Icu Nursing isn't for me help

Esme12, ASN, BSN, RN · Mar 18, 2014

What it it you don't like?

Nurse_Jessie · Mar 18, 2014

Is there any aspect of ICU nursing that you are interested in? My hospital has several different ICU's with different focuses, a Cardiac ICU, a Neuro ICU, an Open Heart ICU, etc. Is there an area that you are interested in that you could use to start building an expertise? What is your favorite type of patient to care for, you favorite things to do while working. Dialysis nursing can often benefit from critical care experience, from what I understand, or you could go for a certification in wound care if that were something that interested you.

If the stress is getting to you, a transfer to Med-Surg might help, though you will still be dealing with stress, just a different type of stress. I'm guessing that transferring to another speciality would likely require a residency of sorts to learn about that specialty, so maybe look for hospitals with residency programs and talk to their educator about if they would be willing to take a more experienced nurse and train them.

Ruby Vee, BSN · Mar 18, 2014

It sounds as if you're in a smaller hospital where one ICU takes everything. In large teaching hospitals, there can be several ICUs, each one a specialty. If you like cardiac, try a CCU or CTICU. If you're into the nervous system, a Neuro ICU would be a fabulous learning experience. There's NICU and PICU. But if it's the fragility of the patients or the urgency in ICU, perhaps you'd be happier elsewhere. Med/Surg would still give you the issue of taking a variety of patients and not becoming an expert in any one specialty, but again, a large teaching hospital will have a Medical Oncology, Surgical Oncology, Renal, Cards -- whatever specialty you can think of floor.

No matter where you get your next job, you'll be dealing with stress; just different stress. I cannot think of anything more stressful than Home Health, unless it's Newborn Nursery . . . but your milage may vary.

Make a list of what you like/enjoy about your job and another list of what stresses you out the most. Be specific -- not "I'm afraid of making a mistake", but "I'm afraid of titrating dopamine." Or whatever. Then come back and share the gist of your list and maybe we can be more helpful!

Stpabv · Mar 19, 2014

Been right there with you, all of my peers said stick it out, and there is a turning point, what don't you like? of course the stress of the ICU in difficult to manage. How many beds in your facility, in the unit, what are your strengths...?

jennycRN · Mar 19, 2014

Dear Ruby Vee--

Did you really mean it when you said that you can't think of anything more stressful than home health? Given that every job has its own stressors of course.

Ruby Vee, BSN · Mar 19, 2014

Dear Ruby Vee--
Did you really mean it when you said that you can't think of anything more stressful than home health? Given that every job has its own stressors of course.

Well, the newborn nursery is a close second but at least there you have back-up!

My Community Health rotation as a student was absolutely excrutiating. I went into one home where the woman was a hoarder. There was junk piled to the ceiling throughout the entire house, with just one narrow little path through from the front door to the kitchen, one place clear at the table, and then another path to the bedroom. The bathtub was full of used toilet paper and the toilet didn't flush. There were about thirty cats living there and no littler box that I could find. The smell . . . .

I had another patient who lived in a not-so-nice part of town. It was winter, and dark when I finished my visit. The patient wouldn't let me leave her house until her husband came home to escort me to my car because she was afraid I'd get beaten up, raped or mugged on the way to my car. When her husband came home, he scared the everlivin' bejesus out of me, but he did get me safely to my car.

And then there was the home health nurse in my area who was murdered while out doing her rounds of her patients. (I think it turned out that the ex-husband did it, but the idea that it might have been a patient kept me in nightmares for weeks!)

The thought of doing home health has me shivering in my boots!

HouTx, BSN, MSN, EdD · Mar 19, 2014

Hey, I'm right there with you Ruby. To me, the scariest patients are those without any monitoring technology. Give me a monitored patient with ventilator, capnography, swann, peripheral A-line, etc.... and I feel much more at ease. There's NOTHING that can happen without my knowing it first. Not the case with a 'walkie talkie' - who knows what's happening in there???? Worst of all?? Pregnant people - for heaven's sake, there's a patient inside where I can't even touch him/her - And to have to deal with a patient in an area where there isn't even a crash cart or mechanism to call a code??? YIKES!!

See, it's all a matter of perspective.

RN-icu · Mar 25, 2014

Thanks for all the responses. I work in a 240 bed community hospital on a 22 bed icu/tcu unit. Our patient ratio is 1-4 depending on the acuity. (1:1 is pretty rare for us tho) We do resp failure, renal failure, gi bleeds, overdoses, post-op, and just old/sick with an assortment of illnesses. We have a trauma 1 hospital 5 minutes away so everything interesting goes there. While in school I did my clinical rotation in their neuro-icu and took care of very interesting patients (gun shots, MVA, and strokes). I enjoyed my time there, but I was a student. I wasn't a nurse responsible for doing it on my own. So I am not sure if I would enjoy it now or be even more stressed because there will be so many things I haven't done and haven't had the opportunity to see yet.

I love when I leave work and know that I connected with a patient/family and they really appreciated all the work I did. Because I do my best and bust my butt to make sure my patients/families are taken care of and getting what they need. I went to nursing school thinking that everyday would be like that and I would really make a difference, but sadly more often then not that isn't the case at all!

Also in nursing school we were told that nursing is the best profession because you can try a different speciality every 6 months until you find the right fit. That doesn't seem to be the case now either.

I guess I need to make a list like rubyvee said and figure out what in particular I do not like

RN-icu · Mar 25, 2014

So here is the list so far. I'm sure I could add to it, but it's getting late and this is all I can think of now.

I dislike:

Titrating pressors. Actually I like doing it, but I do not feel educated enough. It's not all the time that I have the opportunity to do them so I always have to look them up. I can never remember how to mix them, which ones are mcg/kg/hr vs mcg/hr, or the titration ranges. In codes or when my patient is crashing and I need them quick it stresses me out.

NT suction: I hate doing it. It's torture and it's gross

Placing ng/dht: same thing, I hate doing it.

Cleaning up poop: I did that as an CNA and thought I won't have to do this once I'm the nurse with a college degree. I still do it all the time.

Feeling overwhelmed. This happens a lot especially when I have a 3-4patient team. A recent team I had, but pretty indicative of how they make assignments all the time. I had 2 separate gi bleed patients, both getting blood and needing cleaned up a lot. and a dementia patient that kept taking the bipap off. Until he really couldn't anymore and we intubated him. I just felt like I needed to be in all 3 rooms constantly, but that's not possible so I spent my day running from one to the other.

The charting: gosh! if I didn't have to chart so darn much I could actual spend more time in those rooms. (This is everywhere. I know it won't escape it)

Psych patients: gosh! Half the time I feel like we should just rename ourselves psych-icu. I am not a psych nurse for a reason. Hate it!

Codes/crashing patients: I don't really enjoy this. It stresses me out. I think most true icu nurses get a small thrill form this. Not me!

Feeling like im not smart enough: I know I am my own worst critique, but I hate when a patient or a family member asks me a questions and i do not know the answer. I have to say I honestly I do not know, but I will figure it out. I'm sure they don't feel good hearing that from their icu nurse.

Or doctor for that matter. It's worse when you tell them you don't know something or ask them to explain something. Some really do not like that and make it known.

I like:

When I feel appreciated

When I can sit down with patient/family and educate them

one extreme or the other. I like on the vent, calm, and sedated. Or I like the walkie talkies. I do not like the in between and that whats I get most of the time.

Hanging blood products

DKA patients. That is my favorite diagnosis to take care of. I think because you can actually see your work paying off by watching the bs go down every hour and the ketones slowly clear. I know, very random!

Yogapants14 · Mar 25, 2014

What I dislike are nurse managers who says one thing and does another. In other words, they immediately turn their back on you just to cover themselves. I detest that. I know there are different styles of being a nurse manager, but they should use what will actually work for the nurses as a whole. At least give us the courtesy what they will do to us.

Ruby Vee, BSN · Mar 25, 2014

So here is the list so far. I'm sure I could add to it, but it's getting late and this is all I can think of now.
I dislike:
Titrating pressors. Actually I like doing it, but I do not feel educated enough. It's not all the time that I have the opportunity to do them so I always have to look them up. I can never remember how to mix them, which ones are mcg/kg/hr vs mcg/hr, or the titration ranges. In codes or when my patient is crashing and I need them quick it stresses me out.
NT suction: I hate doing it. It's torture and it's gross
Placing ng/dht: same thing, I hate doing it.
Cleaning up poop: I did that as an CNA and thought I won't have to do this once I'm the nurse with a college degree. I still do it all the time.
Feeling overwhelmed. This happens a lot especially when I have a 3-4patient team. A recent team I had, but pretty indicative of how they make assignments all the time. I had 2 separate gi bleed patients, both getting blood and needing cleaned up a lot. and a dementia patient that kept taking the bipap off. Until he really couldn't anymore and we intubated him. I just felt like I needed to be in all 3 rooms constantly, but that's not possible so I spent my day running from one to the other.
The charting: gosh! if I didn't have to chart so darn much I could actual spend more time in those rooms. (This is everywhere. I know it won't escape it)
Psych patients: gosh! Half the time I feel like we should just rename ourselves psych-icu. I am not a psych nurse for a reason. Hate it!
Codes/crashing patients: I don't really enjoy this. It stresses me out. I think most true icu nurses get a small thrill form this. Not me!
Feeling like im not smart enough: I know I am my own worst critique, but I hate when a patient or a family member asks me a questions and i do not know the answer. I have to say I honestly I do not know, but I will figure it out. I'm sure they don't feel good hearing that from their icu nurse.
Or doctor for that matter. It's worse when you tell them you don't know something or ask them to explain something. Some really do not like that and make it known.
I like:
When I feel appreciated
When I can sit down with patient/family and educate them
one extreme or the other. I like on the vent, calm, and sedated. Or I like the walkie talkies. I do not like the in between and that whats I get most of the time.
Hanging blood products
DKA patients. That is my favorite diagnosis to take care of. I think because you can actually see your work paying off by watching the bs go down every hour and the ketones slowly clear. I know, very random!

Your staffing ratios reflect step-down unit more than ICU. I suspect that if you were in a specialty ICU, you'd learn the drugs (including the pressors) and the most common questions patients and family ask. Perhaps you would feel more confident then. At the very least, with 1-2 patients instead of 3-4, you'd have more time to concentrate on each patient. You're still going to have poop though. An ambulatory setting is probably the only place you'll be able to avoid poop, and even then it's not 100%. (I was in the ambulatory surgery waiting room, waiting for my procedure a few years ago, and the patient before me pooped all over the procedure room.)

NGs are probably more or less unavoidable except, perhaps in CCU. NT suctioning can be delegated to the RT, but you'll probably still have to help the patient through it.

If you really dislike codes and crashing patients, ICU is not the place for you. You're not going to ever completely escape the possibility of codes (even if you work in the cafeteria!) but you can minimize it by working in an ambulatory setting.

There are always going to be too many psych patients (or visitors) and too few appreciative ones.

Looking at your list, though, I'd suggest aiming for an ambulatory setting. Good luck.