Most challenging nursing department

exp626 · Jun 29, 2014

The ECC was the most stressful place I've ever worked. I prefer a more controlled environment. All the drama, drama, drama...Yeeeccchhhhh! (It didn't help that it was weekend nights!)

anon456, BSN, RN · Jun 29, 2014

I work in the Pediatric ICU.

I have not worked anywhere else, so I can't say for sure, but I can't imagine any place being harder to work than where I do. I see things that would make a seasoned war veteran's heart break. And I have to stay on my toes because things change minute to minute, even second to second.

We see all kinds of things: newborns to adults as someone else mentioned, airway issues, sepsis, trauma, neuro, child abuse, overdoses and suicide attempts, and lots of rare syndromes and conditions, and I really don't know from day to day what kind of patient I will get.

It's scary, sad, but also satisfied my need to have intellectual stimulation. Docs are always available, there are some amazing advanced nurses to learn from, and I do learn every single day.

I have had to close off my feelings a lot of the time for my own mental health. I went into nursing to be compassionate, to connect to others, and to feel that I was helping to heal body, mind, and spirit. Mostly here I just feel like an advanced auto mechanic working on a very complicated machine. I have to focus on numbers and keep things going. Every so often when things are settled down I get to love on the patients and have that other side come out.

TU RN, DNP, CRNA · Jun 29, 2014

PCU is pretty stressful in that the acuity is high and the turnover is fast. Si no suda no esta trabajando! Two brands of patients IMO: 1. as someone else said they are too sick for the floor but just well enough to be a PITA, and 2. they are ICU patients whose condition the docs will ignore/diminish to accommodate bedboard/ICU bed availability. But guess who got two thumbs and whose ratio doesn't change?

Here.I.Stand, BSN, RN · Jun 29, 2014

For me, by FAR the hardest I've ever worked--mentally and physically--in 5 yrs as a CNA, nursing school, and 11 yrs as an RN combined, was LTAC. Long-term acute care. It's the challenges of med-surg, ICU, and psych on steroids (and subsequently developing new onset Type 2 DM.) :nailbiting:

Picture 3 ICU patients with drips and on vents, even the occasional LVAD. Floor pts on vents and tele. Dressing changes that could take upwards of 2 hours, which are done by yourself unless they happen to be on the WOCN's schedule that day. To illustrate, my current hospital has a burn unit in which all dressing changes are done by an RN/LPN/CNA team. That same pt, when typical hospital covered days ran out, would be transferred to my former LTACH. Now, his/her same burns are cared for and dressed by the RN alone. New DM, sepsis, delirium. Pts and families who were completely mentally worn out from months-long hospitalizations.

I've worked med-surg, worked with peds pulmonary pts who had aged out of peds (think CF, PPH) neuro, SICU/CVICU with fresh heart/lung/liver transplants and all manner of brain surgery, now I work SICU with all manner of trauma and neuro (although more TBI and hypertensive bleeds than my old one which had more tumor excisions), I've worked the rehab floor in an SNF, LTC as a CNA...

I have never in my life worked like I did in LTACH. But I'll tell you, when I had a good day it was a GREAT day!! When that pt was FINALLY well enough to leave and go to a SNF or even home, that was a GREAT day. When we saw their wounds healing, and they expressed gratitude for our care, it was a GREAT day. When a pt was able to come off the vent for the first time in months, it was a GREAT day. :)

sistrmoon, BSN, RN · Jun 29, 2014

I've worked Onc for 7 years. It's definitely stressful. But I would not want to work peds. We get some young adults that are peds Onc patients and I'm a ball of anxiety working with them. Also don't think I could work on a burn unit or neuro.

Dranger · Jun 29, 2014

PCU is pretty stressful in that the acuity is high and the turnover is fast. Si no suda no esta trabajando! Two brands of patients IMO: 1. as someone else said they are too sick for the floor but just well enough to be a PITA, and 2. they are ICU patients whose condition the docs will ignore/diminish to accommodate bedboard/ICU bed availability. But guess who got two thumbs and whose ratio doesn't change?

PCU is also the drunk tank. Med surg has no idea how to handle CIWA and withdrawal protocols so they send them to us WAYYYYY under medicated when they start getting out of hand. Always a fun night. When I have to work PCU I usually get 4 patients with some being really sick critical care wise but not needing intubation. Getting a CNA is a luxury during those times....

We do so many admits and transfers it's not even funny. You like bed hopping? GO to PCU

TraumaJunkieRN · Jun 30, 2014

I agree with what others have stated that the most "challenging" department is different from person to person based on personality, coping skills, and personal preference. For me, however, it is definitely flight nursing on a helicopter.

To start, I did my preceptorship in periop (pre, peri, post-op) and intermediate ICU (progressive care). My challenges with those departments were mostly boredom and mundanity. The most excitement I had that got me through the day was starting an IV, helping nurses complete their crossword puzzles, or calling the occasional rapid response.

I then worked in an ER/Trauma setting for 4 years after I got my RN. It has it's own type of challenges, some of them being dealing with pts who feel entitled, working fast enough to keep up with the busyness of the dept, managing 4 needy pts while understaffed. For example:

1. A walk-in STEMI as your reward for discharging your last pt 30 seconds ago and freeing up the only available bed in the department.

2. The total care C. Diff pt who needs to be changed constantly. Gown, gloves, mask before every room entry.

3. The drug seeker screaming at the top of their lungs and hitting the call light every two minutes, yet is ambulating around the dept demanding to get a taxi voucher home.

4. The combative psychiatric hold who security is having trouble controlling.

And the kicker is you have new orders for all of them at the same time! Not to mention the other 20 patients in the waiting room and 4 ambulances waiting for your next free bed. Even with the excitement of trauma codes, medical codes, stroke codes, and STEMI, it soon lacked mental and intellectual stimulation for me. Everything was pretty routine and you learned to be fast and efficient.

I've been a flight nurse for about 3 months now and I still feel years off before becoming close to proficiency. Not only do we have to transport critical adult, pediatric, and high-risk OB pts, we also have to transport neonates since we have a neonatal program. Basically, you have to be an ICU nurse, a PICU nurse, a NICU nurse, an L&D nurse, and a paramedic for scene calls. Unlike nurses in hospitals, there is no doctor present with you so you are required to make all medication and dosing decisions. Then there are procedures like pleural decompression, intubation, and cricothyrotomy we may need to perform.

If that's not enough, there are operational and logistical challenges too. There's also a whole realm of aviation, navigation, night-vision goggle use, and radio work we have to learn since we play a large role in the safety of our team. Death is a real risk. To add insult to injury, there is the physical side. Wearing our flight suits/gear in 100 degree weather, and hauling heavy bags/equipment. We work 24 hour shifts too so if there's a scene call or interfacility transfer request in the late night or early morning (which happens regularly), there goes your sleep.

All in all, it seems pretty challenging but rewarding to me :)

vintage_RN, BSN, RN · Jun 30, 2014

I'm a new grad, so I won't pretend to know much about anything....but "challenging" depends on how you look at it. I work on a busy surgical/oncology ward...mostly GI surgery, Gyne surgery...cancer related. It's very mentally stimulating for me as a new grad, and the patient acuity is high. It is challenging for me in a good way...I'm always learning.

Challenging as in I want to cry every second was when I did placement on a complex care unit....everyone was total cares, cdiff and MRSA pts incontinent every hour on the hour...constantly changing people who can't roll at all..constantly getting people up using lifts....I hate hate hated it.

My dream job is ICU...PICU OR NICU....some sort of intensive care unit lol. one day.

RNperdiem, RN · Jun 30, 2014

No place kicks my butt as much as Burns.

In no other place do I hang as many antibiotics, give as many narcotics, have as many complex/high ventilator settings, gown and glove for every patient. On top of a rigorous ICU routine, there are the long and meticulous dressing changes. There is a high "tragedy" factor about many of the patients, and a fair number of them have pre-existing problems like addiction and mental illness (self-immolation).

Burns takes every patient from ICU to rehab. A stay can last for months. All ages are taken as well, so I would nominate burns as the most challenging place I have worked.

mmc51264, BSN, MSN, RN · Jun 30, 2014

I forgot about burns. We don't have a burn unit-there is one at the University next door. I could NEVER do that. I find it interesting how many people hate ortho. I love it! No desire for any of the -ICUs or ED or mother-baby. Worked on a uro/gyn floor for a little while-not too bad and quite interesting.

As others have said, whatever is comfortable to you is the best and the most uncomfortable, the hardest.

Here.I.Stand, BSN, RN · Jun 30, 2014

I will never ever, if I live to be 100, forget what went through my mind the first time I'd heard that our Burn unit admitted a self-immolation. Horror doesn't begin to describe it.

I enjoy floating to Burn, but I work overnight and all the tubs/dressing changes are done on days. They always give their ICU pts to the ICU nurses which can be unnerving b/c I'm not a *burn* nurse, but everyone is so great! Maybe I'd feel differently about it after scrubbing someone though.

No place kicks my butt as much as Burns.
In no other place do I hang as many antibiotics, give as many narcotics, have as many complex/high ventilator settings, gown and glove for every patient. On top of a rigorous ICU routine, there are the long and meticulous dressing changes. There is a high "tragedy" factor about many of the patients, and a fair number of them have pre-existing problems like addiction and mental illness (self-immolation).
Burns takes every patient from ICU to rehab. A stay can last for months. All ages are taken as well, so I would nominate burns as the most challenging place I have worked.

eagle78 · Jun 30, 2014

I am not a nurse, needless to say all of it looks challenging to me and I think nurses are the GREATEST!!

But, as an observer, I have the highest admiration for the nurses in the SNF, LTAC or homes (if those acronyms are correctly used in that context). My father was in one prior to his transition, he was a stroke patient. The stroke left him unable to talk, he also had diabetes and hypertension, so his status was fragile and the nurses had to really pay attention to him because he could not express what was wrong when something was wrong.

That was always the amazing part to me with these nurses. They had patients whose comorbidities could make them go south in an instant, and to compile things they had to sometimes rely on their intuition to see them going south because they were not always able to communicate what was wrong. In addition, some walkie talkies do not talk coherently. I saw them have to deal with lots of dementia patients, and it amazed me how they could tell when something was wrong. My father was never a complainer, even when he could talk, so the loss of that ability did not phase him to much. We were there regularly, and we could tell when something was wrong. Trouble was we could not be there 7 x 24, so I thank the Lord for the angels he placed there to care for my father when I could not be there.