Is ICU nursing in California better?

[EternalFeather]

I am from the south... cant say exactly where. Im paranoid someone might discover who iam. I am sick and tired of the unsafe and unfair working conditions at my workplace. Its a MICU but we get other cases sometimes like CV or Neuro. Here we get tripled all the time and getting a 4th pt isnt even a surprise. We do total care, cleaning and turning, multiple drips and all kinds of tubes... the cnas are either clueless or lazy, nurses rarely help each other because evryones maxed out in capacity...

For example, I would be tripled with 3 critical vented pts. Sometimes im tripled with legit super sick critical patients and one of them is a multi organ failure, vented an a DKA!! And then, i had to admit another patient who was also a DKA! I am so ready to quit! im always stressed out, physically and mentally and emotionally drained, im starting to lose passion in my carer. My back, legs knees and feet are constantly aching. Im literally getting sick because of this job.

I am burnt out!

I dont know if i should go to another hospital in this city or statr and experience the same thing or just leave this town and go to california.

Ive never been to california. But i hear many great things like the nurse pt ratio . Is this true? Is it also true that there is always help? I was told that theres a lift team. Are there lift teams in the ICU? I know icu is total care and stuff but is there at least help all the time?

[OncoRN84]

I don't know that nursing is "better" in California. But I can tell you my experience in moving from Ohio to California. Now, keep in mind that I never worked ICU in Ohio, I worked Step-down but the patients that we had in step-down were more than ICU worthy (I now realize this.) We had a 4:1 and 5:1 (depending on short staffing ect..) and we ran pretty much every gtt possible, besides levo. We even did insulin drips. As a new nurse, I seriously thought that's just how things were everywhere. Also, we had no CNAs or even a monitor tech. Hell, I didn't even know there was such a thing until I moved to California. However, I obtained invaluable experience on that unit. Yes, it was hard but I am so glad that I started there.

Nurses have mandated patient ratios in California, this is true. You will, as an ICU nurse have a 2:1 ratio. If you have a hypothermia, CRRT, IABP- 1:1. I recently moved to ICU from oncology/medsurg/bariatrics. We had a 5:1 ratio with chemotherapy infusions. I work in a mixed ICU- we have different ICUs, but the patients get jumbled around, so even if you are in trauma- you might end up with 2 cardiac patients. It just is what it is.

Some hospitals have lift teams, though, as always, they are not there at night.

I work in a hospital with a very strong union. I do not know that all facilities abide by the laws and staffing regulations as closely as mine. I would hope that they do. We have break relief RNs, a transport nurse and a rapid response nurse, however, this is when we are ideally staffed.

As we all know, many times that is not the case. And unfortunately, no- there is not always help all the time. Sometimes, things just go to hell in a handbasket for multiple patients at a time and well, you just do the best you can.

A few strange things about nursing in California-

It almost seemed like I had stepped back in time. Now, this was over 10 years ago, but I went from online orders entirely with CPOE in Ohio back to handwritten orders in California. Things that we were doing clinically in Ohio before I left (again, over 10 years ago) are just now starting to catch on. I really thought that medicine would be more progressive out here, but it was not.

Also, I came from a decent sized teaching hospital (600+ beds) and the physicians and nurses worked as a team. I was shocked at the poor behavior and rude nature of the physicians out here. I work at a much smaller hospital now (350 beds) so maybe that has something to do with it? The culture was very hard to adjust to.

I love living here but it is definitely a different culture in general. I work with some people that hate it in California and cannot wait to move away because the area does not represent their values personally. However, it is a big state and very versatile. You could probably find what you want if you look.

If you have the ability and years of experience, I would suggest travel nursing. You can really get a feel for a hospital and the area. I would suggest this only after a solid 2-3 years of experience and a good level of comfort.

Good luck!!

[Delia37, MSN]

Depends of what is your definition of "better". However, in general, the pay is decent (compared to most states) and the mandatory staffing ratio of 2:1 (which usually requires most hospital to have a breaker to be in compliance) makes all the difference.

[Mergirlc, MSN, APRN, NP]

I have nothing to add regarding if it's a better working situation or not. However, as a native Californian, I feel it's my duty to warn you about the cost of living. Expect to shell out a good chunk of your paycheck on housing, food, etc.. Sure, the wages are more out here, but you also have to pay 3-4x the costs compared to places in the south. It used to be the L.A. area was a bit cheaper than the SF Bay Area, but that is starting to become a distant memory. Yes, there a few areas that aren't that expensive, but not many. You can easily expect to pay $2000 - $3000 a month for a "decent" apartment in San Francisco area. You want a way better area, then $3000+. A little less if you move 30 miles away....but not much less. In the L.A. area, probably drop the SF amount by about $400-500 a month.

Perhaps there are other areas nearby where you live which will offer better conditions without the outrageous cost of living? The only reason I'm still in California is because I moved back in w/ my mother to my childhood home. If it wasn't for that, I'd either be homeless or living in a southern state.