ICU Nursing

[CardiacDork]

I do not know what has changed in recent months. I have always had a love-hate relationship with my job. I’ve always had a little bit of anxiety going in to work, expending the unexpected.

Recently though this has taken a turn for the worse. My sleep is in ruins. I keep waking up, I only sleep 4-5 hours of interrupted sleep.

My eating habits have worsened. I rely heavily on food for comfort, and it’s taking a toll on my physical health, further deteriorating my emotional state.

I am constantly anxious and on-guard at work. Either I’ve come to realize how truly easy it is to commit a mistake, or I’ve become obsessed with making sure I do everything as perfect as possible.

I cannot stand my manager. I cannot fathom him. He is all about the numbers, and picks favorites. Our unit is always the one that is floating and staffing for other units, other units have it easy. Other units don’t struggle the way we do to take time off. Our manager doesn’t approve time off until a few days or a week before the new schedule comes out, and he almost always tries to find a way to cancel your time off.

Then we get stuck covering other units and their time off because we are all staffed to work the unit.

We are self scheduled but I’m so over the schedule not coming out until the weekend before the schedule rolls out! That’s ridiculous. I am also constantly moved around and my work days changed.

I have so much resentment, anger, and an anxiety.

I keep fantasizing about quitting but then I hear how much more bad other hospitals have it with tippled ICU assignments and it scares me because the max right now we get in the ICU is 2:1 for all ICU assignments unless they are an impella.

I am just so tired of the culture of bullies and back talk. Some nurses on days thinking they know everything and yet they are the ones that make the most mistakes. They are the bosses pet and I’m so sick of it. I’m also sick of covering for other units and being the b**** ICU of the hospital.

I don’t know what to do. I’m so sad. I’m so angry. I’m so anxious. I need OUT!!! But I am also scared.

I will be vested very soon, meaning their retirement contribution I will get to keep.

I should have my BSN in August 2020.

Right now I’m an RN, CCRN with five years experience.

[Zookeeper44, RN]

Will it make that big of a difference in the grand scheme of your career, to find something different for the next year while you complete your BSN? You already have 5 years' in CCU, and the certification. Is the 6th year in CCU going to make or break your options later? You need a mental health break for sure.

[ICUNurse32, BSN, RN]

Maybe you should consider CRNA school after your BSN or advance? The bedside seems to be crushing you. Its understandable with the current crunch on the bedside ICU nurse.

[myoglobin, ASN, BSN, MSN]

I have always told my SO that if I wasn't able to go the NP route (PMHNP) in my case and would thus stay in bedside that there is no substitute for California. Why? Ratios mandate no more than 4 to 1 Med/sur, 3 to 1 PCU, and 2 to 1 ICU. In fact 4/1 Medical surgical in California (also with mandatory overtime after eight hours, and mandatory lunch breaks) may be the best deal in nursing. Consider in my seven or eight years in ICU I've maybe been able to take a total of 15 lunches over that entire time and even they were a "gamble" since the relieving nurse was watching four patients (hers plus mine).

[myoglobin, ASN, BSN, MSN]

2 hours ago, ICUNurse32 said:

Maybe you should consider CRNA school after your BSN or advance? The bedside seems to be crushing you. Its understandable with the current crunch on the bedside ICU nurse.

The only negative that I see about CRNA school is that it is a "high risk/high reward" strategy. I have known two individuals (nurses in my ICU) who returned after failing out during the "clinical" portion their last semester. In both cases their preceptor (who was an MD who really didn't think that nurses should be doing the job anyway) basically failed them in clinical. Thus, instead of graduating they owed about 100K in student loan debt and were still RN's. I believe that this is much more likely to occur in "deeply MD dominated areas" such as I live in Florida than it is in more enlightened areas such as Washington State, Oregon, or even Pennsylvania. Of course people can and do fail out of FNP, PMHNP and other programs, but I suspect it is at a substantially lower rate than CRNA school.

[CardiacDork, MSN, RN]

Although a great career for some, I definitely don’t see myself being a CRNA. I do enjoy the cerebral aspect of ICU, and thus I believe I would also enjoy the theoretical nature of anesthesia - while despising the technical.

I am not too excited to be putting in lines and tubes in patients all day.

My preferences are patient education/speaking with patients and their families.

Don’t have a liking for putting in IVs for example. Would much rather educate a patient about CHF.

[brownbook]

On 7/7/2019 at 9:08 PM, ms boogie said:

Hi cardiacdork. I have 2 words for you. Outpatient dialysis. I practiced in critical care for years and I found the perfect nursing job in outpatient dialysis. It is cake and the best kept secret in the nursing world. The pay is amazing (can you say very well sought out specialty) and we are closed on Sundays, nights and major holidays. The best kept secret in the nursing world. And, I have masters degree. My only regret is I wish I found it sooner.

This, plus outpatient surgery clinics. It's better than cake ?, I think of it as Disneyland. We're closed weekends, nights and holidays.

My only warning is if the surgery clinic is part of an acute care hospital you may have to take call for PACU.

[myoglobin, ASN, BSN, MSN]

2 hours ago, brownbook said:

This, plus outpatient surgery clinics. It's better than cake ?, I think of it as Disneyland. We're closed weekends, nights and holidays.

My only warning is if the surgery clinic is part of an acute care hospital you may have to take call for PACU.

The only bad part of dialysis that I see are the 8 hour shifts. For me at least 50% of the reason for going into nursing was to have 12 hour shifts and only work 3 days per week and to be able to work nights (since I'm a night person who would prefer to stay up until 0500 anyway). Dialysis tends to be 8 hour days, five days per week in the past I would have told you that I wouldn't do that for 10 million per year (well I would have said I would take the job for a month, then quit/retire and live off my million), but now I'm becoming a PMHNP so I guess I have to eat my words.

[lilmiz, ASN, RN, EMT-P]

I wish I could say that this isn’t the culture of the monster that is healthcare nowadays. Unfortunately you have just described what I have watched evolve in the last 10 years of my career in ICU, sadly this is becoming the norm from little rural hospitals, to regional hospitals, to large city hospitals and sadly to level one TSICU teaching hospital. It’s not everywhere just yet but I am worried for our profession as well as the patients because this practice is not sustainable. Take your time and really investigate your new job prospects and keep fighting the good fight??

[ms boogie, BSN, MSN]

On 7/11/2019 at 8:56 AM, myoglobin said:

The only bad part of dialysis that I see are the 8 hour shifts. For me at least 50% of the reason for going into nursing was to have 12 hour shifts and only work 3 days per week and to be able to work nights (since I'm a night person who would prefer to stay up until 0500 anyway). Dialysis tends to be 8 hour days, five days per week in the past I would have told you that I wouldn't do that for 10 million per year (well I would have said I would take the job for a month, then quit/retire and live off my million), but now I'm becoming a PMHNP so I guess I have to eat my words.

Please tell me where there are 8 hour dialysis shifts.... my days and everyone else involved in the dialysis wheel involve at least 13+ hours a day. If you are lucky you will only get 50 hours a week working 5 days

[Hoosier_RN, MSN]

13 minutes ago, ms boogie said:

Please tell me where there are 8 hour dialysis shifts.... my days and everyone else involved in the dialysis wheel involve at least 13+ hours a day. If you are lucky you will only get 50 hours a week working 5 days

Southeast Indiana region Fresenius clinics run 2 shifts of nursing to prevent this level of burnout. Sadly, in turn, some nurses don't get their 40 hours. I know a nurse who works at one, and I always think that it's wild that she never gets 40 hours. But I guess not being burned out is worth it