ICU burnout?

[infinitynotzero]

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?

[Yuppers21]

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.

[Greenclip]

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!)

[VANurse2010]

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]

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]

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

[VANurse2010]

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]

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! 😆

[Dranger]

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.

[hawaiicarl, BSN, RN]

Our oral care and turns pop up as nursing tasks, those are charted separately, but glad most people are charting the same.

Cheers

[calivianya, BSN, RN]

I'm starting to think I work at one of the more ridiculous places for charting. Ours is similar to hawaiicarl's with some exceptions.

- Pain q1h.

- Full assessments q4h, focused assessments q2h.

- Patient education and care plans qshift.

- Lines, drains, and turns q2h.

- Our RASS is q2h on everybody, q1h on specific populations (Ketamine, severe agitation).

If they have a temp probe in, we increase temp charting to q1h. If I am going to have to check temp more often than q4h, I just throw a probe in so the data carries over from the monitor. Ain't nobody got time to manually check a temp q2h.

The latest thing management is auditing our charts for is fall risk documentation - the patients have to be scored appropriately, we have to record what interventions we've done, and we have to make a note of why some interventions are inappropriate for that patient if we don't do them. We literally have to add in a comment "patient sedated/unconscious" if we don't select "call bell in reach," have to chart "Patient with bilateral BKA" if we don't chart "nonskid footwear in use."

Seriously, I have already charted in the RASS section (-3), the neuro section (unresponsive, unable to follow commands), the psychosocial section (sedated), and the GCS that the patient is out like a light, but I have to chart it under fall risk under the reason I don't have the call bell in reach, too.

[montinurse, BSN]

Some good advice here. ICU isn't easy. I float in a hospital that doesn't use CNA's or transporters in the ER and ICU. The ICU doesn't have a unit secretary so the charge nurse picks up as much as she can, which isn't usually much bc she's dealing with admissions, transfers, discharges, staffing, etc. Usually everyone burns out quickly. It's a shame, administration knows the problems but refuses to fix them. It's all about learning to balance your personal life so you can let it go after you leave work. I still take a day or two to recover when I work a 12 hour shift in ICU!

[Iliauna]

I'm a new grad in ICU for about a year as well. I feel the same way and just posted about it also. Our staffing is a big part of the problem. Our patients are really high acuity and there will never be 1:1 status and our 2's are poorly assigned as well. Nursing is not as advertised. I'm incredibly unhappy and regretful of my career choice. I'm tired of being hit and cussed out and destroying my body from lack of sleep/food/stress. I wonder if other ICU's are better than this... I hope it gets better for you