Neuro--tell me why you do/don't like it!!

Specialties Neuro

Published

Help! I'm graduating in June, have just been offered a job in Neuro, and am really interested, but also scared! I'd love some input from people in the field, pros, cons, etc...

We get a few neuro patients in our mixed ICU- and I have to say, apart from the fact that sometimes it can be beyond heart wrenching and agonizing.....many times it is amazing to see how patients who had the worst prognosis in the world, open their eyes one fine sunny day and come back to the land of the living. Doesn't happen all that often, but when it does, it makes it all worth it.

Up Vote Up Vote ×
Specializes in Neuro ICU, SICU, MICU.

i am starting in the neuro icu on monday. these posts were really helpful!! . thanks.

Up Vote Up Vote ×
Specializes in M.S.N.(ACNP/FNP), ICU/Flight, Paramedic.

Why I like it:

The human brain is a miracle.

Why I dislike it:

You cannot save them all.

Up Vote Up Vote ×

I've worked in an Neuro ICU for almost a year now. Today I detected subtle changes in my patient that indicated vasospasm. She was treated in angiogram shortly thereafter. I think I saved her brain! That's a good feeling.

There is NOTHING cooler than seeing someone you thought was mentally DEVASTATED walk onto your unit and shake your hand and thank you for your care. It's only happened twice to me so far, but it is a wonderful experience.

I find it devastating when we have to work very hard to keep a "vegetable" alive because of family's denial. Our unit usually has one patient who has a prognosis that is beyond pitiful, but whose family will not consider palliative care. Treating these patients agressively day in and day out is emotionally exhausting for me.

Also, sometimes weeks will go by and it will seem like I'm not helping anyone. Much of the neurological damage is already done and when all of the patients are dying or permanently mentally devastated...you don't feel like the nurse you had envisioned yourself being. I often think, "Ok, who did I help today? Let's see...no one." Other times, the tides change and you see people do really well.

It's emotionally charged -- I think that's the short version of what I'm trying to say.

Up Vote Up Vote ×

hi,

i started as a new bsn grad in a large metropolitan hospital 10 bed neuro icu 10 months ago. i chose the icu because of the two patient load (vs. 8-10 patients in med/surg). don't be fooled! you will work your tail off caring for 2 neuro critical care patients.

what i like about neuro icu:

-opportunity to learn a wide range of skills as a new nurse.

-family appreciation even when circumstances are dire (not always the case, but when it happens, this is very nice).

what i don't like about neuro

-road trips to ct, mri and neuro angio almost daily. in the past week (4, 12 hour shifts) i have gone on 7 road trips.

mri is the worst, it takes you off the floor for at least 60 to 90 minutes, another rn has to watch your patient while you are gone. 50% of the time the patient is confused and will not lay still, the scan will have to be started over and over while you give versed, ativan, haldol (etc) to try to calm the patient down. sometimes sedatives work and sometimes they do not. the ivac pump cannot go into the mri room because it is metallic which means (at our facility) that you have to prime 30 feet of extra line for every drip the patient will have to be on for the scan. i recently had an mri trip with a patient who was on two vasopressors, a heparin drip and an insulin drip, it took forever to prime all that tubing and when i got back there was a giant rats nest of line for me to untangle and replace.

yesterday i gave a guy 5 mg of versed and he still was kicking his legs and moving his hands during the 2.5 hour long mri scan attempt. when i got back to the floor my other patient had basically been neglected because the other nurses where also busy going on road trips and doing admissions. vital signs had not been recorded, and the patient's blood pressure (which was suppose to be maintained at 160-180 on a neo drip) was 202/120 because no one had bothered to check on the titration while i was gone. i had given report to a nurse who was suppose to cover while i was away, but . . .oh well.

i was put on call for the mri at the time i was suppose to take lunch, so once back on the floor i had 10 minutes to wolf down some food in the break room, and then back on the floor to try to finish up details before shift change at 7p.

road trips happen at anytime including right at shift change. twice in the last 2 weeks i have come in at 7:00 to be told i was on call for a road trip and had less than 10 minutes to get report on my patients and pack up for the trip (because transport will only wait 10 minutes and then they will leave and the scan will be put on hold, and docs will be mad!). no chance to assess my patients until coming back to the floor at 9:00.

i've also had multiple trips to ct with critically ill patients on vents/drips etc. where i have had to wait in the hallway (with respiratory bagging the patient) for upwards of 10-15 minutes because ct "squeezed in" another patient while they where waiting for us to come down for the scan.

if i could do neuro icu without the road trips i would be happy as a clam! i work with a great team of doctors and nurses, but with the pressure and hassles of the road trips i will be looking for other options regarding employment once my year in neuro is up :o

Up Vote Up Vote ×

Oh man! Why I like neuro icu! Well, between the current 10 bed nicu I work in and the one in virginia---that adds up to 20 years of neuro.

For some odd reason, the brain with all the invisible working parts, just fascinates me! I love our docs! they treat us with a lot of respect, give us a lot of autonomy and they pass that along to the interns every month---so, that really helps! The wacky neuro patients with their crazy answers to the orientation questions, watching the CCTV and doing conscious sedation with all the propofol, versed and stuff, just really is my thing.

But, neuro is not for everyone.....and, take comfort in knowing that there is a nursing specialty that you will love...you were made to be there (if you have been true to yourself). I tried SICU for a couple years, only because there wasn't a nicu per se, I was good at it, but, it just wasn't where my nursing "home" was. If you are good at something and enjoy it, you are usually gifted for that job. So, be true to yourself, try visiting/shadowing several ICU's and stepdowns and monitor within yourself what you find fascinating, what you feel at peace at doing, and what you are good at.

Up Vote Up Vote ×

for the new grads... is it a strictly neuro icu or is ia neuro/trauma icu? i work in a small neuro icu where the trauma icu is actually a different department.. we have strokes, hemorrages, aneurysms, guillian barre, meningitis, and of course the AMS patients... Most days i love my job though. The patients are of their own breed some times though... lol Vasospasm patients will definately keep you on your toes as far as the hardest physical work.. But working with the families and the politics of the hospital to me are your main emotional battles. I wouldn't change areas though.. People either love neuro or are scared and hate it...best of luck. Message if you have any questions..

Up Vote Up Vote ×

I am a New Grad from NY and I have finished my hospitals brutal core course for critical care and have started Neuro for 3 days :))) after spending 5 weeks in a cardiac step down...i hated the cardiac stepdown...the chest tubes freaked me out...but i must say..i am fascinated by what a Neuro Assessment can provide (information wise). So far I love it!!! I cant wait to continue learning..and go in to work..since this post was written a while ago let us know how you are doing.

Take Care,

New York Nat

Up Vote Up Vote ×
Specializes in Orthopaedics, ITU and Critical Care Outr.

What a good thread! Thank you all for your replies. I'm in a similar position to the OP, just applied for Neuro ICU/HDU job. I loved general ICU but was more than a little scared of the extra emotional charge so well described above, of the permanent disabilities of young people. I forgot to factor in the positive emotional charge of having someone get better!

I feel much more confident now. Will look forward to reading many more replies to this thread. Good luck OP!

Up Vote Up Vote ×
Specializes in Neuro, Critical Care.
Also, it is hard for me to understand what i perceive as callousness and a lack of compassion in the younger nurses in the field. I'm sure this is a necessarry trait one needs to develope to remain in the area, but no thank you. I would hope that I will always be disturbed by a kid who's life is forever ruined. I am shocked by the nurses who complain because the girl in the halo is so needy that it is interfering with their smoke breaks. I wonder what is wrong with me. And i know that i don't belong there. I just put in for my transfer to MS ICU and will be very happy to get back to CVVH, swans, rotorest beds,PC ventilation, and every pressor under the sun. Doris

wow. Such a NOT cool comment to make. Im a "younger" nurse and just bc i am new doesnt mean I lack compassion. What a sweeping, generalized statement! I have met far more older burnt out nurses who I perceive as callous and extremely uncompassionate. And furthermore, I would also be shocked if someone complained about a pt. being 'needy' but I don't see the connection between that and being a young nurse. I have worked in the neuro ICU for about 3.5 months and in that short time I have seen things that will bring you to your knees..its so sad but I love it! Its not for everybody. It takes a special kind of person to work neuro ICU, perhaps the kind of person who doesnt complain about a needy pt in a halo vest.

In my neuro ICU we have swans quite often, have ventillated pts and also use just about every pressor under the sun.

Up Vote Up Vote ×
Specializes in Neuro, Critical Care.
I am a New Grad from NY and I have finished my hospitals brutal core course for critical care and have started Neuro for 3 days :))) after spending 5 weeks in a cardiac step down...i hated the cardiac stepdown...the chest tubes freaked me out...but i must say..i am fascinated by what a Neuro Assessment can provide (information wise). So far I love it!!! I cant wait to continue learning..and go in to work..since this post was written a while ago let us know how you are doing.

Take Care,

New York Nat

I HATE CARDIAC!!!!!!!!!! I agree with you. I worked for awhile on a cardiac step down and I hated hated hated it. I love neuro. I thing the brain is fascinating. I also love neuro exams, I feel like I really use my assessment skills. I love my job!

Up Vote Up Vote ×
Specializes in ICU, Education.

Hey Elk,

I haven't been on allnurses for awhile because i've been extremely busy between family, work, and school. However, your response to my post from several months ago just landed in my email box, and i felt I should respond. I did not mean to imply all young nurses were callous. I'm sorry, i know it did sound that way. The thing is, when i started nursing people went in to it because it was a calling. Today there are a lot more reasons to enter the profession. That's not to say many that enter today don't have a calling. There are a lot however, who lack compassion, adn from what i can see are only in it for the paycheck or flexibility, or whatever reason. I agree that neuro takes a special kind of person. After having children, seeing the devastation that happens to these kids breaks my heart. It is troubling for me to see nurses, young or old, roll thier eyes, sigh heavily, and complain when they have to help someone in such a vulnerable needy situation. If you haven't run across this yet, then you're lucky. Your unit is probably wonderful. I also wanted to add, that I still have a great deal of compassion after 20 years in the profession, and you were generalizing about older nurses just as i did about younger nurses. I am so thrilled to be back to MS ICU. Kudos the caring nurses who can to the job of neuro ICU!

Up Vote Up Vote ×
+ Add a Comment