Most challenging nursing department

Cuddleswithpuddles · Jun 25, 2014

There are fields in nursing that typically require substantially more experience and knowledge that one would typically have right out of school. For example, a new grad is unlikely to hit the ground running in areas such as critical care, flight nursing or management but would be independent fairly quickly in a low-acuity skilled nursing facility or a psychiatric ward. However, what an individual considers difficult or maybe even intolerable is entirely subjective.

For example, I work in ICU and I recently floated into a busy telemetry unit. Even though I have telemetry experience, I was still gobsmacked by the chaos. I felt pulled in so many different directions, was under pressure to discharge quickly and admit just as fast, had to get in touch with substantially higher number of ancillary staff, needed to know more patients and families, more meds etc. I do not miss telemetry at all. It does not fit my interests, my personality and preferred way of doing things. In this sense, telemetry is harder for me than ICU.

Bezoars · Jun 25, 2014

I've worked med/surg float and perinatal float. Med/Surg in general is pretty challenging. You have to be good at time management because you will have 6+ pts at any given time, with all different acuity. I found the Neuro floor (because of all the total cares) and most definitely the Orthopedics floor to be the most challenging.

classicdame, MSN, EdD · Jun 25, 2014

I did my thesis on this concept and believe that it depends on the individual's personality traits, character and preferences. Anything is hard if you do not relate to it or do not like it.

meanmaryjean, DNP, RN · Jun 25, 2014

I find my current position in pediatric critical care the most difficult AND challenging work I've done in 37 years.

Why? we deal with newborns AND teens who are pregnant/ parents themselves. Every body system- medical/ surgical AND psych issues. Every dose of medication is individualized to each patient's weight (which can change daily).

And then there's the parents.....

nurseprnRN, BSN, RN · Jun 25, 2014

I always told my students to ask every nurse why s/he did what s/he did, and also why s/he didn't do what s/he didn't do. Lots of people can tell you why they like something, but it's when they tell you why they don't like something that you can make a decision.

Examples:

"Mother-baby nursing! I love it! What better opportunity to get a new family off to a good start-- a good birthing experience, establish breastfeeding, and all that. And when a new family has a good birth experience, they'll come back to our hospital for care later on in life."

"Mother-baby nursing, yeeeeecccchhhh! Tits and fundi and peripads and screaming brats and if I never see another whiny entitled ***** with a six-page birth plan and a mother-in-law it'll be too damn soon."

Me, I loved critical care when I did it, loved field case management in work comp when I did it, loved being a clinical instructor and CNS when I did it, and love legal nursing doing it now. At any of those places I could have told you what I hated about some other place. For example, right now you couldn't pay me enough to go back to working 12-hour shifts in the cardiac surg ICU, or a 40-hour week as a hospital case manager, and I don't even want to think about going back to field case mgmt in work comp.

I think the key to being happy is to do what you want when you can, and remember that most people are just about as happy as they make up their minds to be. :)

danggirl16 · Jun 25, 2014

The most stressful place I've ever worked was the PICU. I'm 100% adult oriented nurse. I love the ED and ICU is ok too. Worked med/surg for a long time and it was ok. The PICU...I didn't last more than 4 weeks on orientation!!

Pepper The Cat, BSN, RN · Jun 25, 2014

As everyone else has said, it depends on the individual. We had an ER nurse transfer to our sub-acute Rehab unit as she wanted a "less stressful unit". She lasted a month. She said organizing care for 5 or 6 pts challenging. But the worst thing was the fact that the PITA pts/families didn't go away! In ER, you deal with them for a few hours. In Rehab, they are there for days, weeks ,months. And that sent her back to ER

Cricket183, BSN, RN · Jun 25, 2014

I worked inpatient Oncology and loved it. (I'm currently on disability and miss it terribly!) It was always something new and interesting to me. I really think every nurse has their own niche where they really thrive. I am very analytical, have a meticulous nature and love science so oncology appeals to me. Oncology is a very stressful environment in many ways. You are dealing with people at a very vulnerable time in their life. No one wants to have cancer. Patients often require, not only a lot of teaching (which I also really like), but a lot of emotional and spiritual support. Cancer patients are a very special breed of patients--some of the most amazing, strong, beautiful people I have ever met in my life. You often do get to know your patients and their families very well (especially leukemia patients who are often with you for at least 6 weeks at a time). And of course you do lose a portion of your patients. It can be very emotionally draining as a nurse. You have a wide range of acuity you deal with, anywhere from a walking/talking patient just there for chemo to a neutropenic, leukemia patient who is receiving continuous chemo, multiple blood products, and other interventions that require 1:1 care. As far as OR and CCU, I have never worked those areas so I can't tell you about them. But Oncology is incredibly challenging and I pray every day I will be able to go back soon!

Dranger · Jun 26, 2014

Hardest-Trauma PICU/ICU...ED depending on the hospital. But I am critical care so maybe I am biased....

Easiest: M/B or M/B transition. Before you all bite my head off, my gf works M/B and is aghast when I tell her stories about the rest of the stuff nurses deal with on other areas of the hospital. She adamantly admits her job is pretty easy (generally healthy patient population with few post birth complications) but enjoys the education/new life aspect of the specialty even though they involve CPS sometimes. What she doesn't like is the waning portion of her nursing skills.

newohiorn, BSN, RN, EMT-P · Jun 26, 2014

I float all med-surg, intermediate and ICUs in my 700+ bed hospital. Because I float in four-hour blocks the med-surg units with 5-7 patients can be very difficult to get the work done. In particular one of the cardiac units can be a nightmare because the patients are sicker than I think the folks assigning the beds realize and they don't make nursing assignments by patient acuity so you can have four discharges and four admits. The neuro med-surg unit is completely nuts because everyone and their brother needs an echo, a CAT scan and an MRI so they are constantly coming and going and they are frequently confused and require near-total care. Lastly the spine unit where I have quite a bit of experience kicks my butt every single time (and I'm astonished by this every single time) even though the patients are almost all healthy since their surgeries are elective, but I swear they are the most demanding patients in the hospital.

In critical care the main ICU (as opposed to the surgical, cardiac or neuro ICUs) is most difficult for me because the variety is insane and the patients are sicker than snot. It's the only place where I have been assigned a single patient and was seconds away from telling the charge nurse I needed help or I was going to kill this guy. I could not care for him as fast as the docs were writing and rewriting the orders. It was frightening.

RNsRWe, ASN, RN · Jun 26, 2014

The one you got floated to when you aren't feeling too well, have no prayer of getting out on time, and really REALLY wanted to have a smooth shift.

Yep, that unit's the worst!