on pts with central line charted daily

Physician Orders – Review and clean up Q shift, check frequently during shift for new orders

PDP, plan of care, MRSA, palliative care, and immunization screening within 24 hours of admission

Cheers

This is very similar to ours, except we also chart q2 oral care, q2 position changes, and we have to chart lines/tubes/drains and wounds q4, and I&O q1.

On the upside our RASS is only q4! 😆

I give all orientees a copy of this paper. It helps them meet charting requirements, but more importantly it prevents overcharting. This is especially helpful to experienced nurses who may have started with paper charting, and feel a compulsive need to chart more than required. Each hospital will vary slightly, but look through your policies for the minimum charting required.

~ICU CHARTING EXPECTATIONS

Full assessments (including pupils) Q4H – acute system based assessments PRN if changes

Vitals Q1H – more often if Pt labile or titrating pressors

Temp and Pain Q4H – Record result 1 hour post any intervention (analgesic or Tylenol) increase temp to Q2H if pt febrile

I&O Q2H – Increase to 1 hour if results are marginal or actively treating ie Lasix

EKG – post strip and record rhythm Q shift and with any rhythm change

Pt Education - chart when done

Lines, foley care, and drains – chart Q shift, and if inserted/removed

Vent bundle – Q shift on vented Pts

RASS Sedation Scale – Q2H, and with any sedation titration, only used on sedated pts

Rounding sheets – Q shift

CHG bath on pts with central line charted daily

Physician Orders – Review and clean up Q shift, check frequently during shift for new orders

PDP, plan of care, MRSA, palliative care, and immunization screening within 24 hours of admission

Cheers

That's our standard charting as well but we have Q2 turns, Q4 oral care. It's a real pain. Luckily EMR makes it easier.

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