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My experience working in a surgical unit (med surg)vs an intermediate care unit (stepdown)

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by Jna2 Jna2 (New) New

When I was a new grad nurse my dream had always been to work in an ICU somewhere. I've always made strategic moves towards that goal. However now that I'm on an intermediate care unit I feel like my patients are more stable than they were on the med surg floor by far and I have almost completely turned off the critical thinking part of my brain since being there for almost a year.

It's weird because on imcu we get strokes, nstemis, rapid afibs, trach'd/vent'd patients for a variety of reasons, VATS patients. Yet they're all stable. I think I've been apart of three or four rapid responses since I've been there and only one was with my patient.

On the surgical floor I worked on we'd get alot of colectomy/bowel resection patients and other gi surgeries. TURPS requiring alot of hand irrigation and cbi. We'd get urostomy patients/kidney cancer patients who got nephrectomies/ureteral stents. I feel like there were always surgical complications with my patients. Hypotension from hypovolemia, bleed, sepsis. Alot of sepsis. Rapid afibs, ileus, once a patient developed a PE after surgery. And I feel like we had alot of rapids. It was really exciting honestly. I both enjoyed looking for complications and preventing them before they got really bad and also running rapids. I felt really prepared and confident I could handle whatever came up. However because my patients don't have alot of complications on imcu I don't feel this way anymore.

I have a couple of questions. Does my imcu floor have patients that are too stable for most imcu floors? As in- is it not true imcu. And is the fact that we had so many surgical complications indicate that our surgeons did a poor job? Do cardiac patients tend to crump less? IDK I'm so bored these days and am honestly fearful of rapids and crumping patients. I just feel it's mostly CNA work at this point too, alot of turning and baths. 

For reference the hospital I worked surgical at was in Eugene, oregon and the imcu unit I work at is in Portland Oregon.

Sorry I wrote this after my shift so it probably doesn't make any sense.

anewsns

Specializes in Neurosciences, stepdown, acute rehab, LTC. Has 8 years experience.

1 hour ago, Jna2 said:

When I was a new grad nurse my dream had always been to work in an ICU somewhere. I've always made strategic moves towards that goal. However now that I'm on an intermediate care unit I feel like my patients are more stable than they were on the med surg floor by far and I have almost completely turned off the critical thinking part of my brain since being there for almost a year.

It's weird because on imcu we get strokes, nstemis, rapid afibs, trach'd/vent'd patients for a variety of reasons, VATS patients. Yet they're all stable. I think I've been apart of three or four rapid responses since I've been there and only one was with my patient.

On the surgical floor I worked on we'd get alot of colectomy/bowel resection patients and other gi surgeries. TURPS requiring alot of hand irrigation and cbi. We'd get urostomy patients/kidney cancer patients who got nephrectomies/ureteral stents. I feel like there were always surgical complications with my patients. Hypotension from hypovolemia, bleed, sepsis. Alot of sepsis. Rapid afibs, ileus, once a patient developed a PE after surgery. And I feel like we had alot of rapids. It was really exciting honestly. I both enjoyed looking for complications and preventing them before they got really bad and also running rapids. I felt really prepared and confident I could handle whatever came up. However because my patients don't have alot of complications on imcu I don't feel this way anymore.

I have a couple of questions. Does my imcu floor have patients that are too stable for most imcu floors? As in- is it not true imcu. And is the fact that we had so many surgical complications indicate that our surgeons did a poor job? Do cardiac patients tend to crump less? IDK I'm so bored these days and am honestly fearful of rapids and crumping patients. I just feel it's mostly CNA work at this point too, alot of turning and baths. 

For reference the hospital I worked surgical at was in Eugene, oregon and the imcu unit I work at is in Portland Oregon.

Sorry I wrote this after my shift so it probably doesn't make any sense.

This is my experience as well. I used to work in acute rehab which was a med-surg like environment and I felt like there was a lot of patients who were very sick and circling the drain. Switched to neuro stepdown and it seems calmer. We do have more rapid responses than you are indicating here. Maybe 1 a day on our 37 bed unit but I think since we keep their vital signs on tighter leashes and keep up with minor changes we are able to keep them more stable. We also have a rapid response team and an ICU downstairs. Our unit is considered to have very sick patients but it does not feel like it because it is so controlled.  And because it is neuro many tend to stay a while to wait for rehab. It's fast paced in other ways. I like this environment better though. 

The surgical complications do seem a bit sketch to me if there are a lot of them. 

Edited by anewsns

JBMmom, MSN, NP

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

In my opinion, part of what you're seeing is because the patients are in the appropriate level of care. I think that on a med-surg floor they're playing the odds. Patient's aren't continually monitored because the odds of a patient experiencing complications are lower than for those in progressive care or ICU. However, because of the volume of patients, the incidence of complications may have seemed higher. It's unlikely that your surgeons were inept to the point that the complications could all be traced back to them. It's also possible that some of the rapid responses might have been preventable if the nurses there had the time to more thoroughly assess their patients, but the workload of a med-surg unit is such that sometimes things are missed until they're emergent. 

The patients in a step down or ICU shouldn't have rapid response/codes because they are more closely monitored and complications are detected before they become emergent. Some of the most boring shifts of my entire nursing career have been with the sickest patients in the ICU. Maintaining someone on a ventilator can be summed up as changing infusions, turns and mouth care some shifts. I still love picking up on my old med-surg floor every now and then for a good old butt kicking night where I will walk over 10,000 steps in my shift and yes, sometimes take care of some really sick patients.  Your skill set means you are equipped to deal with emergencies, whether you feel like it or not. They're very different animals. Both are very important work environments and will appeal to people for different reasons. Sorry you're feeling a bit bored at times, but it's really an indication of appropriate care for sick patients that need your skills.