My unit is desperate for nurses

[Anoetos, BSN, RN]

And it's not because it's a terrible floor, it's a great floor with a helpful culture. We're a MICU step down, so we handle stable vents, heart drips, DKA, sepsis, etc. We run 1:3 patient to nurse (1:4 when census is high and staffing sags).

I cannot express to you how much I have learned here, but I get why people move on: for one thing it's critical care so the opportunities after a year or two here are enticing. Additionally, yes, there's burn out, we have a lot of PVS patients and I am afraid we aren't exactly leading the way in abbreviating futile care.

We hire constantly, the door is revolving. There is definitely a nursing shortage here.

The trend in critical care seems to be moving toward hiring more new graduates and then vetting them on the job. We had fairly extensive classwork in preparation. I have not seen new hires dropping off, but it's definitely a "see one, do one, teach one" environment.

What is it like in your unit? Are you hiring new nurses? Is it critical care? What do you think about it? Does patient care suffer?

[CAnurse2012]

What hospital is this? Sound pretty interesting for a Step-down

[Anoetos, BSN, RN]

Big teaching hospital in the Detroit area...not sure I should name it?

[tokidoki7, ASN, RN]

I hear a lot of negative things about Detroit.

[Anoetos, BSN, RN]

I hear a lot of negative things about Detroit.

Yes. And it's far worse than anything you've heard.

[Nurse SMS, MSN, RN]

I too am on ICU stepdown. We have a couple of openings at night, but are not hiring new grads for them. We did hire a few in June and they are now starting to get their feet under them. Our unit is supportive and a good one with a good manager. The only reason the door revolves is for people returning to school to advance their degree. Otherwise it is stable.

[dirtyhippiegirl, BSN, RN]

My unit has had something like 60% turnover in the last twelve months. Counting my cohort, we've hired 12 new grads in the last year -- for a sixteen bed unit. And we have three new positions open right now.

It's a burn unit, which is notorious for rating as having the highest turnover for nursing staff. We're a mixed acuity unit with ICU, tele, and floor beds but, honestly, our general patient acuity has definitely been on the low side for several months now. (Someone was joking the other day that the unit is currently more like a rehab floor than anything else right now as we have several boarders with no where to go.)

Prior to me getting hired, I think the unit hadn't had any turnover for 24 months. Seemed like everyone got married, had kids, and/or moved away at the same time. However, the lack of overall experience on the floor and having to continually precept new grad after new grad hire is quickly burning out the experienced staff who are left. It's kind of a scary situation and not one that I look forward to having to deal with as I go into having almost a year of experience on the unit now.

[NotReady4PrimeTime, RN]

dirtyhippiegirl, your unit sounds so much like mine! Our turnover isn't quite that high, but it's high enough. We had 5 people quit all at once last week. In the last year we've hired about 30 new staff, most of them new grads, for a very high acuity ICU with 23 beds. That 30 represents about 25% of our regular staff and the 5 I mentioned are all from this cohort. There are shifts where we don't have enough experienced staff to provide the required level of care for our sickest patients. Today was brutal. And just as we were leaving for the day we heard there'd been a mass casualty incident...

[dirtyhippiegirl, BSN, RN]

dirtyhippiegirl, your unit sounds so much like mine! Our turnover isn't quite that high, but it's high enough. We had 5 people quit all at once last week. In the last year we've hired about 30 new staff, most of them new grads, for a very high acuity ICU with 23 beds. That 30 represents about 25% of our regular staff and the 5 I mentioned are all from this cohort. There are shifts where we don't have enough experienced staff to provide the required level of care for our sickest patients. Today was brutal. And just as we were leaving for the day we heard there'd been a mass casualty incident...

Yikes! We do have days where the most experienced person aside from the charge nurse is one of the new grads that was hired with me. Everyone else is maybe 2-4 weeks off orientation. A pain when you have extensive dressing changes, splinting, direct recoveries post-surgery, etc. but our overall acuity is generally pretty low right now. I can't imagine having to run a high acuity ICU with that sort of staff. :/

Incidentally, our high-acuity SICU has a really high turnover rate as well. It's pretty unabashedly used by new grads as a stepping stone for CRNA school. They put their two years in and then leave.