ICU vs. Med/Surg?

[anne74]

I am a new grad and for 5 months I have been working on a specialty step-downish med/surg unit with a 4:1 ratio. I'm very unhappy - I feel like I have to kill myself to get everything done and I have no time for pt interaction, problem solving, etc. I'm just a taskmaster. It's affecting my health (I'm not sleeping well, lost 14 lbs, I'm afraid to go into work every shift, stomach aches, etc.) I don't feel safe because I'm pulled into so many different directions, there are more opportunities to miss something or make a grave error. I'm asking for a transfer to a new unit.

So my question is, does anyone find it less stressful to keep track of only 1 to 2 patients with higher acuity, compared to 4-5 patients who are less sick, but still needy/high maintainence? (I understand that ICU floors are stressful as well, but can someone describe their type of stress?) I feel that I might do better in a more focused environment, even if the patients are more sick. For those of you who have worked both ICU and med/surg type units, what's your take on that?

[bigmona]

I could have written that myself! I've only been on my floor a month, but it's the same kind of floor, same ratio, and I feel the same way you do about everything. I have also been wondering how ICU compares to where I am and wonder how easily I can make the transition from a PCU/stepdown to an ICU. Sorry I don't have an answer to your question, but I just wanted to let you know I can relate.

[cdchick]

Hi guys!

I know exactly how you feel. I worked stepdown the first year after I graduated. I hated every minute of it. But it prepared me for ICU. I was constantly given the crashing patients in stepdown. I was sending so many patients to ICU:angryfire . I started to know many of the nurses. Working on stepdown I just used them as a place to get experience. I had to wait a year to switch units. When my year was up- I was in ICU. I am very happy. Things are not always easy but it doesn't even compare to stepdown. But I think it is easier keeping up w/ two sick patients than four patients. I have more time to do stuff I normally wouldn't do for my patients. For me it was the best thing i've done so far!

[Creamsoda, ASN, RN]

That is exactly why I went to ICU. I worked surgery for about a year. I started to really dislike it because I felt like a chicken running around with his head chopped off. Ortho was especially bad. Our pt ratio -s 4-5:1 . In our hospital it is all primary care, so there are no nursing attendants to help with baths, getting post of hips out of bed on day 1, getting everyone to the bathroom because they all have to go NOW, etc. We have to do it all. I just got so sick of it. I worked in the surgery float pool, and I was then orientated to a medicine step down unit where the ratio was 2:1, occasionally we would have 3 patents, but thats rare. These are patients who are on cardiac monitoring, but not ventilated but still quite sick and not ready for the floor. The stepdown unit was part of the ICU so after a few months there, I took a critical care course, and started in ICU in beginning of July. I love it. Its a different kind of busy. You have time to make complete assesments, so you know exactly how your patient is doing. Things can change very quickly, but whats nice is they are all monitored so you can see what is going on and hopefully catch something and intervene sooner. Priorities are different. Coming to ICU definately got rid of my unhappiness with nursing. I just felt like on the floor, that I had this many things to do, and no time to do it all. I would definately give it a try. :) Dont get me wrong though...Im scared to come to work every day because im new to ICU and I never know what im gonna run into. Its a big leraning curve. The staff are great and always willing to help.

[Corvette Guy]

Yes, you may be good ICU material. Maybe look for an ICU RN internship program.

Good luck!

[banditrn]

I worked 2 years nites on a telemetry/oncology unit before going to ICU. Our patient ratio was generally 7 or 8 : 1, so your ratio sounds like heaven to me! I waited a year to get into ICU, but loved it once I got there.

One time my supervisor said something about ICU being more stressful than med-surg - and I corrected her. I found the floors MUCH more stressful - in ICU, if a patient went bad, we had the staff and interventions to take care of it.

[nyforlove]

Thanks for all the info.....I was just wondering if a new nurse needs a year in med-surg to get the basics down--e.g., giving shots/IVs, etc....this way, s/he can go into Visiting Nurse/Dr's Office later on if she subsequently decides that's where she would like to go...Starting out in ICU or step-down may limit your future options??

I worked 2 years nites on a telemetry/oncology unit before going to ICU. Our patient ratio was generally 7 or 8 : 1, so your ratio sounds like heaven to me! I waited a year to get into ICU, but loved it once I got there.

One time my supervisor said something about ICU being more stressful than med-surg - and I corrected her. I found the floors MUCH more stressful - in ICU, if a patient went bad, we had the staff and interventions to take care of it.