Just realized, I think I hate ICU, prefer floors

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Specializes in ICU, OR.

I have been a nurse for 8 years, most in ICU. I started out in ICU as a new grad. I have frequently become burned out and have left ICU numerous times only to go back. I always said I didn't like med/surg floors, and liked ICU patients much better. Now I am working agency and doing floors more than ICU. I worked ICU last night and came to a realization. I feel I have been there, done that with all of the "anal" stuff in the ICU, and I now prefer to be on the floors. I never thought I would feel this way, and honestly never heard anyone else say this. I always have been anti-floor. I feel like a load has been lifted now that I realized that I think I hate ICU. Maybe it is because the nursing assistants do more of the tedious stuff on the floors. I realized I am happy having more than two patients, it's OK to have 5-6 patients and not knowing every inch of their body. I am perfectly happy doing the floors and also ER once in a while.

I guess I am just announcing this because I feel like I have had a breakthrough! Anyone else experience this?

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Specializes in neuro, ICU/CCU, tropical medicine.

I worked the floor for nearly 5 years before I started in ICU. There is a tendency to think that ICU nurses are some how better than floor nurses, but I assure you, that is not the case.

On the floor I learned to assess my patient from the door - to learn what a patient looks like when she/he is in trouble. I watched an ICU nurse let a patient bleed out because that person did not believe me when I stood at the door and said, "your patient is restless, confused, and tachycardic because he is bleeding." I've seen docs do the same thing. "Look at the patient!"

I don't know that ICU nurses are by nature "anal." I think there are anal nurses everywhere you go. I love ICU nursing and I am absolutely not anal.

I wouldn't trade the skills I learned on the floor for anything - but then, I'll never work the floor again!

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

I have 16 years of nursing experience with about 9 of that in various types of ICUs. After working as a clinical coordinator in a large sub-acute and dementia facility I decided to go back to ICU. I realized about 4 weeks into my re-orientation that I like talking to my patients and their families, teaching them how to care for their medical issues in real life situations not just in the sterile environment of a critical care unit....and yes ICU is a bit too task oriented for me now.

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Specializes in LTC, Med/Surg, ICU, clinic.

MommyandRN, it must feel so good to make that realization! I have to agree with snowfreeze, ICU seems too task oriented for me. Though I do miss vents and knowing my patients inside out and backwords, there's a lot to be said for interacting with patients and families, seeing them ready to go home, etc. Although there's also something to be said for hourly sedation...

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Specializes in Cardiac, ICU, ER.

Yes! Others feel this way. I am a new nurse and have work in the CVICU :redbeathe for 4 months and DO NOT enjoy it to say the least, I see it as a stepping stone to bigger and better things but am wondering if I can aleast last a year like I want to for "resume" purposes. I think I am more of procedure girl rather than TOTAL patient care. Any suggestions from some experieced nurses out there?

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Specializes in ICU, Telemetry, Neuro, Ortho, Med/Surg.

I am glad I saw this post. I have been contemplating a change from floor nursing, and one of the options I have considered has been putting in a transfer to ICU, but I have not been so sure about it. I love reading and hearing about other opinions/experiences/insights. Will continue to follow this and research before I take a leap....

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Specializes in FNP.

I don't find it task oriented really. Sure, there are more technical procedures, PA lines and whatnot, but I have found it to be more brain power, less muscle. And for christs sake, I'm not saying floor nurses don't use their brains, so don't go there. I simply found the day to day business of floor nursing more rote, if you will. That said, I'm not going to agree to take care of 6 patients again, under any circumstances, ever, so hats off to those of you that do it every day.

I had a coworker who went back to med-surg once b/c she hated the noise in the ICU, vents, alarms, etc. THAT I can understand, it is deafening!

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Specializes in ICU, ER, EP,.

As an ICU nurse whom gets floated to the floor.... although not recently

ICU is NOT task nursing, it's more assessing, monitoring and thinking... "what can be going on?". Tasking has NO place in the ICU. Tasking is purely performing MD assigned things to accomplish an ending of crossing it off a list.

IN the ICU I have many lists, my tasks will or will not get done because tasks in the ICU are not a priority! Routine meds in a stable patient are a task that can be blindly done by a floor nurse. I have to compute adjusting multiple vasoactive drips, decide to turn a patient for skin breakdown or leave them due to instability, turn them anyway and have to adjust drips and vent settings, monitor labs, sometimes every two hours, call for orders... got a prolonged QT interval... what meds and diagnosis are affecting it.. do I need to call to make med adjustments... what meds are peaking at what times, I know them all... put this with a chest pain with a new MI and a HR of 50... I know what meds to give, not because of an MD order... a task... I know to give the beta blocker, up the nitro, call for dobutamine, get a stat EKG and dang know how to read it to call in the cath team or not.

I know that when I turn my vent patient and they desat, they need time to adjust, I don't treat the numbers...

My point is that I never ever in my ICU career have just "tasked"... the floor tasks. I think, worry, watch, plan and act. The fact that the OP has considered the wide berth that I do tasking is insulting.

I'll leave the need to task with an appropriate patient population on the floor, where it is potentially safe. BUT in MY ICU care... there will be no tasking..I'll hunt your decreased urine output to the enth degree and fix it and there is no TASKING behind it.

OP, you have found your niche on the floor, but be mindful, there is little room for tasking there as well.

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I work in a busy ICU step down unit and I love it - more challenging than floor nursing and more varied than ICU because we take total care pts as well as walkie-talkies. We see art lines, CVP monitoring, amio, dilt, heparin, insulin drips (to name a few), and respiratory support of all types except vents. Our pts are not on pressors or knocked out on propofol, but they are often on q 2 hour neuro/vital checks, etc. We are ever monitoring for a crashing pt, which happens constantly. Then we have to push to the ICU. Unfortunately, that's when we often have to take another admission!

This rapid pt movement is exciting and demanding, and we have to be on our toes and work as a team to stay above water.

Are other stepdown units this crazy? I'd love to hear from other ICU stepdown nurses out there. Registry nurses who come to fill in tell me no - that we are unique because we do so much...

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Specializes in Family Practice, ICU.

I've worked on an SICU for 1 year, am now working between five different ICU's and the ER as a critical care float nurse. Great job, by the way, highly recommend it.

It is true that working in the ICU you can learn a lot. Getting the patient with multiple drips, dialysis machines, VADs, vents and all that technical stuff is pretty intriguing... at least for awhile. But it's definitely not everyone's cup of tea, and it can be very grueling.

You do have a lot more autonomy in critical care (ICU and ED), to a degree. But I can understand what the OP is trying to say. There are a lot of "tasks" that need to be done in an ICU. Hourly I's and O's, bladder pressures, zeroing lines, suctioning, oral care, flushing lines, measuring waveforms, printing strips, head to toe assessments every four hours, tons of meds, titrating drips, wedging PA catheters, labs labs labs, calculating how much fluid you're pulling off a patient with CVVHD, rounds, q hour neuro checks, q 30 minute lumbar drains, all the meanwhile trying to make sure the patient and family know what's going on, all the while trying to make sure YOU know what's going on and trying to anticipate any potential problems.

Of course, I think it's like any type of nursing: it is what you make of it. You can go through the motions, or you can dive into it and become very, very good at it. For me, being a floater, a lot of times I am trying to keep up with everything I need to do on top of thinking about what is going on and anticipating the patient's needs.

It's a lot to take in, and I think you have to really enjoy taking care of really sick people. I for one am learning that this isn't me. While I enjoy the critical thinking aspect of the ICU, I find aspects of it very depressing, among them:

  • sitting on some patients for days and days without making any changes to their plan, wondering if the docs are even bothering to think about your patient
  • thinking about all the technology available, and then realizing that a lot of it "has been proven to not statistically improve patient outcomes" (i.e. swans)
  • seeing people there for months on end with no progress in sight
  • watching people waste away and die despite your best efforts (although the opposite happens just as often, namely bringing a patient from the brink of death back to health)
  • having to coordinate confilcting orders between 2 to 4 different teams who all are involved in the patient's care

Frankly, I am looking to get away from ICU and get into outpatient work or home health, ultimately going back for my FNP to work in primary care. I think it's just my style. The constant alarms get to me, too. I kind of miss working with patients who can actually answer me when I talk to them or carry on a conversation (i.e. not sedated or delerious).

And there are a lot of egos in the ICU, especially surgical ICU (surgeons AND anesthesiologists? Oy vey!) And that's not counting the nurses, who can be very type A.

But that's the beauty of nursing: you aren't stuck with one type of work. There are a lot of options out there.

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Specializes in PCU/Telemetry.

I like "floor" nursing (PCU w/ 4-5 pts each) b/c I actually get to interact w/ my pts in that they are not intubated & sedated w/ tubes coming out of every known orifice. I always thought I would like ICU nursing b/c of the critical thinking involved & the "seriousness" of the illnesses/injuries involved w/ ICU pts. However, I discovered in my ICU clinicals that I really did not like this type of nursing. I found that I much preferred PCUs b/c there I was able to see a bit more "interesting" stuff than basic med/surg but the majority of my pts could foresee some sort of "normal" life post discharge. I think everyone is cut out for something different & I'm just glad there are nurses who enjoy every type of nursing b/c I know there are many types that aren't for me (OB, peds, ED, etc).

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